scholarly journals The profile of suspected criminal offenders referred for psychiatric evaluation on an outpatient basis at Ngwelezana Hospital

2021 ◽  
Vol 27 ◽  
Author(s):  
Sithembisile Mngadi ◽  
Andrew Tomita ◽  
Vusi Khanyile ◽  
Bonginkosi Chiliza
Keyword(s):  
Intellectual Disability ◽  
Forensic Psychiatry ◽  
Psychotic Disorders ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Forensic Assessment ◽  
Waiting List ◽  
Psychiatric Evaluation ◽  
Outpatient Basis ◽  
Criminal Offenders

Background: Some suspected criminal offenders in South Africa are required to undergo forensic psychiatry assessments before or during the trial, which can be delayed as a result of the shortage of psychiatrists and inpatient forensic psychiatry beds. In KwaZulu-Natal (KZN) province, only one hospital (Fort Napier Hospital [FNH]) is designated for the 30-day inpatient forensic psychiatry assessments and there is a long waiting list for suspected criminal offenders awaiting assessment. There is a need to find ways of alleviating the backlog in the waiting list, with the use of outpatient forensic assessments being a possible adjunctive method.Aim: To determine the demographic, clinical and forensic profile of suspected criminal offenders referred for outpatient preliminary assessment to Ngwelezana Hospital, and identify the profile of those who most likely require referral to FNH for a 30-day inpatient assessment.Setting: The study was conducted at Ngwelezana Tertiary Hospital, in KZN, South Africa.Methods: We conducted a retrospective chart review of 207 suspected criminal offenders referred for outpatient forensic assessment from January 2009 to June 2015.Results: The majority of the participants were males (94.2%), with a diagnosis of substance use disorder (28.2%), intellectual disability (23.4%) or psychotic disorders (21.8%). Forty three per cent were charged with sexual crimes and 10.7% with murder. Fifty seven per cent were recommended for referral to FNH for a 30-day inpatient forensic assessment, whilst 43% were not recommended for referral. Those recommended for inpatient assessment were significantly more likely to have a lower level of education (p = 0.02), to be on a disability grant (p 0.01), and to have been diagnosed with intellectual disability (p 0.01), than those not recommended for referral.Conclusion: Identifying the characteristics of suspected criminal offenders who are most likely to be recommended for referral to FNH will potentially reduce the number of unnecessary referrals.

Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital

2021 ◽  
Author(s):  
Gabriel Kraus-Fischer ◽  
Raquel Alfonso-Ballester ◽  
Isabel Mora-Oliver ◽  
Norberto Cassinello-Fernández ◽  
Joaquín Ortega-Serrano
Keyword(s):  
Bariatric Surgery ◽  
Tertiary Hospital ◽  
Waiting List ◽  
Special Program ◽  
Effectiveness And Efficiency

scholarly journals 1631. Mycobacterium septicum: A 6-year Clinical Experience from a Tertiary Hospital and Reference Laboratory

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S807-S807
Author(s):  
John Raymond U Go ◽  
Cristina G Corsini Campioli ◽  
Omar Abu Saleh ◽  
John Wilson ◽  
Sharon Deml ◽  
...  
Keyword(s):  
Lung Disease ◽  
Treatment Duration ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
High Rate ◽  
Clinical Microbiology Laboratory ◽  
Reference Laboratory ◽  
Peritoneal Dialysis Catheter ◽  
Increased Risk

Abstract Background Mycobacterium septicum is a rapidly growing non-tuberculous mycobacterium. It is a ubiquitous organism capable of causing infections in both healthy and immunocompromised individuals. Only a few cases have been reported to date, and standard therapeutic regimens, and optimal treatment duration have not been defined. Methods We conducted a retrospective chart review of all patients seen at Mayo Clinic in Rochester, MN from July 2014 to March 2020 from whom Mycobacterium septicum was isolated in culture by our clinical microbiology laboratory. Results There were 12 patients identified with M. septicum infection – 7 males and 5 females. The average age was 67 years, with an age range of 48 to 80 years. Seven of 12 isolates obtained were from sputum samples. Only one patient was on immunosuppressive medication. Three cases were considered clinically significant infections for which directed anti-mycobacterial therapy was instituted. In two of these three cases, co-infection with Mycobacterium avium complex (MAC) was seen. Underlying structural lung disease was present in the two cases of pulmonary infections. Peritoneal dialysis catheter-related peritonitis was seen in the third case. All the isolates were susceptible to amikacin, ciprofloxacin, imipenem, linezolid, moxifloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX). The isolates were resistant to clarithromycin and doxycycline. Patient Characteristics, Associated M. septicum Illness, and Therapy Provided Antimicrobial Susceptibility Profiles of the Mycobacterium septicum Isolates, MIC (mcg/mL) and Interpretation Patient Demographics and Specimen Source of Mycobacerium septicum Isolates Conclusion M. septicum is an unusual cause of non-tuberculous mycobacterial infection. The presence of a foreign body may increase the risk of infection. Individuals with underlying structural lung disease are also likely to be at increased risk of developing pulmonary infection. Generalized treatment recommendations are limited by the lack of prospective controlled trials; hence, optimal antibiotic regimen and treatment duration have not been firmly established. Susceptibility testing should be performed to guide treatment selection, but the use of combination therapy with potentially empiric agents like amikacin, ciprofloxacin, imipenem, linezolid, moxifloxacin, and TMP-SMX as demonstrated in this small study, can be considered. A high rate of macrolide resistance was noted in our study. Disclosures All Authors: No reported disclosures

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

A Consideration of the Relationship between the Rules of Court and the Code of Ethics in Forensic Psychiatry

2004 ◽  
Vol 38 (1-2) ◽  
pp. 20-25
Author(s):  
Peter C. Gaughwin
Keyword(s):  
Forensic Psychiatry ◽  
Code Of Ethics ◽  
Clinical Work ◽  
Federal Court ◽  
Forensic Assessment ◽  
Expert Witnesses ◽  
Ethical Challenges ◽  
Medical Speciality ◽  
Personal Conflict ◽  
The Relationship

Objective To consider the relationship between the Rules of Court for expert witnesses and the revised Ethical Guideline No. 9 and Practice Guideline No. 9 of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and how this affects the responsibilities that psychiatrists have to a court and to their profession, when they enter the legal arena. Method Literature relevant to the subject, the Federal Court rules relating to expert witnesses and the RANZCP Guidelines are discussed and compared, with examples used to illustrate particular issues that arise from time to time in the civil jurisdiction. A distinction is drawn between the functions of those psychiatrists who undertake forensic assessment and those who undertake clinical work, and some of the ethical challenges facing forensic psychiatrists are considered. Results The Rules of Court relating to expert witnesses and the RANZCP Guidelines No. 9 have a complementary relationship and are thus ethically consistent with each other and provide a basis for psychiatrists to maintain and enhance the integrity of their profession. Conclusion Forensic psychiatry is a particularly complex medical speciality and one that can create enormous personal conflict for clinicians, especially those who are not forensic consultants. It may therefore be time for the College to develop an accreditation process for those prepared to undertake further study in the nature and practice of forensic psychiatry.

Clinical manifestations in patients with acute and transient psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S363-S364
Author(s):  
Á. López Díaz ◽  
A. Soler Iborte ◽  
S. Galiano Rus ◽  
J.L. Fernández González ◽  
J.I. Aznarte López
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Exact Test ◽  
Chi Squared ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Competing Interest

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Suicide, the main cause of referral of patients from a general hospital for psychiatric evaluation

2021 ◽  
Vol 5 (1) ◽  
pp. 018-021
Author(s):  
Gómez Elena ◽  
Guzmán Marianela ◽  
Torres Oriol Yuguero
Keyword(s):  
Suicide Attempts ◽  
Hospital Admissions ◽  
Cross Sectional Study ◽  
Psychiatric Evaluation ◽  
Outpatient Basis ◽  
Test Results ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
Life Threatening

Introduction: Psychiatric emergencies constitute between 1% - 10% of general emergencies in Spain, of which a quarter will end up being hospital admissions. There is little literature on patients who are referred from general to specialized hospitals. Methods: Cross-Sectional study of all the patients referred in 2018. Sociodemographic variables and clinical variables, such as diagnosis and discharge destination, were analyzed. An analysis was performed by comparing means with the Chi Square test. Results: 433 derived emergencies were analyzed. Most of the patients were women. The main reason for derivation were suicide attempts. Of those patients, 40% required hospitalizations. More than 50% of the derived emergencies were referred to the home and followed up on an outpatient basis. Conclusion: Most derived emergencies are referred to the home after evaluation. This implies that most are not life-threatening and that with adequate tools for evaluating suicide risk, we could avoid transfers and improve the resolution of these cases.

INSURE (INtubate, SURfactant and Extubate) method in preterm infants with respiratory distress syndrome: a retrospective study

2020 ◽  
Author(s):  
Mohamed Mubarak Shaik Kidur Mohideen ◽  
Deepika Wagh ◽  
Sam Athikarisamy
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
P Value ◽  
Severe Respiratory Distress ◽  
Surfactant Administration

Abstract Background: Preterm infants with severe respiratory distress syndrome (RDS) are usually managed with endotracheal intubation and surfactant administration followed by mechanical ventilation however this has immediate and long-term complications. Hence, INSURE (Intubate, surfactant administration and extubate) method combined with continuous positive airway pressure (CPAP) support has been accepted as an alternative method in eligible infants. Aim of this study is to look at our experience of administering INSURE and to look at the factors predisposing to the failure of INSURE. Methods: A retrospective chart review was done of all the babies who were born in a tertiary hospital between 1 st January 2014 to 31 st December 2015 (2 years) and received surfactant through INSURE method. Infants requiring reintubation and mechanical ventilation within 3 days post INSURE are considered as INSURE failure for our study purpose. Results: Eighty-five infants were included in the review with gestational age (GA) ranging from 26 +3 to 35 +5 weeks and birth weight ranging from 680 to 3340 grams. Of these, 22 infants (26%) had INSURE failure. INSURE failure rate was higher in infants born <30 weeks gestation (40%). Higher FiO2 requirement prior to INSURE (mean FIO 2 0.5 vs 0.3, P value <0.001) and preeclampsia in mothers of infants < 30 weeks of GA (P value 0.027) were strongly associated with INSURE failure. No mortality was noted in either group. Conclusion: We found that INSURE method may be useful in preventing the need for mechanical ventilation in late preterm infants with RDS. However, this method may be less successful in preterm infants with lower GA (<30 weeks) and higher FiO2 requirement (≥0.5). More prospective studies are needed to assess the effectiveness of INSURE method.

Mental health and emotional well being

2009 ◽  
pp. 213-248
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Intellectual Disability ◽  
Anxiety Disorders ◽  
Secondary Care ◽  
Psychotic Disorders ◽  
Tertiary Care ◽  
Well Being ◽  
Prevalence Rates

Introduction 214 Promoting emotional well-being 216 Promoting assertiveness 218 Primary care 220 Secondary care 222 Tertiary care 224 Prevalence rates 226 Factors contributing to mental health 228 Anxiety disorders 230 Psychotic disorders 232 Organic disorders 234 Dementia (in people with intellectual disability) 236 Psychopathology 238...

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