bluuebunny/crossref_metadata_2025 huggingface dataset:
Inter-observer and intra-observer reliability in the radiographic diagnosis of avascular necrosis of the femoral head following reconstructive hip surgery in children with cerebral palsy
Authors: Hesketh Kim , Sankar Wudbhav , Joseph Benjamin , Narayanan Unni , Mulpuri Kishore
Published: March 2016

Purpose

The incidence of avascular necrosis (AVN) following reconstructive hip surgery in cerebral palsy (CP) ranges from 0 to 69 % in the current literature. The purpose of this study was to determine the inter- and intra-observer reliability of radiographically diagnosing AVN in children with CP after hip surgery.

Methods

A retrospective review of 65 children with CP who had reconstructive hip surgery between 2009 and 2012 at BC Children's Hospital was completed. Anterior–posterior and lateral radiographs were presented to four pediatric orthopaedic surgeons over two rounds. Surgeons were asked to review the set of unidentified radiographs and comment ‘yes’ or ‘no’ for the presence of AVN. Two weeks later the same set of radiographs was sent in a different order and the surgeons were again asked to comment on AVN. Inter- and intra-observer reliability was determined using kappa statistics.

Results

The intra-observer reliability ranged from 0.65 to 0.88 with an average score of 0.76. Inter-observer reliability showed greater variability, ranging from 0.41 to 0.77 with an average score of 0.56 across all surgeons.

Conclusions

Although the intra-rater reliability produced a strength of “good” and the inter-rater reliability a strength of “moderate” agreement, the variability within these scores is clinically important as it demonstrates the difficulty in identifying AVN. This may explain the variability in AVN that is reported in the literature. The need for further education and research in the diagnosis of AVN in children with CP who have undergone reconstructive hip surgery is clinically necessary.
Dural Reduction Surgery: A Treatment Option for Frontotemporal Brain Sagging Syndrome
Authors: Mostofi Emily , Schievink Wouter I. , Sim Valerie L.
Published: March 2016

Frontotemporal brain sagging syndrome is a dementia associated with hypersomnolence, personality changes, and features of intracranial hypotension on magnetic resonance imaging. The literature is sparse with respect to treatment options; many patients simply worsen. We present a case in which this syndrome responded to lumbar dural reduction surgery. Postoperative magnetic resonance imaging indicated normalization of brain sagging and lumbar intrathecal pressure. Although no evidence of cerebrospinal leak was found, extremely thin dura was noted intraoperatively, suggesting that a thin and incompetent dura could result in this low-pressure syndrome. Clinicians who encounter this syndrome should consider dural reduction surgery as a treatment strategy.
Splitting of a two-dimensional liquid plug at an airway bifurcation
Authors: Vaughan Benjamin L. , Grotberg James B.
Published: March 2016

Certain medical treatments involve the introduction of exogenous liquids in the lungs. These liquids can form plugs within the airways. The plugs propagate throughout the branching network in the lungs being forced by airflow. They leave a deposited film on the airway walls and split at bifurcations. Understanding the resulting distribution of liquid throughout the lungs is important for the effective administration of the prescribed treatments. In this paper, we investigate numerically the splitting of a liquid plug by a two-dimensional pulmonary bifurcation under the influence of a transverse gravitational field. The splitting is characterized by the splitting ratio, which is the ratio of volume of the liquid plug in the daughter channels and depends on the capillary number and the orientation of the bifurcation plane with respect to a three-dimensional gravitational field. It is observed that gravity induces asymmetry in the splitting, causing the splitting ratio to be reduced. This effect is mitigated as the capillary number is increased. It is also observed that there exists a critical capillary number where the plug will not split and will instead propagate entirely into the gravitationally favoured daughter channel. We also compute the wall stresses on the bifurcation walls and observe the locations where stresses and their gradients are the highest in magnitude.
Internal wave attractors examined using laboratory experiments and 3D numerical simulations
Authors: Brouzet C. , Sibgatullin I. N. , Scolan H. , Ermanyuk E. V. , Dauxois T.
Published: March 2016

In the present paper, we combine numerical and experimental approaches to study the dynamics of stable and unstable internal wave attractors. The problem is considered in a classic trapezoidal set-up filled with a uniformly stratified fluid. Energy is injected into the system at global scale by the small-amplitude motion of a vertical wall. Wave motion in the test tank is measured with the help of conventional synthetic schlieren and particle image velocimetry techniques. The numerical set-up closely reproduces the experimental one in terms of geometry and the operational range of the Reynolds and Schmidt numbers. The spectral element method is used as a numerical tool to simulate the nonlinear dynamics of a viscous salt-stratified fluid. We show that the results of 3D calculations are in excellent qualitative and quantitative agreement with the experimental data, including the spatial and temporal parameters of the secondary waves produced by triadic resonance instability. Further, we explore experimentally and numerically the effect of lateral walls on secondary currents and spanwise distribution of velocity amplitudes in the wave beams. Finally, we test the assumption of a bidimensional flow and estimate the error made in synthetic schlieren measurements due to this assumption.
Boundary layer transition mechanisms behind a micro-ramp
Authors: Ye Qingqing , Schrijer Ferry F. J. , Scarano Fulvio
Published: March 2016

The early stage of three-dimensional laminar-to-turbulent transition behind a micro-ramp is studied in the incompressible regime using tomographic particle image velocimetry. Experiments are conducted at supercritical micro-ramp height $h$ based Reynolds number $Re_{h}=1170$. The measurement domain encompasses 6 ramp widths spanwise and 73 ramp heights streamwise. The mean flow topology reveals the underlying vortex structure of the wake flow with multiple pairs of streamwise counter-rotating vortices visualized by streamwise vorticity. The primary pair generates a vigorous upwash motion in the symmetry plane with a pronounced momentum deficit. A secondary vortex pair is induced closer to the wall. The tertiary and even further vortices maintain a streamwise orientation, but are produced progressively outwards of the secondary pair and follow a wedge-type pattern. The instantaneous flow pattern reveals that the earliest unstable mode of the wake features arc-like Kelvin–Helmholtz (K–H) vortices in the separated shear layer. Under the influence of the K–H vortices, the wake exhibits a high level of fluctuations with a pulsatile mode for the streamwise momentum deficit. The K–H vortices are lifted up due to the upwash induced by the quasi-streamwise vortex pair, while they appear to undergo pairing, distortion and finally breakdown. Immediately downstream, a streamwise interval of relatively low vortical activity separates the end of the K–H region from the formation of new hairpin vortices close to the wall. The latter vortex structures originate from the region of maximum wall shear, induced by the secondary vortex pair causing strong ejection events which transport low-speed flow upwards. The whole pattern features a cascade of hairpin vortices along a turbulent/non-turbulent interface. The wedge-shaped cascade signifies the formation of a turbulent wedge. The turbulent properties of the wake are inspected with the spatial distribution of the velocity fluctuations and turbulence production in the developing boundary layer. Inside the wedge region, the velocity fluctuations approach quasi-spanwise homogeneity, indicating the development towards a turbulent boundary layer. The wedge interface is characterized by a localized higher level of velocity fluctuations and turbulence production, associated to the deflection of the shear layer close to the wall and the onset of coherent hairpin vortices inducing localized large-scale ejections.
Receptivity coefficients at excitation of cross-flow waves due to scattering of free-stream vortices on surface vibrations
Authors: Borodulin V. I. , Ivanov A. V. , Kachanov Y. S. , Roschektaev A. P.
Published: March 2016

This paper is devoted to an experimental investigation of receptivity of a laminar swept-wing boundary layer due to scattering of free-stream vortices on localized (in the streamwise direction) surface vibrations. The experiments were conducted under completely controlled disturbance conditions by means of a hot-wire anemometer on a model of a swept wing with a sweep angle of 25°. Both the free-stream vortices and the surface vibrations were generated by disturbance sources; their frequency–wavenumber spectra were measured thoroughly. The free-stream vorticity vectors were directed perpendicular to the incident-flow velocity vector and parallel to the swept-wing-model surface. The linearity of the receptivity mechanism under investigation (in a sense that the corresponding receptivity coefficients are independent of the disturbances amplitudes) has been checked carefully. The main goal of this experiment was to estimate the vibration-vortex receptivity coefficients as functions of the disturbance frequency, spanwise wavenumber and vortex offset parameter. This goal has been attained. Being defined in Fourier space, the obtained receptivity coefficients are independent of the specific surface vibration shape and can be used for verification of various receptivity theories.
Building Evidence-Based Tobacco Treatment in the Eastern Mediterranean Region: Lessons Learned by the Syrian Center for Tobacco Studies
Authors: Asfar Taghrid , Ward Kenneth D. , Al-Ali Radwan , Maziak Wasim
Published: March 2016

The tobacco epidemic in Syria is characterised by high rates of cigarettes smoking in men and dramatic re-emergence of waterpipe smoking, especially among youths and women. The Syrian Center for Tobacco Studies (SCTS), an NIH-funded pioneer research and capacity building institution, has developed a research infrastructure and conducted three randomised clinical trials to develop and rigorously test culturally appropriate tobacco treatment programmes integrated into primary healthcare (PHC) centres. This review aimed to discuss challenges and lessons learned from the Syrian experience. Addressing these challenges may inform future cessation research activities in Syria and other developing countries. To develop a research infrastructure, the SCTS has established Syria's first IRB and trained physicians/medical students in both tobacco treatment and research methods. Main challenges to conduct the cessation trials were difficulties of coordination between the local and international collaborators; high Smoking Rates among PHC providers; lack of pharmacological agents used in tobacco treatment; and difficulties of conducting research in a politically volatile region. Strategies to overcome these challenges were ensuring an active and regular involvement of all investigators; and advocating for a national smoking cessation plan that involves training healthcare providers in smoking cessation treatment and make pharmacological agents used in smoking cessation available.
Malnutrition in a Modernising Economy: The Changing Aetiology and Epidemiology of Malnutrition in an African Kingdom, Buganda c.1940–73
Authors: Nott John
Published: March 2016

The ecological fecundity of the northern shore of Lake Victoria was vital to Buganda’s dominance of the interlacustrine region during the pre-colonial period. Despite this, protein-energy malnutrition was notoriously common throughout the twentieth century. This paper charts changes in nutritional illness in a relatively wealthy, food-secure area of Africa during a time of vast social, economic and medical change. In Buganda at least, it appears that both the causation and epidemiology of malnutrition moved away from the endemic societal causes described by early colonial doctors and became instead more defined by individual position within a rapidly modernising economy.
Agreement between an online dietary assessment tool (myfood24) and an interviewer-administered 24-h dietary recall in British adolescents aged 11–18 years
Authors: Albar Salwa A. , Alwan Nisreen A. , Evans Charlotte E. L. , Greenwood Darren C. , Cade Janet E.
Published: March 2016

myfood24 Is an online 24-h dietary assessment tool developed for use among British adolescents and adults. Limited information is available regarding the validity of using new technology in assessing nutritional intake among adolescents. Thus, a relative validation of myfood24 against a face-to-face interviewer-administered 24-h multiple-pass recall (MPR) was conducted among seventy-five British adolescents aged 11–18 years. Participants were asked to complete myfood24 and an interviewer-administered MPR on the same day for 2 non-consecutive days at school. Total energy intake (EI) and nutrients recorded by the two methods were compared using intraclass correlation coefficients (ICC), Bland–Altman plots (using between and within-individual information) and weighted κ to assess the agreement. Energy, macronutrients and other reported nutrients from myfood24 demonstrated strong agreement with the interview MPR data, and ICC ranged from 0·46 for Na to 0·88 for EI. There was no significant bias between the two methods for EI, macronutrients and most reported nutrients. The mean difference between myfood24 and the interviewer-administered MPR for EI was −230 kJ (−55 kcal) (95 % CI −490, 30 kJ (−117, 7 kcal); P=0·4) with limits of agreement ranging between 39 % (3336 kJ (−797 kcal)) lower and 34 % (2874 kJ (687 kcal)) higher than the interviewer-administered MPR. There was good agreement in terms of classifying adolescents into tertiles of EI (κw=0·64). The agreement between day 1 and day 2 was as good for myfood24 as for the interviewer-administered MPR, reflecting the reliability of myfood24. myfood24 Has the potential to collect dietary data of comparable quality with that of an interviewer-administered MPR.
THE “DISINHERITED” DAUGHTER AND THE DISAPPROVING MOTHER
Authors: Sloan Brian
Published: March 2016

MELITA Jackson died in 2004, leaving an estate worth £486,000. In 2002, she had made a will in which she left a £5,000 legacy to the BBC Benevolent Fund and divided the remainder of her estate between the Blue Cross, the Royal Society for the Protection of Birds, and the Royal Society for the Prevention of Cruelty to Animals (“the Charities”). Mrs. Jackson had also written a letter of wishes in which she explained her decision to exclude her only daughter, Heather, from her will. Heather had left home in 1978 at the age of 17, without her mother's knowledge or agreement, in order to live with Mr. Ilott, whom Heather later married. Mrs. Jackson clearly disapproved of her daughter's choice of lifestyle. Heather and her husband had five children (the last one living at home, being due to go to university in 2015) and lived in straitened financial circumstances. For example, Heather never went on holiday, found it difficult to afford clothes for the children and a range of food, and possessed many items that were old or second-hand. Despite attempts at reconciliation, mother and daughter were estranged for some 26 years, and Heather was fully aware before Mrs. Jackson's death that she was due to be excluded from the will.
THE “BENEFIT CAP” SCHEME AND THE UN CONVENTION ON THE RIGHTS OF THE CHILD
Authors: Palmer Stephanie
Published: March 2016

THE appeal in R. (on the application of SG) (previously JS) v Secretary of State for Work and Pensions (Child Poverty Action Group and another intervening) [2015] UKSC 16 concerned a challenge to the cap on welfare benefits, one of the measures introduced as part of the Government's austerity-driven economic and social policy. The “benefit cap” operates to limit the amount of welfare benefits that can be received by non-working households, to the equivalent net median earnings of a working household. The Welfare Reform Act 2012 contains provisions allowing the Secretary of State to make regulations providing for a “benefit cap” scheme. It is implemented through the Benefit Cap (Housing Benefit) Regulations 2012 and operates by a reduction in housing benefit once a specified maximum amount is reached. Benefits covered by the cap include housing benefit, child benefit, and child tax credit. Once the cap is reached, no account is taken of the number of children in the family. The lawfulness of the Act itself was not challenged. The appellants’ argument was that the implementation of the scheme was discriminatory and contrary to the Human Rights Act 1998.
Reflections on the Constitutional Regulation of Property and Land Rights under the 2013 Zimbabwean Constitution
Authors: Tsabora James
Published: March 2016

Property rights discourse, particularly the scope, nature, distribution, redistribution, recognition and protection of property rights, has dominated debate in African post-colonial property rights systems. In Zimbabwe, property rights law has been a contested space since the colonial era. That the property rights system is a contested arena is particularly so in view of the fact that colonial subjugation in Zimbabwe was characterized, in a very important way, by politically motivated land dispossession and, consequently, inequitable property rights distribution patterns. As a result, Zimbabwe's property rights law has always responded to mainstream, albeit fluid, political and economic undercurrents. This has meant that mainstream historical and contemporary debates have provided the context for understanding the constitutional regulation of property and land rights in Zimbabwe. This article assesses the constitutional regulation of constitutional property and land rights in Zimbabwe, and the conflicts and tension that are accommodated in the constitutional property rights framework.
VALIDITY OF USING WAIST AND HIP CIRCUMFERENCE MEASUREMENTS TO DETERMINE BODY COMPOSITION OF YOUNG SYRIAN MEN
Authors: Al-Bachir Mahfouz , Ahmad Husam
Published: March 2016

This study examined the relation between waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR) and triceps skin-fold thickness and percentage body fat in young Syrian men. The aim was to develop equations that can use these anthropometric characteristics to estimate percentage body fat in this group of subjects. A total of 2470 healthy Syrian men aged 18–19 years were enrolled in the study in 2010–2011. The anthropometric characteristics of all subjects were measured. The percentage body fat of 213 of the subjects was determined using the deuterium dilution (DD) technique as a reference method. The validity of using WC, HC, WHpR and WHtR to calculate percentage body fat, in comparison with the reference method (DD technique), was assessed by calculating biases and limits of agreement. The estimates of percentage body fat using ‘WC’ and ‘WC with triceps skin-fold’ measurements ranged from 13.00±5.56% to 14.55±8.63%, and were lower than those determined using the reference method (21.32±6.42%). A better prediction equation is proposed for young adults, based on a multiple linear regression model using WC, HC and WHtR.
Pulmonary embolism secondary to clozapine therapy
Authors: ul-Haq Anwar , Holland Edmond
Published: March 2016

Clozapine is an atypical antipsychotic indicated for paranoid schizophrenia (treatment resistant type). However its use has been limited by the well established association with neutropenia and agranulocytosis. It has also been suggested that clozapine therapy is associated with other serious adverse effects such as fatal myocarditis or cardiomyopathy.
Medication adherence and knowledge in older patients
Authors: Cahill Richard , O'Loughlin Kieron , Swanwick Gregory , Bhriain Siobhan Ni
Published: March 2016

Objectives: To assess the degree to which a sample of older individuals – who are engaged with psychiatric services – are knowledgeable about their medication and the reason for its prescription; to assess the degree to which these patients adhere to what is prescribed.

Methods: Convenience sample of 24 patients over 65 years old, under the care of psychiatric services for Later Life, included. Patients who scored < 23 on Mini-mental State Examination were excluded. A questionnaire was administered which evaluated patients' knowledge of the names of, and reasons for, all prescription medications. Adherence rates were measured. Comparisons were made regarding to self-reported adherence rates and medication knowledge. These were based on diagnosis, age, number of medications prescribed and the presence or absence of sensory impairment.

Results: The median percentage of medication names recalled was 60%. A total of 25% of patients reported having some problem with adherence. No patient with a diagnosis of dementia was able to recall the names of, or reasons for, all medications prescribed. Patients with depression and dementia were as likely to be fully adherent as the total sample. Patients (a) aged 78 years or more and (b) those who were on more than six medications – were less knowledgeable about and less likely to adhere to prescribed drug regimens. We did not identify an association between reduced visual acuity and reduced medication adherence

Conclusion: Patients require ongoing education concerning all aspects of medication, especially the reasons for prescription. Older patients and those receiving more complex regimens may be at particular risk of adherence problems.
Analysis of prescribing practices in an acute psychiatric ward
Authors: Tully John , Park Elizabeth , Dunne Allison , Murray Ivan T , McDonald Colm , Hallahan Brian P
Published: March 2016

Objectives: Prescription writing is a basic clinical skill for all doctors; however, errors in prescriptions are frequent and can result in significant harm to patients both from sub-therapeutic dosages and from over prescribing. This study examines the prescribing practices of ‘as required’ medications in an acute psychiatric inpatient unit attached to a university teaching hospital.

Method: A clinical audit was conducted to examine both prescribing practices of ‘as required’ medication and recording of ‘as required’ medication in nursing notes. A series of educational interventions were undertaken in an attempt to improve prescribing practices in relation to ‘as required’ medication and two further audits were completed to assess any change in practice and whether such changes were sustained.

Results: Psycho-education led to an improvement in a number of prescribing practices, including increased generic prescribing, improved documentation of indications for medication administration and increased writing of medication dosages in acceptable abbreviations. These benefits were maintained four months after the education interventions. Rates of documenting the frequency of medication correctly and recording the administration of medication in nursing notes remained low.

Conclusion: Our audit cycle clearly demonstrates that education can ameliorate prescribing practices and these improvements were maintained four months after education was delivered. However some aspects of prescribing practice remained deficient, and more focused educational interventions are required in these areas.
Treatment considerations in clozapine induced enuresis or incontinence
Authors: Apantaku-Olajide Tunde D.
Published: March 2016

Antipsychotic related urinary symptoms are recognised and they remain a potential treatment-limiting sideeffect of clozapine. This article reports the incidence and management of two cases of clozapine-associated incontinence in psychiatrically stable patients. Both cases occurred during treatment and appear to have a similar pathophysiology, which may be related to the atypical nature of clozapine therapy. We searched the PubMed and MEDLINE databases for articles published from 1980 to 2008 that contain the keywords 'clozapine and enuresis, ‘clozapine and incontinence,’ ‘clozapine and seizures’. We also manually searched the bibliographies of these articles for related sources, and explored the reported treatment options to this side-effect of clozapine therapy. Both patients gave an informed consent.
Stress in an Irish inner city emergency department revisited (2000-2006)
Authors: Breslin Tomás , McInerney John , Sheehan John , Natin Dominick , Codd Mary
Published: March 2016

Objectives:

Stress levels among staff in the Mater Misericordiae University Hospital Emergency Department were studied by questionnaire in 2000, which demonstrated a high level of self reported stress. The aim of this study was to ascertain if stress levels had reduced following changes in the department.

Method:

The study was repeated using the same questionnaire in 2006, after changes had occurred.

Results:

There was a significant reduction in the percentage of staff that reported they were under severe or unbearable stress, from 37% in 2000 to 10% in 2006 (p = 0.002). A total of 60% felt the social environment of their work was satisfactory in 2006 compared to 40% in 2000 (p = 0.03). Compared to 2000, a significantly lower proportion reported they had a low degree of control over their job, and a significantly higher proportion reported a medium level of control over their job in 2006 (p = 0.03).

Conclusions:

Compared with the results of the previous study, reported stress levels have reduced overall, which coincided with a significant increase in staffing levels in the department.
A potential model for primary care mental health services in Ireland
Authors: Kierans Joanne , Byrne Michael
Published: March 2016

Objectives:

A high demand for the inclusion of psychosocial interventions for primary care mental health presentations has become more apparent in recent years. Current policies have proposed models of care highlighting principles required for a quality service. However, implementation has been slow to date. This article aims to inform the current debate relating to primary care service delivery models for mental health presentations and to contribute towards future planning initiatives.

Method:

A narrative review of a range of policies and selected articles relevant to primary care mental health in an Irish context.

Results:

The search produced four distinct themes: current service provision in Ireland; stakeholders' views; psychological care options; and potential service structures. Thereafter, a potential service delivery model is proposed. This formulated model employs a combination of elements from the reviewed themes to provide a clinically- and cost-effective, equitable and accessible service driven by service user and carer input.

Conclusions:

Although this review was selective in nature, the proposed potential model can complement future research agendas for more favourable primary care practice in Ireland. Recommendations are made for the planning of services including policy implementation procedures, training and communication.
Toxicity of lofepramine and fluvoxamine in heart disease
Authors: Cooney Colm , Barber Mark
Published: March 2016

Therapeutic doses of lofepramine and fluvoxamine were associated with the development of first degree and second degree heart block, respectively, in an 83 year old man with a normal ECG prior to treatment and with no history of cardiovascular disease. Caution is recommended in treating patients with newer generation antidepressants, even in cases where cardiac status appears normal prior to treatment.
Attendance at child psychiatry new patient clinics
Authors: Munjal Arun , Latimer Mark , McCune Noel
Published: March 2016

Objective: An audit of referrals to a child psychiatry clinic is described. The process of asking families to confirm appointments and offering appointments to other families if no confirmation is received was analysed.

Method: Referral information on those refusing appointments offered, whether by declining the offer or by default, was compared with that of families attending first appointments.

Results: Longer waiting times and referral for treatment as opposed to assessment or advice were associated with higher likelihood of appointment refusal

Conclusion: The referral process resulted in a reduction in wasted professional time.
The psychiatrist in primary care: let's look before we leap
Authors: Phelan Darra
Published: March 2016

Objective: Irish psychiatrists may begin to spend, as their British have counterparts have, at least some of their time delivering a psychiatric service from primary care settings. It was therefore decided to review the origins and development of attitudes towards and outcome this practice in Britain.

Method: A literature search and review of relevant papers was undertaken.

Results: Collaboration between psychiatrists and general practitioners began to expand significantly in the 1970s and 1980s. Three main models are used, the shifted outpatient model, the selected consultation model and the liaison-attachment team model. The shifted out-patient model is liked by patients whose attendance rate is better at such clinics and in some areas this model has resulted in a fall in hospital admission rates. There is a paucity of papers examining outcome of the other models. Results of the one extensively studied team liaison approach reports higher treated prevalence rates and lower admission rates for those patients referred. There was no effect on detection of illness by GPs and the service was much more costly.

Conclusions: While some benefits may result from use of the shifted out-patient approach, they are not compelling enough to enable a firm recommendation for its widespread implementation to be made. The results to date suggest the team-liaison approach does not produce benefits sufficient to outweigh the increased cost. The selected consultation model may hold greater potential but needs to be more extensively researched. Finally the structure of general practice in Ireland, with so few GPs working in multiple partner practices makes it highly unlikely that the widespread introduction of collaboration will be feasible.
Trends in suicide in Northern Ireland 1922-1992
Authors: McCrea Paul H
Published: March 2016

Objective: The trends in suicide in Northern Ireland over a 70 year period were examined with respect to sex, age and method used, and then compared with rates of unemployment and homicide.

Method: The records in the office of the registrar general in Belfast were examined to obtain data. Unemployment figures were obtained from the Department of Economic Development.

Results: Suicide is increasing in Northern Ireland and particularly in young men (aged 34 and under). There is a relation to unemployment although it is not felt to be directly causal. Men prefer more violent methods although vehicle exhaust gas is popular. A large number of women still choose drowning.

Conclusions: Despite all initiatives, the suicide rate is increasing in Northern Ireland, in common with many European countries. It represents a major health care issue. Measures of a social or political nature may have more effect than health care advances in reducing the rate of suicide.
The psychiatric presentation of a cerebellopontine angle tumour
Authors: Ball Chris
Published: March 2016

A 54 year old woman presenting to the psychiatric services with persecutory delusions, complex visual hallucinations and fluctuating levels of consciousness was discovered to have a meningioma occupying the cerebellopontine angle. The psychiatric symptomatology of cerebellopontine angle lesions is reviewed and the pathogenic mechanisms are explored in the light of the symptomatology observed.
A study of general practitioner needs of a new child psychiatric service
Authors: Adamson Neil , Killelea Deirdre
Published: March 2016

Objectives: General practitioners were surveyed by questionnaire for their opinions on their needs and usage of a new child psychiatric service in the Midwestern Health Board.

Methods: The questionnaire was returned by 72% of GPs. Their practices included inner city, new towns, country town, and rural communities.

Results: It was found that 160 children were awaiting referral to the new service of which the most prominent presenting problems were hyperactivity, learning difficulties, enuresis, poor parenting skills, dysfunctional families, anorexia/eating disorders and psychosomatic problems. Primary school children required more frequent referral than secondary school children. GPs appreciated telephone access to the psychiatrist and for the service to be available for emergencies. A few GPs requested discussion meetings following referral. Most GPs were satisfied with any member of the multi-disciplinary child psychiatric team assessing the children.

Conclusions: This study was a useful method of assessing the numbers and nature of problems which might present to a new child psychiatric service in order that staff and treatment programmes could be organised. Results suggest that further research is necessary.
The attitude of general practitioners in North-West England to patients with schizophrenia
Authors: Holden John
Published: March 2016

Objectives: The closure of long-stay mental hospitals has led to more patients with psychoses being cared for in the community. Although surveys have been conducted in the London area, little is known about the attitudes of general practitioners in provincial parts of the United Kingdom towards schizophrenic patients and their care.

Methods: A questionnaire was sent to all general practitioners in the St Helens area in north-west England.

Results: 94 doctors replied, 53% of those circulated. Only a minority consider that such patients cause them a great deal of work. Problems with medication were cited most often as causing difficulties for the general practitioners. Psychiatrists were considered to be the group with whom the general practitioners had the best communication, but also where they wished communication to improve further. Despite the shift towards community care, there was no clear trend in the amount of work created by schizophrenic patients perceived here.

Conclusions: Only a minority of those doctors surveyed found that schizophrenic patients cause them an undue burden of work. Perhaps developments in community based psychiatric services should be directed first at those general practitioners who report excessive problems from patients with long-term mental health problems.
A failed suicide pact
Authors: Amin S , Fisher K
Published: March 2016

Suicide pacts are rare in clinical psychiatric practice and usually one or more of the parties die. Here we present a case report where both parties survived. We point out similarities and differences between this pact and others described in the literature.
The Greysteel massacre: the local effect on the prevalence of admissions with overdose
Authors: Sharkey John
Published: March 2016

Objective: To explore the nature of the relationship between the Greysteel massacre and the low number of admissions with overdose to the area general hospital in the following week.

Method: Ward records over a ten year period were examined for seasonal and yearly trends for admission with overdose.

Results: In the two year period surrounding the week following the Greysteel massacre there were no similar periods of low admission with overdose.

Conclusion: A direct relationship between the Greysteel massacre and the ensuing dearth of admissions with overdose seems likely.
Community organisations' expectations of mental health statutory services
Authors: Bhugra Dinesh , La Grenade Janet
Published: March 2016

Objective: Community organisations provide care for psychiatric patients at multiple levels. With increasing emphasis on joint planning and purchasing of care it is important to ascertain the views of such organisations towards statutory organisations and services the latter provide.

Method: All community organisations working within one inner city catchment area in London were approached in order to obtain their views and experiences on the mental health services provided by the secondary care services. This was a postal survey and non-responders were contacted by personal calls.

Results: Sixty organisations out of a total of 100 in the database responded. More than half had experiences of statutory services and these were generally negative. The services provided were perceived as being rigid and inflexible. A large majority of the organisations wished services to be more flexible as well as provide more training for voluntary organisations.

Conclusion: The survey suggests that the perceptions of the statutory services and co-working with voluntary organisations can succeed only if the two groups work together closely to make good quality community care possible.
Evidence-based medicine and psychiatry
Authors: Geddes John
Published: March 2016

Over the last five years the adjective ‘evidence-based’ has become difficult to avoid. Indeed, a MEDLINE search for articles containing the phrase ‘evidence-based medicine’ in their titles or abstracts reveals one mention in 1992, rapidly increasing to 53 in 1996. So great has been the increase that the National Library of Medicine now includes ‘evidence-based medicine’ as a MeSH heading for indexing papers.

But what is evidence-based medicine (EBM)? First and foremost, EBM is a set of strategies designed to help the clinician keep up-to-date and to base his clinical decision making on the best available external evidence. EBM has been espoused by policymakers, purchasers and others — and, although the approach is open to misuse by these groups as a cost-cutting exercise, there are refreshing signs that they will be able to use the approach to help produce real improvements in patient care. However, the essential focus of EBM is on assisting doctors and other clinicians make decisions about individual patients. The steps involved in EBM include: a precise definition of the clinical problem (a crucial first step — in medical practice it will usually include making a diagnosis), an efficient search for the best available evidence, critical appraisal of the evidence and integration of the research findings with clinical expertise. Finally, the clinician assesses the outcome of the process and continues to improve his EBM skills.
Acute psychiatric services: an appraisal of a major change in service delivery within one catchment area
Authors: O'Doherty Miriam
Published: March 2016

Objectives: To investigate effects on one psychiatric inpatient service of a 40% reduction in the number of acute beds and the establishment of an acute day hospital.

Method: A retrospective review of all public admissions to the acute inpatient unit during two three-month study periods; before and almost three years after the changes. Review of attendance at the acute day hospital during the second study period.

Results: The number of admissions actually increased by 3% from 169-174; the mean duration of stay fell from 27-17 days; and the number of brief admissions of three days duration or less almost tripled from 15-43. Although fewer patients suffering from schizophrenia were admitted in the second study period than in the first, their mean duration of stay and the frequency of re-admission within 28 days of discharge changed little, while patients with diagnoses of mild/moderate depression and substance misuse experienced significantly shorter admissions and higher readmission rates. The use of temporary orders under the Mental Treatment Act (1945) doubled, and the readmission rates within 28 days increased by over 60%.

The acute day hospital treated 98 patients who had a diagnostic profile similar to that of the inpatients; 53% of them required admission before and/or after attendance at the day hospital.

Conclusions: The major reduction in the number of acute inpatient beds and the opening of an acute day hospital resulted in greater concentration of inpatient resources on the more severely ill patients. The increase in re-admissions and the failure to effect a reduction in admissions and may have a complex aetiology and merits further investigation.
Bilateral autoenucleation in a man with a severe personality disorder
Authors: Meagher David J , Fahy Tom J , Nolan John
Published: March 2016

A case of self-inflicted eye injury is described in a setting of alcohol intoxication and severe personality disturbance. The case is believed to be the only one of its type described this century. The relevant classical and contemporary literature is reviewed and psychopathological explanations discussed. Possible indicators of impending self-violence are reviewed.
The Tukes of York
Authors: Breathnach Caomhghin S
Published: March 2016

At the instigation of William Tuke the York Retreat was built in 1794 by the Society of Friends. From its opening in 1796 until 1845 its management was in the hands of lay administrators, and the moral treatment of insanity which was the creation of George Jepson between 1797 and 1823 became a model of its kind. The great tradition thus established was continued by William's grandson, Samuel Tuke, and Samuel's son Daniel Hack Tuke. Daniel's older brother James is better known to Irish history for his philanthropy during Black '47 which is still warmly embedded in folk memory in the West of Ireland.
Admissions to a day hospital and to a general hospital psychiatric unit in a new community psychiatric service
Authors: Joseph Anil P , Loane Ruth , Sheehan John
Published: March 2016

Objective: To conduct an audit of the patients treated at a day hospital or in an inpatient unit of a district general hospital from the South Kildare sector of the Kildare Mental Health Service, a new community based psychiatric service.

Method: Retrospective case note review of all admissions over a six month period. ICD-9 diagnosis used.

Results: There were 39 and 29 admissions to the inpatient unit and day hospital respectively. The average duration of stay in the inpatient unit was 14 days, 66% were discharged home and 33% discharged to the day hospital. The average duration of stay was 30 days in the day hospital, 62% were discharged home and 17% discharged to the inpatient unit.

Conclusions: The trend was to treat more neurotic patients in the day hospital; psychotic patients were treated in both settings; the proportion of patients discharged home was similar. The duration of stay was longer in the day hospital.
The molecular genetics of affective disorders: An overview
Authors: Mynett-Johnson Lesley A , McKeon Patrick
Published: March 2016

Objective: Genetic mapping, the method of comparing an inheritance pattern of a disease to that of a chromosomal region, has brought about a revolution in the field of human inherited diseases. Diseases which exhibit a more complex pattern of inheritance now afford the next challange in the application of genetic mapping to the field of human disease. This article aims to review the application of genetic mapping to affective disorders.

Method: Review of literature concerning the molecular genetics of affective disorders.

Findings: This article describes the evidence for a genetic role in affective disorders, reviews the research to date and describes the difficulties arising out of the complex nature of these disorders.

Conclusions: Although progress to date in psychiatric genetics has been somewhat disappointing, the combined approach of using all the genetic tools currently available on large collections of affected individuals and families should enable the genetic basis of affective disorders to be identified.
Schizophrenia in a patient with established Gilles de la Tourette Syndrome
Authors: Cassidy Elizabeth C , Miller Steven John , Chalmers Julie F
Published: March 2016

A 24 year old man with established Gilles de la Tourette Syndrome (GTS)and schizophrenia of recent onset is described. Other comorbid reports of schizophrenia and GTS are reviewed showing this association to be rare, with only nine previous reported cases. GTS and schizophrenia have many phenomenological similarities and a link has been considered between the two disorders but never clearly established. Reasons for the lack of an association where one might be expected are considered. Possibilities include under reporting or misdiagnosis of GTS or the possible masking of psychotic symptoms by treatment of the GTS.
Primary and secondary erotomania: Is the distinction worthwhile?
Authors: Garland Malcolm , McGennis Aidan
Published: March 2016

Objective: To examine the phenomenology of erotomania and to discuss the relevance of its classification into primary and secondary forms.

Method: Two case reports are presented. Both were female, non-Irish nationals who travelled to Ireland expressly to pursue their objects, who were both members of an internationally famous rock band. Case 1 and Case 2 are presented as primary and secondary erotomania, respectfully.

Result: The difficulty in distinguishing primary from secondary erotomania is discussed; the modern literature is referred to, which appears to be divided about the status of the primary form of this disorder as a distinct entity.

Conclusion: Until further advances are made in elucidating mental disorders, diagnosis will remain symptom-based, leaving diagnostic formulations somewhat over-crowded with syndromes of undetermined aetiology. Such is the case with erotomania.
Unilateral auditory hallucinations in association with ear infection
Authors: Carroll Andrew , Milnes David
Published: March 2016

We report the case of a patient with unilateral left-sided auditory hallucinations in association with a left middle ear infection, who in addition demonstrated a symptom of passivity, attributing the infection to the actions of a voice. The case demonstrates the potential for complex interplay between physical and mental pathology.
Characteristics of epilepsy in a population based cohort of adults with learning disability
Authors: Deb Shoumitro , Joyce Joseph
Published: March 2016

Objectives: The purpose of the study was to define various aspects of epilepsy in a population based sample of adults with a learning disability.

Method: A purpose-designed questionnaire was used to collect information on various aspects of epilepsy on 143 adults with a learning disability and epilepsy. Names of these subjects were collected from a hospital for learning disabled adults, specialist epilepsy clinics and social services department. Data was gathered from case notes and direct patient examination.

Results: Generalised tonic clonic seizure was the most common seizure type. Seventy-three per cent sustained a seizure within the previous 12 months of the study. Abnormal EEG findings including excessive slow background activities and epileptiform waves were documented in a high proportion of subjects with a learning disability and epilepsy.

Conclusions: Both resistant epilepsy and generalised tonic clonic seizures seem to be more frequent among the learning disabled population compared with the general population.