ABSTRACT
AIM: To assess the validity of an online referral guide for melanocytic fund us lesions available to optometrists. METHODS: A prospective inter-observer agreement assessment of a novel grading system for melanocytic fundus lesions using digital images from the Liverpool Ocular Oncology Centre. RESULTS: The study was completed by 94.5% (52/55) of optometrists recruited. A total of 2594 valid grading scores were obtained for 400 different melanocytic lesions which were assigned to three management categories (monitor, routine referral or urgent referral). The linear weighted kappa value between the optometrists and the ocular oncologist was 0.66 (95% CI 0.64-0.68). Optometrist inter-observer agreement was 0.62 (95%CI 0.57-0.67). CONCLUSIONS: This online referral guide for melanocytic lesions shows substantial agreement between optometrists and a gold standard opinion. It is easily accessible and could be helpful to community optometrists managing patients with a melanocytic fundus lesion.
Subject(s)
Fundus Oculi , Nevus, Pigmented/diagnosis , Optometry/standards , Referral and Consultation/standards , Retinal Neoplasms/diagnosis , Adult , Female , Humans , Male , Middle Aged , Observer Variation , Pilot Projects , Prospective Studies , Reproducibility of Results , Young AdultABSTRACT
OBJECTIVE: To summarize the current state of knowledge on the use of seclusion and restraint with children and adolescents and to report the findings of an exploratory study to identify factors that place a child or adolescent at increased risk of seclusion during their admission. METHOD: Literature searches were undertaken on MEDLINE, CINAHL and PsycINFO databases. Articles were identified that focused specifically on seclusion and restraint use with children and adolescents or contained material significant to this population. The study reports findings from a retrospective review of patient charts, seclusion registers and staffing from an Australian acute inpatient facility. RESULTS: The data available in regard to seclusion use in this population is limited and flawed. Further research is needed on the use and outcomes of seclusion and restraint and on alternative measures in the containment of dangerousness. Both the literature and this study find that patients with certain factors are at increased risk of being secluded during an inpatient stay. These factors include being male, diagnoses of disruptive behaviour disorder and a previous history of physical abuse. Staffing factors did not show a relationship to the use of seclusion. CONCLUSIONS: There are patient factors that predict increased risk of seclusion; these factors and their interrelationships require further elucidation. Further research is also needed on the outcomes, both positive and negative, of seclusion use and of alternatives to seclusion.
Subject(s)
Mental Disorders/epidemiology , Patient Isolation/statistics & numerical data , Restraint, Physical/statistics & numerical data , Adolescent , Age Factors , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit and Disruptive Behavior Disorders/therapy , Child , Child Abuse/diagnosis , Child Abuse/statistics & numerical data , Child, Preschool , Comorbidity , Female , Humans , Logistic Models , Male , Mental Disorders/diagnosis , Mental Disorders/therapy , Psychiatric Department, Hospital , Queensland , Retrospective Studies , Risk , Sex Factors , Utilization Review/statistics & numerical dataABSTRACT
OBJECTIVE: To review the origins, processes, clientele and outcomes of a child and youth interagency forum, a collaborative response to children and youth with severe and complex presentations. METHODS: After a description of the Forum origins, membership and processes, both qualitative and quantitative information is provided on the Forum clientele. The Forum's effectiveness is considered in terms of changes in services provided to this group, as well as changes in agency and interagency work practices. RESULTS: Forum clients were predominantly boys aged 12 years, with an overrepresentation of indigenous and intellectually disabled children. Few lived with biological parents, and on average had experienced five schools, 11 or more residential placements and were involved with six agencies. Disruptive behaviour symptoms were common, as were suicidal thoughts or actions (43%), history of physical (50%) or sexual abuse (21%), alcohol (29%) and drug use (14%). On average Forum clients were taking three psychotropic medications. Forum client impairment ranged from major impairment to gross impairment across several domains. CONCLUSIONS: While this is not a formal outcome study, evidence suggesting Forum usefulness included qualitative feedback from agencies, altered clinical and interagency practices, and decreased client impairment. Practical interventions for clients with chronic, complex multidomain impairments are discussed in the context of current Australian child and adolescent mental health services.
