Homoeopathic Management of Conduct Disorder: A Case Series

Conduct disorder is a psychiatric syndrome occurring in childhood and adolescence, and is characterised by a long-standing pattern of violations of rules and antisocial behaviour. The aetiology of conduct disorder involves an interaction of genetic/constitutional, familial and social factors. Conduct disorder increases the risk of several public health problems, including violence, weapon use, substance abuse and dropping out of school. Thus, it is important to identify conduct disorder and begin intervention as early as possible.Three cases of conduct disorder are presented here, which have been treated exclusively with homoeopathic medicines without any supportive therapies. The diagnosis and severity were assessed by Conduct Disorder Diagnostic Tool and the symptomatic assessment was done by using Conduct Disorder Rating Scale-Parent Version. Possible causal attribution of changes was explicitly depicted by Naranjo Criteria.The initial outcome of homoeopathic treatment shows a positive role of homoeopathy as the cases are exclusively managed by homoeopathic medicine.

Audit of methods used to contact the duty doctor - Abraham Cowley Unit

AimsThe aim of this audit was to determine whether the duty doctor of a 4 ward inpatient psychiatric unit is contacted safely, effectively and in a manner that can be monitored. This is in line with trust protocol and the method stated is via switchboard. Should a deficit be found it was the aim to make an appropriate intervention.BackgroundIn the Abraham Cowley Unit, there is a Senior House Officer ‘on-call’ duty doctor 24/7. The shifts are 2 x 12.5 hours daily and at all times the duty doctor should be contacted via switchboard. Contacting via switchboard is important to ensure there is an audit trail of calls made. Issues that arise from using other methods of contact, e.g. calling direct extensions, include miscommunication and the doctor not being reached in a timely manner. This had been identified as an issue anecdotally by junior doctors on call and also highlighted following an untoward incident.MethodThe method by which the on call doctor was contacted was recorded in Excel for 5 consecutive 12.5 hour shifts in October 2019. The standard set for calls via switchboard was 80%. Following the initial results and the subsequent intervention, a repeat audit was performed using the same method.ResultInitial OutcomeInitially it was found that only 25% of calls received where through the appropriate channel (5 out of 20 calls). This fell far below the 80% standard and an intervention was therefore devised.InterventionIn order to ensure that all ward staff were aware of the trust policy posters were created and placed above all ward telephones and the telephone in the assessment suite office. This information was also handed over to the nurses in charge directly in order for it to be filtered through to other staff during handover.Post Intervention OutcomeFollowing the intervention 88% of calls received where through the appropriate channels (7 out of 8 calls) and the 80% standard was achieved.ConclusionThere has been a demonstrable improvement in the adherence to trust policy when contacting the duty doctor, with the percentage of calls made through the appropriate channel rising from 25% to 88%. This has now met the agreed standard of 80% and will improve the trust's ability to monitor contact of the duty doctor effectively.

Thought Conditioning: Inducing and Reducing Thoughts About the Aversive Outcome in a Fear-Conditioning Procedure

The human fear-conditioning paradigm is a widely used procedure to study anxiety. However, merely thinking about the aversive outcome is typically not measured in this procedure. This is surprising because thinking of an aversive event is of clinical relevance (e.g., in the form of intrusions) and theoretical interest. We present two preregistered studies that (a) included thinking of an aversive outcome as an additional dependent variable and (b) compared several interventions to reduce it. We found that mere thinking of an aversive outcome could be successfully conditioned. Among the participants who showed successful acquisition, extinction training was less successful in reducing it than counterconditioning. Presenting new additional outcomes also proved effective to reduce thoughts about the initial outcome when the new outcomes were positive stimuli. Including thinking of the aversive outcome as an additional dependent variable may serve to enhance the understanding of anxiety-related disorders and inform their treatment.

Initial Outcome of Surgical Management of Parotid Gland Neoplasm

Introduction: Surgical excision is the gold standard for treatment of parotid gland neoplasm. But the complex relationship of the tumour to the facial nerve in the parotid gland makes the surgery very challenging. Objective: To evaluate the initial outcome of parotid gland neoplasm surgery. Materials and Methods: This cross-sectional observational study was conducted from January to December 2012 where 20 surgically treated patients with parotid gland neoplasm were selected by random sampling technique. They were followed up from 03 to 06 months to assess the minor post-operative complications. Results: The study revealed that 35% of patients belonged to the 4th decade of life. Pleomorphic adenoma constituted 85% of the tumours. Superficial parotidectomy was performed in 95% of cases. 40% of patients developed neuropraxia of the marginal mandibular branch of the facial nerve but all improved over a period of 3-6 months. 5% had permanent facial nerve weakness. Frey’s syndrome was observed in 20% of cases clinically but improved gradually. The rate of wound infection, parotid fistula and hypoesthesia of the skin over the ear lobule occurred in 10%, 5% and 20% cases respectively. Conclusion: Safe and effective parotid gland surgery requires a clear understanding of the regional anatomy, the experience of the surgeon, meticulous surgical technique along with detailed preoperative informed consent for surgery to reduce post-operative complications and morbidity of the patient. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 193-195

Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh

Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare providers, and government personnel, document reviews and meeting observations were used in analysis. Results The study showed that participants were enthusiastic and willing to take part in the CSC intervention. They perceived CSC to be useful in raising awareness about health in the community and facilitating structured monitoring of CC services. The process facilitated building stronger community ownership, enhancing accountability and stakeholder engagement. The participants identified issues around service provision, set SMART (specific, measurable, attainable, relevant and time-bound) targets and indicators on supplies, operations, logistics, environment, and patient satisfaction through CSC. However, some systematic and operational challenges of implementation were identified including time and resource constraint, understanding and facilitation of CSC, provider-user conflict, political influence, and lack of central level monitoring. Conclusion The findings suggest that CSC is a feasible and acceptable tool to engage community and healthcare providers in monitoring and managing health facilities. For countries with health systems faced with challenges around accountability, quality and coverage, CSC has the potential to improve community level health-service delivery. The findings are intended to inform program implementers, donors and other stakeholders about context, mechanisms, outcomes and challenges of CSC implementation in Bangladesh and other developing countries. However, proper contextualization, institutional capacity building and policy integration will be critical in establishing effectiveness of CSC at scale.

Palatalizations in the Romance Languages

Major dialect-dependent differences in articulatory fronting and strengthening for the front lingual affricate and fricative outcomes of Latin sequences composed of /t, d, k, g/ and a following front vocalic segment in the Romance languages may be accounted for assuming that those outcomes were issued from (alveolo)palatal or palatalized stop realizations exhibiting variable closure fronting degrees. The place and manner of articulation characteristics of the front lingual affricate and fricative outcomes in question depend on several aspects about the Latin stop sequences: stop closure location and voicing status, whether the vocalic segment was a vowel or a glide, and word position. While differences in fronting and strengthening associated with etymological stop voicing occur in both Eastern and Western Romance, those related to the other factors hold mostly in Western Romance and especially in Raetoromance. Several diachronic pathways are difficult to interpret; thus, in early times, [c] derived from Latin /ki,e/ and /kj/ may have been more anterior in Western Romance than in Eastern Romance, or else the initial outcome [tʃ] of the affrication process stayed palatoalveolar in the latter domain and fronted to [ts] in the former. Gestural blending accounts not only for the realizations [c, ɟ] of /t, d, k, g/ before a front vocalic segment but also for the alveolopalatal and palatoalveolar end products of the Latin sequences /kt/ ([c]), /nj/ ([ɲ]), /lj, kl/ ([ʎ]) and /sj, ks/ ([ʃ]).

The Relevance of “Trust and Confidence” in Financial Markets to the Information Production Role of Banks

Banks are informational intermediaries whose efficient operation is strongly tied to the maintenance and continuance of the trust and confidence produced by them and by external sources. The literature on trust and confidence with relevance to banking has shown particular interest in their links with panics and bank runs, together with their wider resulting implications on the macro-stability of the financial system. However, on the micro level, an initial outcome emanating from a lack of trust and confidence would be the disruption of the information production that ultimately paves the way for further deterioration, leading to a vicious circle. To investigate this further, this article will shed light on this micro aspect of bank information production and its relationship with public trust and confidence.