bluuebunny/crossref_metadata_2025 huggingface dataset:
The New View in Action: College Students Discuss 21st-Century Sexuality
Authors: Loe Meika
Published: October 2008

This article explores how junior and senior college students enrolled in `Women, Health, and Medicine' discuss and critique women's sexual problems in the 21st century during one 90-minute class structured around cultural artifacts. The discussion touches on medical marketing, the gendering of sex, social measures and definitions of sexuality, and the cultural ambivalence in US social policy and sex education. Throughout the discussion these students actively use ideas from the `New View' — already part of their sexual health common sense — to critique `dysfunction' discourse, complicate `normal sex', put sexuality in broad perspective, and suggest social changes to advance large-scale sexual health and well-being.
A New View from Women of Thailand about Gender, Sexuality, and HIV/AIDS
Authors: Norsworthy Kathryn L. , Khuankaew Ouyporn
Published: October 2008

The authors describe their collaborative, feminist, participant-action-based projects with groups of Thai women from grassroots, governmental, and non-governmental sectors. We present workshop participants' analysis of the cultural context for HIV-infected women of Thailand, the methodology of empowerment and partnership used for working with the groups, and the action plans developed by the group members themselves during the projects. The projects demonstrate how the philosophy, framework, and particular concepts from The New View can be utilized in a grassroots Thai context.
Gender Roles and Informal Care for Patients With AIDS
Authors: Tarimo Edith A. M. , Kohi Thecla W. , Outwater Anne , Blystad Astrid
Published: October 2008

As HIV/AIDS imposes an overwhelming pressure on the capacity of an already overburdened health care system in many African countries, families have increasingly been noted to supplement hospital care services for patients with AIDS. The aim of the present study is to generate knowledge on the experiences of family caregivers to the patients with AIDS at the household level in Dar es Salaam, Tanzania. Data were collected through in-depth interviews with 20 family caregivers and were analyzed using thematic content analysis. The article provides the reader increased insight on the obligations that AIDS caregiving has imposed on women within the close kin group of the patient. The study indicates that caregiving has increased the workload and in the same vein the economic marginality of women, who themselves are increasingly widowed heads of households. The study findings demonstrate strong gendered implications for community and policy makers.
Born to Hand Jive
Authors: Wheat Brenda M. , Hargrove Tracy Y.
Published: October 2008

This article discusses the use of hand-clapping games and dances in the music classroom. In addition to their use for teaching music skills and concepts, these games can be quite useful for making cross-disciplinary connections to reinforce the eighth and ninth National Standards for Music Education (Standard 8: understanding relationships between music, the other arts, and disciplines outside the arts; Standard 9: understanding music in relation to history and culture). Specifically, the article focuses on the Hand Jive and the ways that it may be used to help students see connections to music in history and culture as well as the underlying mathematical concept of repeated patterns on which the movements are based.
Parental Perspectives of the Quality of Life in School Environments for Children With Asperger Syndrome
Authors: Brewin Bethany Jackson , Renwick Rebecca , Fudge Schormans Ann
Published: October 2008

Findings reported here are from a secondary analysis of in-home, semistructured interviews with a subsample of 9 participants from a larger study examining the perspectives of parents of children with Asperger Syndrome (AS) concerning what contributes to and detracts from their children's quality of life at school. Audiotaped interview data used in the secondary analysis had already been gathered by a trained interviewer and then transcribed verbatim. The secondary analysis followed a modified grounded theory approach. Major themes identified are highlighted, specifically, how quality of life is affected by (a) awareness of AS in the school system, (b) quality of social interaction, (c) the role of the teaching staff and professionals, and (d) the role of the institution and educational structure. Implications, recommendations, and future research directions are discussed.
Convergence Calls
Authors: Thurman Neil , Lupton Ben
Published: October 2008

This article uses qualitative interviews with senior editors and managers from a selection of the UK's national online news providers to describe and analyse their current experimentation with multimedia and video storytelling. The results show that, in a period of declining newspaper readership and TV news viewing, editors are keen to embrace new technologies, which are seen as being part of the future of news. At the same time, text is still reported to be the cornerstone for news websites, leading to changes in the grammar and function of news video when used online. The economic rationale for convergence is examined and the article investigates the partnerships sites have entered into in order to be able to serve their audience with video content. In-house video is complementing syndicated content, and the authors examine the resulting developments in newsroom training and recruitment practices. The article provides journalism and interactive media scholars with case studies on the changes taking place in newsrooms as a result of the shift towards multimedia, multiplatform news consumption.
Double Jeopardy for Children Who Stutter
Authors: Blood Gordon W. , Blood Ingrid , Kreiger Jennifer , O'Connor Shelah , Qualls Constance Dean
Published: October 2008

The primary purpose of this study was to examine the influence of racial and ethnic backgrounds in children who stutter (CWS) with 18 specific coexisting disorders. A sample of 1,184 speech-language pathologists responded to a detailed questionnaire designed to answer questions about the type and prevalence of coexisting disorders in 2,535 CWS. Results suggest that 866 (34.1%) children from diverse racial and cultural backgrounds displayed six major coexisting disorders: learning disabilities, literacy disorders, attention deficit disorders, auditory processing disorders, neuropsychological disorders, and behavioral disorders. Measures of risk, relative risks, and odds ratio for racial and ethnic differences among groups of CWS were calculated. African American CWS show a higher risk for coexisting learning disabilities, literacy disorders, attention deficit disorders, and behavioral disorders than White, non-Hispanic, Hispanic, and Asian CWS. Males who stutter had a significantly greater number of coexisting disorders than females who stutter. A number of alternative interpretations are presented.
A Literature Review of Health Care Professional Attitudes Toward Complementary and Alternative Medicine
Authors: Sewitch Maida J. , Cepoiu Monica , Rigillo Nicole , Sproule Donald
Published: October 2008

Objective. To summarize health care professionals' attitudes toward complementary and alternative medicine (CAM).

Methods. In October 2006, we searched Allied and Complementary Medicine Database (AMED; 1985—2006), Excerpta Medica Database (EMBASE; 1980—2006), and MED-LINE (1960—2006) for Canadian or US studies of health care professionals' attitudes toward CAM, published in English or French.

Results. A total of 21 surveys of physicians, nurses, public health professionals, dietitians, social workers, medical/nursing school faculty, and pharmacists were included that focused on beliefs about CAM efficacy, personal use, clinical practice use and referrals, communication with patients about CAM, level of knowledge, and the need for information regarding various CAM therapies. Physicians were more negative compared to other health care professionals. Positive attitudes toward CAM did not correlate with CAM referral or prescription patterns. Health care professionals of all disciplines wanted more information about CAM.

Conclusions. Heterogeneity in the CAM definition and questionnaire items precluded summarizing health care professionals' attitudes toward CAM. Providing CAM education to health care professionals may help to integrate CAM into mainstream medical care.
Room temperature hardness of carbide strengthened cast alloys in relation with their carbon content and aging temperature Part 1 – Case of nickel alloys
Authors: Berthod P.
Published: October 2008

The addition of hard particles in a ductile alloy may lead to a substantial increase in its hardness and in the difficulty to machine it. The present work aims to specify the role of chromium carbides in the hardness of cast nickel alloys. A Ni–30 wt-%Cr alloy and six 0·2–2 wt-%C containing alloys based on the first one were elaborated by foundry. Their microstructures after aging at 1000, 1100 and 1200°C were described, and the room temperature, Vickers hardness of all the alloys for the three aging treatments were measured. Hardness increases with carbon content following a curve which is almost parabolic, while it increases more linearly versus the volume fraction of carbides. Hardness is generally lowered by choosing higher aging temperature. The evolution of hardness was compared with a law of mixture based on the hardness and the volume fractions of the matrix and of the carbides.
Long-term survival in Waldenstrom macroglobulinemia: 10-year follow-up of Southwest Oncology Group–directed intergroup trial S9003
Authors: Dhodapkar Madhav V. , Hoering Antje , Gertz Morie A. , Rivkin Saul , Szymonifka Jackie , Crowley John , Barlogie Bart
Published: October 2008

The survival of patients with Waldenstrom macroglobulinemia (WM) varies enormously. The development of prognostic models in WM has been fraught by limited follow-up in current studies. Here, we update the outcome of a prospective WM trial with a median follow-up of 10 years for live patients. Of the 59 previously untreated patients who initially were observed, only 12 patients (21%) required therapy at a median follow-up of 100 months. Multivariate analysis among the 183 patients requiring therapy reaffirmed age 70 years or greater, previous nonprotocol therapy, and β-2 microglobulin (B2M) of 3 mg/dL or greater as prognostic factors. Importantly, increased serum lactate dehydrogenase (LDH) was identified as an additional independent variable, which improved risk assessment beyond the recent WM international prognostic scoring system (ISSWM). By using age, previous therapy, B2M, and LDH, we identified 3 risk groups with 8-year survival estimates of 55%, 33%, and 5% (P < .001). These data provide novel insights into factors predicting long-term outcome in WM. This trial has been registered with www.cancer.gov under ID 4852904.
Cell signaling and transcription factor genes expressed during whole body regeneration in a colonial chordate
Authors: Rinkevich Yuval , Rinkevich Baruch , Reshef Ram
Published: October 2008

Background

The restoration of adults from fragments of blood vessels in botryllid ascidians (termed whole body regeneration [WBR]) represents an inimitable event in the chordates, which is poorly understood on the mechanistic level.

Results

To elucidate mechanisms underlying this phenomenon, a subtracted EST library for early WBR stages was previously assembled, revealing 76 putative genes belonging to major signaling pathways, including Notch/Delta, JAK/STAT, protein kinases, nuclear receptors, Ras oncogene family members, G-Protein coupled receptor (GPCR) and transforming growth factor beta (TGF-β) signaling. RT-PCR on selected transcripts documented specific up-regulation in only regenerating fragments, pointing to a broad activation of these signaling pathways at onset of WBR. The followed-up expression pattern of seven representative transcripts from JAK/STAT signaling (Bl-STAT), the Ras oncogene family (Bl-Rap1A, Bl-Rab-33), the protein kinase family (Bl-Mnk), Bl-Cnot, Bl-Slit and Bl-Bax inhibitor, revealed systemic and site specific activations during WBR in a sub-population of circulatory cells.

Conclusion

WBR in the non-vertebrate chordate Botrylloides leachi is a multifaceted phenomenon, presided by a complex array of cell signaling and transcription factors. Above results, provide a first insight into the whole genome molecular machinery of this unique regeneration process, and reveal the broad participation of cell signaling and transcription factors in the process. While regeneration involves the participation of specific cell populations, WBR signals are systemically expressed at the organism level.
Calculating expected DNA remnants from ancient founding events in human population genetics
Authors: Stacey Andrew , Sheffield Nathan C , Crandall Keith A
Published: October 2008

Background

Recent advancements in sequencing and computational technologies have led to rapid generation and analysis of high quality genetic data. Such genetic data have achieved wide acceptance in studies of historic human population origins and admixture. However, in studies relating to small, recent admixture events, genetic factors such as historic population sizes, genetic drift, and mutation can have pronounced effects on data reliability and utility. To address these issues we conducted genetic simulations targeting influential genetic parameters in admixed populations.

Results

We performed a series of simulations, adjusting variable values to assess the affect of these genetic parameters on current human population studies and what these studies infer about past population structure. Final mean allele frequencies varied from 0.0005 to over 0.50, depending on the parameters.

Conclusion

The results of the simulations illustrate that, while genetic data may be sensitive and powerful in large genetic studies, caution must be used when applying genetic information to small, recent admixture events. For some parameter sets, genetic data will not be adequate to detect historic admixture. In such cases, studies should consider anthropologic, archeological, and linguistic data where possible.
Selection and mutation on microRNA target sequences during rice evolution
Authors: Guo Xingyi , Gui Yijie , Wang Yu , Zhu Qian-Hao , Helliwell Chris , Fan Longjiang
Published: October 2008

Background

MicroRNAs (miRNAs) posttranscriptionally down-regulate gene expression by binding target mRNAs. Analysis of the evolution of miRNA binding sites is helpful in understanding the co-evolution between miRNAs and their targets. To understand this process in plants a comparative analysis of miRNA-targeted duplicated gene pairs derived from a well-documented whole genome duplication (WGD) event in combination with a population genetics study of six experimentally validated miRNA binding sites in rice (O. sativa) was carried out.

Results

Of the 1,331 pairs of duplicate genes from the WGD, 41 genes (29 pairs) were computationally predicted to be miRNA targets. Sequence substitution analysis indicated that the synonymous substitution rate was significantly lower in the miRNA binding sites than their 5' and 3' flanking regions. Of the 29 duplicated gene pairs, 17 have only one paralog been targeted by a miRNA. This could be due to either gain of a miRNA binding site after the WGD or because one of the duplicated genes has escaped from being a miRNA target after the WGD (loss of miRNA binding site). These possibilities were distinguished by separating miRNAs conserved in both dicots and monocot plants from rice-specific miRNAs and by phylogenetic analysis of miRNA target gene families. The gain/loss rate of miRNA binding sites was estimated to be 3.0 × 10-9 gain/loss per year. Most (70.6%) of the gains/losses were due to nucleotide mutation. By analysis of cultivated (O. sativa; n = 30) and wild (O. rufipogon; n = 15) rice populations, no segregating site was observed in six miRNA binding sites whereas 0.12–0.20 SNPs per 21-nt or 1.53–1.80 × 10-3 of the average pairwise nucleotide diversity (π) were found in their flanking regions.

Conclusion

Both molecular evolution and population genetics support the hypothesis that conservation of miRNA binding sites is maintained by purifying selection through elimination of deleterious alleles. Nucleotide mutations play a major role in the gain/loss of miRNA binding sites during evolution.
Acne vulgaris, mental health and omega-3 fatty acids: a report of cases
Authors: Rubin Mark G , Kim Katherine , Logan Alan C
Published: October 2008

Acne vulgaris is a common skin condition, one that is associated with significant psychological disability. The psychological impairments in acne include higher rates of depression, anxiety, anger and suicidal thoughts. Despite a paucity of clinical research, patients with skin conditions and/or mental health disorders are frequent consumers of dietary supplements. An overlap may exist between nutrients that potentially have both anti-acne and mood regulating properties; examples include omega-3 fatty acids from fish oil, chromium, zinc and selenium. Here we report on five cases of acne treated with eicosapentaenoic acid and antioxidant nutrients. Self-administration of these nutrients may have improved inflammatory acne lesions and global aspects of well-being; the observations suggest a need for controlled trials.
Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty
Authors: Yiotakis Ioannis , Eleftheriadou Anna , Giotakis Evagelos , Manolopoulos Leonidas , Ferekidou Eliza , Kandiloros Dimitrios
Published: October 2008

Background

Osteomas of ethmoid sinus are rare, especially when they involve anterior skull base and orbit, and lead to ophthalmologic and neurological symptoms.

Case presentation

The present case describes a giant ethmoid osteoma. Patient symptoms and signs were exophthalmos and proptosis of the left eye, with progressive visual acuity impairment and visual fields defects. CT/MRI scanning demonstrated a huge osseous lesion of the left ethmoid sinus (6.5 cm × 5 cm × 2.2 cm), extending laterally in to the orbit and cranially up to the anterior skull base. Bilateral extensive polyposis was also found. Endoscopic and external techniques were combined to remove the lesion. Bilateral endoscopic polypectomy, anterior and posterior ethmoidectomy and middle meatus antrostomy were performed. Finally, the remaining part of the tumor was reached and dissected from the surrounding tissue via a minimally invasive Lynch incision around the left middle canthus. During surgery, CSF rhinorrhea was observed and leakage was grafted with fascia lata and coated with bio-glu. Postoperatively, symptoms disappeared. Eighteen months after surgery, the patient is still free of symptoms.

Conclusion

Before management of ethmoid osteomas with intraorbital and skull base extension, a thorough neurological, ophthalmological and imaging evaluation is required, in order to define the bounders of the tumor, carefully survey the severity of symptoms and signs, and precisely plan the optimal treatment. The endoscopic procedure can constitute an important part of surgery undertaken for giant ethmoidal osteomas. In addition, surgeons always have to take into account a possible CSF leak and they have to be prepared to resolve it.
Motion compensation with a scanned ion beam: a technical feasibility study
Authors: Grözinger Sven Oliver , Bert Christoph , Haberer Thomas , Kraft Gerhard , Rietzel Eike
Published: October 2008

Background

Intrafractional motion results in local over- and under-dosage in particle therapy with a scanned beam. Scanned beam delivery offers the possibility to compensate target motion by tracking with the treatment beam.

Methods

Lateral motion components were compensated directly with the beam scanning system by adapting nominal beam positions according to the target motion. Longitudinal motion compensation to mitigate motion induced range changes was performed with a dedicated wedge system that adjusts effective particle energies at isocenter.

Results

Lateral compensation performance was better than 1% for a homogeneous dose distribution when comparing irradiations of a stationary radiographic film and a moving film using motion compensation. The accuracy of longitudinal range compensation was well below 1 mm.

Conclusion

Motion compensation with scanned particle beams is technically feasible with high precision.
Delayed involution of lactation presenting as a non-resolving breast mass: a case report
Authors: Kumar Yashwant , Chahal Alka , Garg Monika , Bhatia Alka , Mahajan NC , Ganju Anil
Published: October 2008

Introduction

Involution of lactation is a physiological process. Rarely, it may be delayed and troublesome for the lactating woman. Though lactation-induced changes in breast are well known, morphological features of delayed involution are not clear.

Case presentation

We report a case of a 22-year-old lactating mother who presented with a painful, non-resolving breast mass 5 months after delivery. Clinically, it simulated an inflammatory carcinoma. Histopathology, however, revealed involuting lactational changes.

Conclusion

To the best of our knowledge, lactational involution with such a presentation has not been described in the English literature. The case needs to be reported so that this entity can be considered among the differential diagnoses of breast masses in a lactating patient.
Observations on Convulsions
Authors: Boyd Robert
Published: October 2008

The term spasm was applied by Dr. Cullen, to a state of muscular contraction more violent in degree than is usual in health. Where the contraction is succeeded by relaxation, and immediately repeated without the concurrence of the will, or from natural causes, he applies the term convulsion. Dr. Copland, in his Dictionary, has given a fuller definition, to distinguish convulsions from allied and specific diseases, as tetanus, &c. Andral's definition is similar to Copland's, with this addition, that there is or is not loss of consciousness. When there is loss of consciousness the disease is termed eclampsia, always without foaming at the mouth; by which eclampsia is distinguished from epilepsy.
On the Pathology of the Urine, and the relation which that Fluid bears to other Excretions in Mental Diseases
Authors: Burnett C. M.
Published: October 2008

Our knowledge of the causes of mental diseases, in spite of the conflicting statements of morbid anatomy, has of late years had a tendency to remove from our minds, many doubts we might have been disposed to retain, as to the important part which the body takes, as an organic system, in the production of those diseases; and the ample results of a persistent and judicious application of therapeutic means, justifies the belief, that as the science of animal chemistry advances, and our knowledge, not merely of ultimate analysis, but of organic synthesis, is enlarged, we may have the gratification of seeing this protean malady deprived of many of its most painful and most formidable symptoms.
Voluntary schizophrenia organisations
Authors: O'Shea Brian
Published: October 2008

I previously reported (O'Shea, 1989, 1992) on the experience of national voluntary Huntington's disease (HD) and Alzheimer's disease (AD) organisations. This series of enquiries stemmed from an observation of Black (1988) that the medical profession in general offered little support to voluntary groups, a statement which has been largely supported for both HD and AD organisations in the first two parts of this trilogy. This final paper examines the experiences and attitudes of (mostly national) schizophrenia organisations.
An alternative to the panel scheme for the diversion of mentally disordered offenders
Authors: Mendelson Eric F. , Frost Carol
Published: October 2008

Multi-agency review of the diversion of mentally disordered offenders in the Southampton area did not reveal particular problems or lack of professional interest, but delays and difficulties could occur at any stage. To enhance the diversion process a facilitator approach was established. An experienced social worker undertook the roles of acting as a link, educator, supervisor and monitor. This has encouraged discontinuance of criminal proceedings, assisted the integration of mentality disordered offenders into ordinary psychiatric services and reduced the need for specialist assessment and care.
Outcomes in hospital hostels
Authors: Shepherd Geoff , King Charles , Fowler David
Published: October 2008

Activity and outcome data for two ‘ward-in-a-house’ projects for new long-stay in-patients are described. The results confirm that up to a third may be successfully resettled providing that good quality sheltered housing is available. However, a similar proportion appear to find such environments too demanding and may be transferred after an acute exacerbation of symptoms or a violent incident. The remainder need high quality, ongoing care.
Three months in the life of a community mental health team
Authors: Scott Jan , McCluskey Sara , Smith Lesley
Published: October 2008

An audit was undertaken to assess the efficacy and efficiency of a community-based mental health service which attempts to prioritise the care of those with severe and enduring disorders. Referral patterns over a three month period and change in case-load over the subsequent 12 months were recorded. Seventy-five per cent of new referrals met the priority group criteria, allaying anxieties that community services unceasingly get drawn to the care of those with less severe disorders. Furthermore, at 12 months the service had maintained contact with all patients previously admitted to hospital and all those presenting with psychotic disorders (27% referrals). Some changes in service structure are also suggested as a result of this evaluation.
Religion as an index of the rise and fall of ‘moral treatment’ in 19th century lunatic asylums in England
Authors: Rollin Henry R.
Published: October 2008

“…; and the tone of the chapel bell, coming across the Valley of the Brent, still reminds me, morning and evening, of the weft-remembered and mingled congregation of the afflicted, and who are then assembling, humble yet hopeful, and not forgotten, and not spiritually deserted.”

As a function of the Christian ethic, monasteries in Britain from the Middle Ages onwards set aside a section for the care of the sick. The monastic tradition ensured that the spiritual needs of the physically sick were well taken care of: chapels formed an integral part of the building complex and chaplains were, of course, constantly on tap. The mentally sick were less well served, however. For example, the second building to be occupied by St Luke's Hospital, London, opened in 1787, did not even boast a chapel, a distinction shared with Bethlem, the other major charity asylum, then occupying a purpose-built structure in Moorgate in the City of London.
Trainees' experience of organising their training
Authors: McConville Pauline , Langa Arturo
Published: October 2008

Little has been published by trainees of their involvement in the organisation of their academic curriculum. This article discusses the experience of two trainee representatives to the Post Graduate Training Committee (PGTC) in Fife with particular regard to three areas (academic programme, general assessment and exam preparation) over a one year period.
Compulsory treatment in the community: some debating issues
Authors: Turner Trevor
Published: October 2008

Compulsory treatment in the community has engendered considerable differences in opinion, and the recent rejection of a supervision order by a Parliamentary Committee. The arguments were recently debated, at a Section meeting of the College. More detailed research and a wider discussion within the College, and between the College and other interested parties, is needed. Refining these issues, whatever the legislative outcomes, should lead to improvements in community care.
A personal view of the role of the chaplain at the Reaside Clinic
Authors: Stephens Joseph
Published: October 2008

The contribution of the chaplain to patient care is rarely discussed and is sometimes forgotten. This paper discusses the role of the chaplain in a regional secure unit.
A letter from Bosnia: mission to investigate allegations of the sexual abuse of Bosnian Muslim women
Authors: Mezey Gillian C.
Published: October 2008

I am not a brave person. I have never been tempted to sign up for the armed forces, go parachuting or enrol on an Outward Bound course. It was therefore as much a surprise to me as anyone to find myself in January, travelling through central Bosnia, in flak jacket and helmet in an armoured personnel carrier. Together with my three female companions we had been despatched by the EC to investigate allegations of systematic rape and sexual abuse of Muslim women.
The role of the NHS Health Advisory Service
Authors: Williams Richard , Travers Ray
Published: October 2008

In this article, the Director of the NHS Health Advisory Service describes the task which he was given upon appointment and the new roles of the HAS. A senior registrar in forensic psychiatry illuminates one of its new roles by describing his attachment.
Elder abuse and the community psychiatric team
Authors: Kerr Judith S. , Dening Tom , Lawton Claire
Published: October 2008

To date, there are few reports on the extent of elder abuse among patients referred to old age psychiatry services. This study examined suspected cases of abuse among new referrals to a community psychiatric team for the elderly, at a time when guidelines and procedures for the detection and management of elder abuse were about to be introduced. of 74 cases assessed, seven (almost 10%) were probably being abused. Several types of abuse were described, with no single pattern, and the professional responses therefore needed to be flexible. The impact of introducing the guidelines win be assessed later.
A regional gender reassignment service
Authors: Snaith Philip , Butler Alan , Donnelly Jo , Bromham David
Published: October 2008

A Regional Gender Identity Clinic was established in Yorkshire ten years ago. It is an entirely NHS-based service and is well used by the psychiatrists in the region. The Director of the clinic is a psychiatrist and there is a cohesive group consisting of a plastic surgeon, gynaecologist (who supervises medication) and a speech therapist. The clinic has won the recognition of the Leeds Community & Mental Health Services Teaching NHS Trust which supports its continuation. An audit of outcome of the first 12 male to female reassignment procedures was conducted by a independent assessor. The result gave the team clear indication that the work should continue. A plea is made for the establishment of more regional services.
Community psychiatry: weasel words?
Authors: Robertson J.A.
Published: October 2008

The practice of modern high quality psychiatry would be well served by the abandonment of the expression ‘community psychiatry’ and a moratorium on its further use for at least a decade.
NSF: A voluntary organisation that cuts both ways
Authors: Hogman Gary
Published: October 2008

The National Schizophrenia Fellowship (NSF) was founded in 1972 following a period of correspondence in The Times initiated by John Pringle. It currently has a membership of around 7000 people linked to over 160 groups throughout England, Wales and Northern Ireland. The majority of the members are informal carers. The organisation provides direct care to about 3000 people each week.
Post-marketing surveillance (Phase IV drug studies)
Authors: Freeman C. P.
Published: October 2008

Several College members have been in touch with the Research Committee asking for advice on the conduct of Phase IV trials. This topic has been extensively debated at the Research Committee, and we thought it would be helpful to members to have some guidance notes.
Care programme approach
Authors: Kingdon David
Published: October 2008

The care programme approach has been introduced to improve the delivery of services to people with severe mental illness and minimise the risk that they lose contact with mental health services. Its essential elements are assessment of health and social need, a written care plan, nomination of a key worker, and regular review. It requires interprofessional collaboration and negotiation of care plans with users and carers but individual patients vary in their needs for multidisciplinary involvement and review.
Psychodynamic forensic psychotherapy
Authors: Cordess Christopher , Riley Wendy , Welldon Estela
Published: October 2008

A brief description of the place of psychodynamic psychotherapy in the treatment of offenders is followed by an account of a forensic psychotherapy course run under the auspices of the British Postgraduate Medical Federation. The first year of a second year course leading to the diploma in Forensic Psychotherapy of the University of London is also described.
Drug management of disturbed behaviour by psychiatrists
Authors: Cunnane J.G.
Published: October 2008

The aggressive, acutely psychotic patient may present in many medical settings. Drugs are usually necessary to avert or abort a crisis yet specific guidance on such management is lacking from standard psychiatric texts. Consultant psychiatrists have a crucial advisory role in these situations but information on their prescribing habits has not been published. This study aims to determine whether there is any consensus on the drug management of the aggressive, acutely psychotic patient by consultant psychiatrists.
Psychiatric admission services for people with learning disability
Authors: Singh I. , Khalid M.I. , Dickinson M.J.
Published: October 2008

As the care of people with learning disability has shifted from large Victorian hospitals to the community, provision for in-patient psychiatric treatment has, in many districts, also moved. Purpose built district or supra-district admission services represent the most common model. An alternative is the use of existing general psychiatric beds. In this article we describe the first 18 months of the Hillingdon district service where this latter model has been adopted.
Collegiate Trainees Committee report on career guidance in psychiatric training
Authors: Kehoe R.F. , Guthrie E. , Haggith A.
Published: October 2008

To determine the availability of career guidance within psychiatric training, the Collegiate Trainees Committee surveyed 300 trainees who had recently sat the MRCPsych Part II examination and 136 (45%) responded. Most trainees had received little or no career guidance and some had sought career advice without success. One third of trainees felt they had encountered discrimination within their psychiatric training. We urge trainees to be pro-active in seeking career guidance, identify sources of advice and make suggestions for topics to be discussed within consultant supervision sessions. We recommend that local access to career advice should be assessed by visiting College inspection panels.
What's so good about the Kings Fund management course?
Authors: Bristow M.F. , Douzenis A.
Published: October 2008

In an era where management training is vital for any would-be consultant, the Kings Fund training course for senior registrars is the best known and most expensive. Examining it critically, we feel that despite its flaws it is still worth the extra money both for its wealth of practical exercises and for the unique, although not very reassuring, glimpse it affords us of management ideology at source. Local courses, although unable to reproduce the atmosphere, could benefit from its practical emphasis.
Psychiatry: a contracting specialty?
Authors: Richardson Gregory J. R.
Published: October 2008

Psychiatric services delivered outside agreed contracts between purchasers and providers will not be paid for. Reduced income will then mean reduced services. This article describes how psychiatrists might understand and address the contracting issues for their service, so that they effectively involve themselves in the contracting process in their locality, and so maintain the services for their patients.
General practitioners' involvement in psychiatric patients' discharge plans
Authors: Wylie A. Scott
Published: October 2008

The aim of this study was to determine the extent to which general practitioners are informed of and involved in their psychiatric patients' discharge plans, their satisfaction with the present level and methods for improvement. Postal questionnaires were sent to 100 GPs from different practices in England. They reported a high level of dissatisfaction with the present frequency with which they are informed of and involved in discharge plans before the event. They report being informed and involved too infrequently or randomly, or both. This dissatisfaction could generally be resolved by pre-discharge telephone discussion with a member (preferably medical) of the multidisciplinary team.
Informal psychiatric patients requesting discharge
Authors: McGilp Robin , Kidd Brian , Stark Cameron , Henderson Tom
Published: October 2008

A retrospective investigation of case-notes compared 54 incidents of informal psychiatric in-patients being detained in hospital on an emergency basis with 66 incidents of discharge against medical advice (AMA). The characteristics of the two groups were compared. Detained patients were more likely to have been detained previously, to be suffering from a psychotic illness, and to have threats of violence or self-harm mentioned in their case-notes. AMA patients were more likely to have a history of substance abuse but were no more likely than the detained group to have been discharged AMA in the past. The results suggest that psychiatrists in this hospital are using current legislation on detention appropriately.
Allocating resources in psychiatric hospitals according to casemix
Authors: McCrone Paul
Published: October 2008

There are advantages to be gained from a knowledge of the patient casemix that psychiatric hospitals, and community services, are likely to encounter. In particular the efficient allocation of resources would be better achieved if individuals could be ‘placed’ into groups. These groups would need to be clinically distinct and contain similar members. Previous methods of defining casemix have focused upon clinical diagnosis. However, the effectiveness of diagnosis in predicting resource utilisation is limited. A range of other factors could be used, including comorbidity, severity of illness, and previous hospital contact.
Do patients who have been on ‘sections' get refused visas?
Authors: Allen Danny , Allen Karen
Published: October 2008

A reason sometimes given for not applying a section off the Mental Health Act 1983 to patients for the first time is that this may stigmatise them in some way. A practical example off stigmatisation is that patients who have previously been ‘sectioned’ may be refused tourist or immigration visas to other countries. Since no information on this subject is available in the psychiatric literature this paper attempts to clarify the policy of diplomatic missions in the UK in relation to visa applicants who report a history of mental illness and compulsory hospital treatment.
An ethical dilemma in the learning disability services: too much money
Authors: Matthews Helen , Hollins Sheila , Smith Jeanette , Adshead Gwen
Published: October 2008

Learning disability services care for the needs of patients whose autonomy of thought and action is impaired by processes that often cannot be reversed. Their autonomy may also be limited by external influences such as carers' attitudes, both positive and negative. Others may therefore find themselves making decisions for such patients. The case presented in this paper illustrates how these factors can condemn a wealthy woman to a life of relative poverty, lacking in pleasures she could so easily afford, because she lacks competence in some areas of decision making. A possible solution is proposed.
The rights of voluntary patients in hospital
Authors: Sugarman Philip , Moss Julia
Published: October 2008

The law in England and Wales regarding consent to treatment is of some complexity, but it remains true that hospital patients have two basic rights: to refuse treatment of any kind, and to leave hospital. Two hundred and seven teaching hospital in-patients were asked about their care, and what would happen if they exercised these rights. Informal psychiatric patients were the most likely to disagree with their treatment in hospital, while almost half of all patients did not know that they had the right to refuse it. Many anticipated coercive responses from staff. Patients in hospital should be better informed of their rights.
Architectural design and acute psychiatric care
Authors: Taj Rizwan , Sheehan John
Published: October 2008

All staff based in a newly built acute psychiatric unit for more than six months were asked about the difficulties they encountered in the implementation of their duties and what changes they recommended. The problem areas identified included poor design and location of nursing observation station, lack of proper seclusion facilities, insufficient ventilation, unsafe position of the roof garden, exposed beams and supports, proximity to the lake and inadequate interview facilities for all staff. The urgent recommendations included alteration in the design and positioning of observation station, improving ventilation, making the roof garden safe, and covering all exposed beams and supports. The desirable changes included extra interviewing facilities and a spacious observable television room. Consultation by mental health professionals during the initial stage of designing of psychiatric units is essential.
Training in the psychiatry of sleep disorders
Authors: Yousaf Farida , Rozewicz Leon
Published: October 2008

Sleep disorders are common in psychiatric and non psychiatric consultations. Yet there is very little education and training available to medical trainees in the UK. In this paper we describe our experience in a sleep laboratory during a part time six months attachment. We feel that a basic knowledge and experience in assessment, investigations and treatment of sleep disorders and involvement in academic and research activities in this field should be considered to be a part of the psychiatric training schemes.
The Health of the Nation
Authors: Jenkins Rachel
Published: October 2008

The Health of the Nation – A Strategy for England is a national response to WHO'S Health for All by the Year 2000 initiative. It has great importance both because it focuses on health outcomes and because it selects mental illness as one of five priority areas. This article traces the historical background to the development of the White Paper, summarises the content of the mental illness key area and current progress in improving information and understanding and developing comprehensive services, and improving good practice. It draws out the implications for individual practitioners, users and cares, and for the working arrangements between purchasers and providers.
The Mental Health Act Commission
Authors: Curran Christopher , Bingley William
Published: October 2008

The aim of this article is to promote a clearer understanding of the Mental Health Commission's development, structure and function. Over recent years, mental health professionals and patients have become more aware of the organisation and its work, although some may remain uncertain about its function and how it fits into the overall care of detained patients. The Commission's fundamental job is to safeguard the well-being and interests of patients detained under the Act. Its remit does not extend to informal patients. Unless otherwise indicated, all statutory references are to the 1983 Mental Health Act.
Identifying children with mental handicap in new referrals to a community child and family service
Authors: Colgate Robert
Published: October 2008

Clinical experience suggested that between one tenth and one fifth of new referrals to a county-wide child and family service were referrals of children who had mental handicap. The purpose of this project was to establish the proportion prospectively with the clinical assessment used routinely by the service.
A substance misuse clinic for adolescents
Authors: Blennerhassett Richard , Gilvarry Eilish , Tayler Peter
Published: October 2008

We describe the operation of a substance misuse clinic for adolescents as a Joint venture between a voluntary organisation ‘Streetwise’ and the Adult Substance Misuse Services and Child and Adolescent Psychiatry Services in Newcastle upon Tyne. A number of issues are discussed relevant to improving clinical services for adolescent substance misusers.
Resuscitation skills and doctors working in psychiatry
Authors: McNaughton Gordon , Hall David J. , Stark Cameron
Published: October 2008

Doctors working in psychiatry have been shown to lack practical skills in basic cardiac life support (BCLS), but these have not been regarded as priorities for training. This study assessed levels of experience, confidence and skill in BCLS, in psychiatrists, and examined the effect of a single training session on practical skills. Levels of skill were generally poor but significant improvement was seen following training. It is recommended that all psychiatrists undergo brief regular practical training in BCLS.
The use of the Mental Health Act in elderly patients in one health district
Authors: Morris C. , Anderson I.M.
Published: October 2008

There has been little published on the application of the Mental Health Act (1983) in the elderly. We therefore surveyed its use in a district old age psychiatry service covering a mixed rural and urban population with about 60,000 people over 65 years. The MHA was applied 36 times to 32 patients over a two year period. The primary diagnosis was a functional psychiatric illness in 64% patients (usually depression) and dementia in 36%. Functionally ill patients were most frequently detained on a treatment section (S3) and demented patients on an assessment section (S2). Only one patient with dementia was placed on a guardianship order. The outcome of treatment is described.
The distribution of mental health services within NHS trusts
Authors: Harrison Judy
Published: October 2008

From April 1994, over 95% of health care services will be provided by NHS trusts. Mental Health services have a choice of remaining within the acute hospital trust or forming part or all of a community trust. Using data from trust directories, the distribution of mental health services within the first three trust waves is described. Forty per cent of acute hospital trusts currently do not include mental health services. Unlike other specialities, a significant proportion of mental health services are choosing to form specialist mental health trusts. The implications of the alternative trust arrangements for psychiatry are discussed.
How to produce an annual report
Authors: James Adrian , Donovan Martin
Published: October 2008

In the new style NHS an annual report is essential for all services. Senior registrars have the necessary skills and are ideally placed to co-ordinate such an enterprise as part of their management training. The typical structure for such a report is described and suggestions are made on content and format. Pitfalls are outlined from the authors' experience.
A trainee's experience of group therapy with pre-adolescents
Authors: Procter Elizabeth
Published: October 2008

Very few trainees have experience in group psychotherapy. I describe my experience of co-facilitating a group for pre-adolescents who were being bullied. This proved a valuable learning experience as part of a multidisciplinary team, and increased my understanding of how groups function and the particular problems involved in running a group for children.