scholarly journals Survey of suicides in the Fife region of Scotland

1999 ◽  
Vol 23 (5) ◽  
pp. 267-269
Author(s):  
Fergus Douds ◽  
Vicky Bridges
Keyword(s):  
Risk Factors ◽  
General Practitioner ◽  
General Practitioners ◽  
Clinical Audit ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
History Of ◽  
Previous Contact ◽  
General Practices ◽  
Reduce Risk

Aims and methodsSuicides in the Fife region were investigated over a two-year period. The timing of the final contact with general practitioners and psychiatric services was ascertained. Data were collected from procurators fiscal records, general practices, and where applicable, psychiatric records.ResultsThere were 74 suicide victims during the study period. Forty-six per cent of suicide victims saw their general practitioner in the month before death, and 55% had a history of previous contact with psychiatric services, although only 27% of this group saw a psychiatrist in the month before death.Clinical implicationsClinical audit of suicide is an important task for psychiatric services. Practitioners must continually assess risk and attempt, where possible, to reduce risk factors.

Adult Victimization over Time

2018 ◽  
pp. 171-174
Author(s):  
Mary C. Zanarini
Keyword(s):  
Risk Factors ◽  
Sexually Abused ◽  
Female Gender ◽  
Physical Assault ◽  
Clinical Implications ◽  
Axis Ii ◽  
Borderline Patients ◽  
History Of ◽  
Over Time

At baseline, borderline patients reported higher rates of adult rape and physical assault by a partner than Axis II comparison subjects. Four risk factors were found to significantly predict whether borderline patients had an adult history of being a victim of physical and/or sexual violence before their index admission: female gender, a substance use disorder that began before the age of 18, childhood sexual abuse, and emotional withdrawal by a caretaker (a form of neglect). At six-year and 10-year follow-up, borderline patients reported higher rates of being verbally, emotionally, physically, and sexually abused or assaulted than did Axis II comparison subjects. However, each of these forms of abuse declined significantly over time. The clinical implications of these prevalence and predictive findings are discussed.

scholarly journals Changes in diagnoses before admission to a specialist medium secure unit

2012 ◽  
Vol 36 (11) ◽  
pp. 404-408 ◽  
Author(s):  
Amrith Shetty ◽  
Dilum Jayawickrama ◽  
Pamela J. Taylor
Keyword(s):  
Substance Misuse ◽  
Service Providers ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
Psychotic Illness ◽  
Violent Behaviour ◽  
Medium Security ◽  
History Of ◽  
Secure Unit ◽  
Study Participants

Aims and methodThere is evidence that changing diagnoses may be an important factor preceding homicide, but there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. Our aim was to establish the frequency of a history of changing diagnoses in patients in a UK specialist unit, and to explore the characteristics of these patients.ResultsIn total, 38 of 42 study participants had prior contact with psychiatric services. Just over 40% (16 of the 38) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common in this group; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services.Clinical implicationsChanges in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. They are a testimony to the difficulties experienced by service providers in delivering a consistent service. This needs to be studied further.

Childhood Sexual Abuse Among New Psychiatric Outpatients in a City in Northern Alberta-prevalence Rate and Demographic/Clinical Predictors

2017 ◽  
Vol 41 (S1) ◽  
pp. S120-S120
Author(s):  
V. Agyapong ◽  
M. Juhás ◽  
A. Ritchie ◽  
O. Ogunsina ◽  
L. Ambrosano ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Mental Illness ◽  
Sexual Abuse ◽  
Prevalence Rate ◽  
Psychiatric Services ◽  
Psychiatric Outpatients ◽  
Clinical Predictors ◽  
Family Histories ◽  
History Of ◽  
Previous Contact

Child sexual abuse (CSA) is a major global health problem with serious adverse effects at later ages. Our paper examines the prevalence rates and the demographic and clinical predictors of CSA among adult psychiatric outpatients. A data assessment tool was used to compile information on the demographic and clinical characteristics of all new patients assessed in four psychiatric outpatient clinics between 1st January 2014 and 31st December 2015. The 12-month prevalence rate for CSA among new psychiatric outpatients in Fort McMurray was 20.7% (10.7% for males and 26.9% in females). With an odds ratio for sex of 3.30 (CI = 2.06–5.29), female patients are about three times more likely to report a history of CSA compared to male patients when controlling for other factors. Similarly patients with at most high school education (OR = 1.8, CI = 1.145–2.871) and those with previous contact with psychiatric services (OR = 1.7, CI = 1.124–2.616) were about two times more likely to report a history of CSA compared to the patients with college/university education or those with no previous contact with psychiatric services respectively. Similarly, patients with histories of substance abuse (OR = 1.5, CI = 1.179–2.642) and patients with family histories of mental illness (OR = 1.8, CI = 1.032–2.308) had higher likelihoods of reporting histories of CSA compared to patients without histories of substance abuse or family histories of mental illness respectively. Our findings suggest that victims of CSA are an at-risk population in need of ongoing mental health and educational support.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patterns of HIV Testing in Scotland: A General Practitioner Perspective

1997 ◽  
Vol 42 (4) ◽  
pp. 108-110 ◽  
Author(s):  
J.D.C. Ross ◽  
D.J. Goldberg
Keyword(s):  
General Practitioner ◽  
Hiv Testing ◽  
General Practitioners ◽  
Temporal Trends ◽  
Low Risk ◽  
Drug Misuse ◽  
Hiv Counselling And Testing ◽  
History Of ◽  
Independent Association ◽  
Risk Sexual Behaviour

General practitioners are one ofthe largest groups who offer HIV testing but little is known about the patient group who present for HIV counselling and testing in primary care. This study describes the risk factors, positivity rate, temporal trends and demographic profile of patients presenting to their general practitioner for HIV testing in central Scotland. Of 8,466 tests taken 1% (84) were positive with an independent association between a positive result andage group, history of drug misuse, homosexuality andregion of testing. The majority of tests were performed in those who were at low risk and because ofpatient concern about HIV. No increase in the number of positive tests was apparent over the five-year study period. Variations between GP testingfor HIV occurs in different regions and may reflect the underlying HIV positivity rate. General practitioners performing HIV tests are well placed to educate their patients about HIV and encourage low risk sexual behaviour patterns.

scholarly journals Medical records: Doctors' and patients' experiences of copying letters to patients

2004 ◽  
Vol 28 (2) ◽  
pp. 40-42 ◽  
Author(s):  
Harpal Nandhra ◽  
Graham Murray ◽  
Nigel Hymas ◽  
Neil Hunt
Keyword(s):  
General Practitioner ◽  
Pilot Study ◽  
General Practitioners ◽  
Medical Records ◽  
Letter Writing ◽  
Initial Assessment ◽  
Clinical Implications ◽  
Usual Practice ◽  
To Receive ◽  
Writing Practice

Aims and MethodWe conducted a pilot study to determine patients' views on receiving a copy of the assessment letter sent to their general practitioner and to determine how psychiatrists' letter writing practice would be altered in the knowledge that patients would receive copies of such letters. Seventy-six consecutive new outpatients received copies of the initial assessment letter sent to general practitioners. Patients were asked to complete a short questionnaire on how the practice affected them. For each letter, psychiatrists were asked to provide details of anything of importance that had been omitted from the letter that in their normal practice they would have included.ResultsThere was a broad range of responses on how patients felt about the letters. Only two patients found the letters unhelpful, and 83% expressed a positive desire to continue receiving letters, even though initially 18% found the letter distressing. For 56 out of 76 patients, psychiatrists stated that they composed and sent out the letter to the GP in accordance with their usual practice and copied the letter to the patient in an unaltered form. For 17 patients, the psychiatrist stated that some information he/she would usually have included in the GP letter was omitted in the copy the patient received. In a further 3 cases, the psychiatrist sent no letter to the patient.Clinical ImplicationsPatients found it helpful to receive copies of their assessment letters. Psychiatrists might require training and reassurance about this policy before implementation.

scholarly journals Mind the gap – using clinical audit to minimise medication information errors at hospital discharge

2010 ◽  
Vol 34 (6) ◽  
pp. 248-250
Author(s):  
Ashok Kumar Jainer ◽  
Fabida Noushad ◽  
Tim Coupe ◽  
Chaya Rekha Mupiri ◽  
Anoop Saraf
Keyword(s):  
General Practitioner ◽  
Health Risks ◽  
Clinical Audit ◽  
Discharge Summary ◽  
Clinical Implications ◽  
Medication Information ◽  
Retrospective Audit ◽  
Information Errors ◽  
Patient Confidence ◽  
Discharge Summaries

Aims and methodWe conducted a retrospective audit of 100 discharge summaries to evaluate the accuracy of medication recording and the recording of as required (PRN) prescribing, and to see whether or not general practitioners were advised on how long to continue the latter. After a formal guideline was introduced we conducted a re-audit.ResultsThere was an improvement in summaries recording medication correctly (from 64 to 83%). The number of summaries with one or more missing medications halved and PRN sedative prescribing reduced from 18 to 3%, but provision of advice on the latter did not improve.Clinical implicationsAccurate recording of medication in the discharge summary is an important element of the transfer of patient care to the general practitioner. Medication errors may pose serious health risks and undermine patient confidence in the service. The clinical audit and interventions implemented helped to reduce errors in medication recording in discharge summaries.

Risk factors for asthma attacks and poor control in children: a prospective observational study in UK primary care

2021 ◽  
pp. archdischild-2020-320110
Author(s):  
David Lo ◽  
Caroline Beardsmore ◽  
Damian Roland ◽  
Matthew Richardson ◽  
Yaling Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Asthma Control ◽  
Symptom Control ◽  
Asian Ethnicity ◽  
Increased Risk ◽  
Children With Asthma ◽  
History Of ◽  
Observational Cohort ◽  
General Practices

ObjectiveTo identify risk factors for asthma attacks and poor asthma control in children aged 5–16 years.MethodsProspective observational cohort study of 460 children with asthma or suspected asthma from 10 UK general practices.Gender, age, ethnicity, body mass index, practice deprivation decile, spirometry and fraction of exhaled nitric oxide (FeNO) were recorded at baseline. Asthma control scores, asthma medication ratio (AMR) and the number of asthma attacks were recorded at baseline and at 6 months.The above independent variables were included in binary multiple logistic regression analyses for the dependent variables of: (1) poor symptom control and (2) asthma attacks during follow-up.ResultsPoor symptom control at baseline predicted poor symptom control at 6 months (OR 4.4, p=0.001), while an increase in deprivation decile (less deprived) was negatively associated with poor symptom control at 6 months (OR 0.79, p=0.003). Higher FeNO levels (OR 1.02, p<0.001) and a recent history of asthma attacks (OR 2.03, p=0.02) predicted asthma attacks during follow-up. Asian ethnicity was associated with a lower OR for a future attack (OR 0.32, p=0.02).A decrease in AMR was also associated with an increased OR for future asthma attacks (OR 2.99, p=0.003) when included as an independent variable.ConclusionsWe identified risk factors for poor symptom control and asthma attacks in children. Routine assessment of these factors should form part of the asthma review to identify children at an increased risk of adverse asthma-related events.

scholarly journals What's in a name? Views on psychiatric services for older people

2006 ◽  
Vol 30 (3) ◽  
pp. 97-100
Author(s):  
Fionnuala Kelly ◽  
Julianne Reidy ◽  
Gregory Swanwick
Keyword(s):  
Older People ◽  
Old Age ◽  
General Practitioners ◽  
Psychiatric Service ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
Clinical Use ◽  
Age Related ◽  
Hospital Doctors ◽  
Over Time

Aims and MethodThe aim of this study was to provide a name for a psychiatric service for older people in Dublin. A total of 296 individuals (167 doctors, 129 workshop attendees) were surveyed regarding their views on a name for the service.Results‘Age-related psychiatry’ was a universally popular term. It was chosen by 43% of general practitioners, 56% of hospital doctors and 44% of the workshop attendees, as one of their top three choices. ‘Psychiatry of old age’, ‘geriatric psychiatry’ and ‘psychogeriatrics' were unpopular with all three groups.Clinical ImplicationsNames can gradually become stigmatising over time. This applies to the terms for ‘old’ and ‘psychiatry’. In this survey all groups surveyed rejected some of the terms in widespread clinical use.

The Impact of a Clinical Audit on GP Detection of Depression

2003 ◽  
Vol 9 (1) ◽  
pp. 88
Author(s):  
Patrick G. Bolton ◽  
Sharon M. Parker ◽  
Kylie J. Fergusson ◽  
Jannifer D. Orman
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Rating Scale ◽  
Treatment Guidelines ◽  
Clinical Audit ◽  
Depression Scale ◽  
Self Report ◽  
Comprehensive Treatment ◽  
The Impact ◽  
Educational Workshop

Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.

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