Undergraduate psychiatry students' attitudes towards teaching methods at an Irish university.

BACKGROUND: At University College Dublin, teaching in psychiatry includes clinical electives, lectures, small-group and problem-based teaching, consistent with international trends. AIMS: To determine final-year psychiatry students' attitudes towards teaching methods. METHODS: We distributed questionnaires to all final-year medical students in two classes (2008 and 2009), after final psychiatry examination (before results) and all of them participated (n = 111). RESULTS: Students' interest in psychiatry as a career increased during psychiatry teaching. Students rated objective structured clinical examination (OSCE) as the most useful element of teaching and examination. The most common learning style was "reflector"; the least common was "pragmatist". Two thirds believed teaching could be improved (increased patient contact) and 89 % reported that experience of psychiatry changed attitudes towards mental illness (increased understanding). CONCLUSIONS: Students' preference for OSCEs may reflect the closeness of OSCE as a form of learning to OSCE as a form of assessment: OSCEs both focus on specific clinical skills and help prepare for examinations. Future research could usefully examine the extent to which these findings are university-specific or instructor-dependent. Information on the consistency of various teaching, examination and modularisation methods would also be useful.

Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4).

BACKGROUND: Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Identification of clinical subtypes can allow for more targeted clinical and research efforts. We sought to develop a brief method for clinical subtyping in clinical and research settings. METHODS: A multi-site database, including motor symptom assessments conducted in 487 patients from palliative care, adult and old age consultation-liaison psychiatry services was used to document motor activity disturbances as per the Delirium Motor Checklist (DMC). Latent class analysis (LCA) was used to identify the class structure underpinning DMC data and also items for a brief subtyping scale. The concordance of the abbreviated scale was then compared with the original Delirium Motor Subtype Scale (DMSS) in 375 patients having delirium as per the American Psychiatric Association's Diagnostic and Statistical Manual (4th edition) criteria. RESULTS: Latent class analysis identified four classes that corresponded closely with the four recognized motor subtypes of delirium. Further, LCA of items (n = 15) that loaded >60% to the model identified four features that reliably identified the classes/subtypes, and these were combined as a brief motor subtyping scale (DMSS-4). There was good concordance for subtype attribution between the original DMSS and the DMSS-4 (κ = 0.63). CONCLUSIONS: The DMSS-4 allows for rapid assessment of clinical subtypes in delirium and has high concordance with the longer and well-validated DMSS. More consistent clinical subtyping in delirium can facilitate better delirium management and more focused research effort.

The role of a neuropsychiatry clinic in a tertiary referral teaching hospital: a 2-year study.

OBJECTIVES: Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided. METHODS: We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82). RESULTS: The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson's disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history. CONCLUSION: Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.

Attitudes and experiences of nursing staff to the Mental Health Act 2001: lessons for future mental health legislation.

OBJECTIVES: The Mental Health Act 2001 was implemented in 2006 to bring Ireland into line with international practice and United Nations Conventions on Human Rights. Previous studies have reported some practical difficulties for the professionals involved. We wished to examine the experiences of nursing staff and the impact of the Act on clinical nursing practice since its implementation. METHOD: This cross-sectional survey was conducted by questionnaire. It contained questions examining training in and attitudes to the Act, and any resultant changes in nursing practise. RESULTS: A total of 317 questionnaires were returned. Of the nurses, 92% reported having received training in the Act, and 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative, with increased paper work, lack of clarity and an excessive focus on legalities being the most common difficulties reported. CONCLUSIONS: Nursing staff have shown mixed attitudes to the Mental Health Act 2001, but many of the difficulties encountered are similar to those experienced by other professionals.

The digital age: is this the future of medical education? A cross-sectional study to assess medical students' opinions about e-learning in psychiatry undergraduate medical education.

OBJECTIVES: The main objectives were to assess medical students' opinions about e-learning in psychiatry undergraduate medical education, and to investigate a possible relationship between learning styles and preferences for learning modalities. METHOD: During the academic year 2009/2010, all 231 senior Royal College of Surgeons in Ireland (RCSI) medical students in their penultimate year of study were invited to answer a questionnaire that was posted online on Moodle, the RCSI virtual learning environment. RESULTS: In all, 186 students responded to the questionnaire, a response rate of 80%. Significantly more students stated a preference for live psychiatry tutorials over e-learning lectures. Students considered flexible learning, having the option of viewing material again and the ability to learn at one's own pace with e-learning lectures, to be more valuable than having faster and easier information retrieval. CONCLUSION: Students prefer traditional in-class studying, even when they are offered a rich e-learning environment. Understanding students' learning styles has been identified as an important element for e-learning development, delivery and instruction, which can lead to improved student performance.

Implementing the Mental Health Act 2001 in Ireland: views of Irish general practitioners.

OBJECTIVES: The Mental Health Act 2001 introduced important reforms of Irish mental health law and services. This paper aims to provide an evidence-based exploration of general practitioners' views on the implementation of the Mental Health Act 2001. METHODS: We posted questionnaires to 1200 general practitioners in Ireland seeking their views on their experiences with the Mental Health Act 2001. RESULTS: Eight hundred and twenty general practitioners (68.3%) responded. Among those who provided comments, a majority (75.2%) provided negative comments. The most commonly occurring themes related to difficulties with transport of patients to inpatient facilities, form filling, time requirements and administrative matters. Other negative comments related to general practitioner recommendations for involuntary admission, training, mental health tribunals, applications for involuntary admission and the position of children. Minorities provided neutral (18.0%) or positive comments (6.8%), chiefly related to user-friendliness, transparency and improved communication. CONCLUSIONS: General practitioners highlight a need for greater training and clear guidelines in relation to the Mental Health Act 2001. Their forthright responses demonstrate deep engagement with the new legislation and eagerness to see the Mental Health Act 2001 realise its full potential to improve the involuntary admission process and protect human rights, in the best interests of patients.

Clozapine-induced late leukopenia.

A patient with a 28-year history of schizophrenia was treated with a wide range of antipsychotic medications since diagnosis. She had experienced no clinically significant symptomatic relief until she commenced treatment on clozapine. Her psychotic symptoms, self care, and general sense of well-being improved significantly. After 6 years of successful treatment, she developed leukopenia and clozapine was discontinued. The following issues will be discussed in the article: rechallenge with clozapine following leukopenia during previous therapy and the choice of and haematological monitoring needs with other antipsychotic medications after clozapine-induced blood dyscrasia.

What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.

AIM: This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction. METHODS: Patients attending the Mater Misericordiae University Hospital psychiatric outpatient clinics over a 13-week period, and the Mater Misericordiae University Hospital clozapine clinic over a 4-week period and were invited to complete the Barker Scale of Patients' Views Towards Care Received From Psychiatrists. RESULTS: One-hundred and ninety-two patients were invited to participate and there was a response rate of 94%. Eighty-six percent of respondents were satisfied with their care; 92% stated psychiatrists were caring towards them; 85% that psychiatrists know what they are doing; 84% that their illness was explained by their psychiatrist; and 65% that psychiatric care is improving; but 65% stated that psychiatric services are still not good enough. Eighty-six percent were, or had been, in receipt of a psychological treatment. On multi-variable analysis, satisfaction was associated with the view that doctors explained treatment clearly, the view that doctors do not rely excessively on medication, and having been visited by a community mental health nurse. CONCLUSION: Patients attending psychiatry outpatient services reported a high degree of satisfaction with the treatment they were receiving, although there were discrepancies between satisfaction with their own specific service and with psychiatric services in general.

National survey of psychiatrists' responses to implementation of the Mental Health Act 2001 in Ireland.

BACKGROUND: Ireland's Mental Health Act 2001 resulted in substantial changes to mental health services and the process of involuntary admission. AIMS: To determine the views of Irish psychiatrists regarding the new legislation, 1 year after full implementation. METHODS: We sent questionnaires to all 735 members of the Royal College of Psychiatrists in Ireland. RESULTS: The response rate was 43.7%. As much as 84% of respondents reported satisfaction with training; 69.1% reported increased workloads; 26.8% reported decreased time with service-users; 40.7% reported changes in relationships with service-users (e.g. increased empathy, but more legalistic, conflicted relationships). Almost one in three (27.4%) stated that it was not feasible to implement the Mental Health Act. Negative comments highlighted the adversarial nature of mental health tribunals, effects on therapeutic relationships and issues related to children. CONCLUSIONS: The implementation of the Mental Health Act 2001 has resulted in increased workloads, more conflicted relationships with service-users and adversarial mental health tribunals.

Tamponade-balloon for obstetrical bleeding.

OBJECTIVES: To study the effectiveness of a large volume, fluid-filled tamponade balloon in the management of post-partum hemorrhage originating from the implantation site of low-lying placenta/placenta previa. METHODS: A silicone, fluid-filled balloon was designed for tamponade function, with a filling capacity volume of 500 cc of sterile saline, and strength to withstand a maximum internal and external pressure of 300 mmHg. Five women with postpartum bleeding caused by low-lying placenta/placenta previa, and one woman with cervical ectopic pregnancy, underwent a tamponade balloon insertion as a conservative measure in the management of bleeding. RESULTS: The tamponade balloon was used in five women with post-partum bleeding caused by low-lying placenta/placenta previa, and in one woman with cervical pregnancy. The balloon was effective in controlling post-partum hemorrhage originating from the placental site of the lower uterine segment, and bleeding from the implantation site of cervical ectopic pregnancy. CONCLUSION: Hemostasis in cases of post-partum bleeding caused by low-lying placenta/placenta previa can be achieved by using a large volume, fluid-filled tamponade balloon.

Genetic compounds--Hb S, thalassaemias and enzymopathies: spectrum of interactions.

In areas with high occurrence of the red cell genetic abnormalities, i.e. sickle cell gene, alpha- and beta-thalassaemias, and glucose-6-phosphate dehydrogenase deficiency, various genes frequently co-exist in the same population. Co-inheritance of two or more abnormal genes in the same individual is frequently encountered, particularly in certain 'closed' tribes in Arabia in which consanguinity is the norm. Such genetic interactions modify the clinical presentations of the disease state. During our studies, we encountered a large number of individuals who were carriers of two or more abnormal genes. The most frequent genetic compounds were double heterozygous HbS-beta zero-thalassaemia and HbS-beta(+)-thalassaemia with associated alpha-thalassaemia or G-6-PD deficiency. Clinical history, and assessment, as well as blood analysis for haematological, biochemical, and molecular pathology determinants were carried out. The patients were classified into subgroups, based on the genetic findings. The clinical, haematological and biochemical data were assessed separately for each group. Sickle cell anaemia (Hb SS) cases, without any other abnormal gene, were used as a reference group. The results showed severe anaemia in patients with HbS/beta zero-thalassaemia and associated alpha-thalassaemia and/or G-6-PD deficiency. Patients with HbS/beta zero-thalassaemia exhibited features similar to that of the sickle cell anaemia. While sickle cell anaemia patients with alpha-thalassaemia and G-6-PD deficiency exhibited a milder presentation. This paper presents various forms of genetic associations, their influence on the clinical presentation and the laboratory parameter data, and discusses the implications of the findings.

Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure.

Between January 1980 and December 1990, 75 (57.3%) of 131 patients with metastatic gestational trophoblastic tumor had pulmonary metastases detected on plain chest roentgenography at the King Faisal Specialist Hospital and Research Centre. Pulmonary involvement was commonly extensive, with 32 (42.7%) patients having > 10 pulmonary metastases and 45 (60%) patients having a pulmonary lesion > 5 cm in diameter. Greater than 50% lung opacification, mediastinal involvement and pleural effusion were present in 25 (33.3%), 25 (33.3%) and 36 (48%) patients, respectively. Eight (10.7%) patients developed early respiratory failure requiring mechanical ventilation within one month of presentation. The development of early respiratory failure was significantly associated with the presence of dyspnea, anemia, clinical pulmonary hypertension, cyanosis, > 50% lung opacification, mediastinal involvement and bilateral pleural effusion. Because all patients requiring mechanical ventilation died, the use of extracorporeal perfusion should be considered in patients with early respiratory failure.

Brain metastases of gestational trophoblastic tumor.

Brain involvement by gestational trophoblastic tumor (GTT) was diagnosed by computed tomography in 23 (17%) of 131 patients with metastatic GTT at King Faisal Specialist Hospital and Research Centre between January 1980 and December 1990. All 23 patients had concurrent lung involvement, and 20 presented with neurologic symptoms. There were three treatment groups: Group A--methotrexate, actinomycin-D, chlorambucil and brain irradiation; group B--cisplatin, VP-16, actinomycin-D and intrathecal methotrexate; and group C--palliative therapy and other chemotherapy. While no patients in groups A or C survived, 4 (57%) of 7 patients in group B achieved complete, sustained remission. Serum:cerebrospinal fluid beta-human chorionic gonadotropin ratios were measured in 9 patients and were < 60 in only 4 patients. The clinical features of patients with brain metastases are reviewed in detail.

Effect of different types of finishing lines and etching methods of the enamel and dentin on the marginal integrity of Hi-ceram crowns.

Porcelain is one of the oldest materials used in the dental field. It has the advantages of perfect shade reproduction, chemical and abrasion resistance and biologic compatibility to the oral tissue. The only drawback of dental compatibility to the oral tissue. The only drawback of dental porcelain is the occurrence of brittle fracture. Minute cracks formed on the outer surface of the porcelain crown are the cause of the fracture. These cracks are formed during cooling of the ceramic as a result of low thermal conductivity of the porcelain. Differential dimensional changes of the outside and the internal surface take place inducing the cracks. Tensile stresses on the internal surface of the porcelain lead to cracks propagation and fracture.

Liver metastases of gestational trophoblastic tumor.

A retrospective study was conducted to determine if a chemotherapy regimen incorporating cis-platinum, etoposide, and actinomycin D (PEA) was associated with an outcome different from that of the standard triple regimen of methotrexate, actinomycin D, and chlorambucil (MAC) in patients with gestational trophoblastic tumor and liver metastases. Subjects were treated at the King Faisal Specialist Hospital Gestational Trophoblastic Center (KFSH-GTC) between January 1980 and December 1990. Of 19 patients with gestational trophoblastic tumor and liver metastases, 6 received MAC chemotherapy, and 8 received PEA. Five patients were terminally ill and received palliative treatment only. Treatment outcome was measured by beta-subunit human chorionic gonadotropin assay (beta-HCG) and by imaging studies which included ultrasound, computerized axial tomography, and/or magnetic resonance imaging. Durable remission was obtained in 5 of 8 (62.5%) PEA-treated patients and none of 6 MAC-treated patients. There was no difference in risk status or World Health Organization (WHO) prognostic score between the two groups. We conclude that PEA is a relatively effective chemotherapy regimen in the treatment of gestational trophoblastic tumor with liver metastases, and it may be worthy of consideration for prospective clinical trials.

Nd: YAG pulsed laser: a successful tool to desensitize hypersensitive prepared abutment teeth in fixed prosthodontics.

Dentinal hypersensitivity follows several therapeutic dental procedures as well as occurring de novo. Pain being an unpleasant sensation, originates from dentine which has a rich supply of myelinated nerve ending. There are several theories that explain the mechanism of pain of dentinal origin. Thermal, tactile and chemical stimuli when applied to affected teeth might result in brief mild discomfort to prolonged severe pain. There are several theories regarding dentinal hypersensitivity.

Evaluation of a new glass ionomer cement "visible light cured" as a core buildup under a cast restoration.

Proper restoration of endodontically treated teeth is a frequent challenge to many clinicians. The majority of restorations are using various types of vertical support that can be placed in teeth, these include different prefabricated post systems as well as cast posts and cores. Less emphasis, unfortunately, has been placed on the materials utilized for final build up. Unless the tooth being treated undergoes minimal loss of tooth structure some from of augmentation will be necessary to increase the tooth strength and provide adequate support and retention for the final cast restoration. It is generally accepted that the ideal methods of corono-radicular buildup for nonvital teeth is a properly fabricated cast post and core.

Immunosuppression by human seminal plasma fractionated by DEAE Sephadex A-50 ion exchange chromatography.

We fractionated the whole human seminal plasma on DEAE Sephadex A-50 ion exchange columns. Complete separation was achieved in seven peaks using different salt concentrations in phosphate buffer pH 6. The seminal plasma proteins were separated by sodium dodecyl-sulphate polyacrylamide gel electrophoresis. Human seminal plasma (SP) and its fractions were used in mixed lymphocyte reaction in vitro. Fractions 3, 4, and 7 were found to suppress the proliferation of human peripheral blood mononuclear cells to phytohemagglutinin and pokweed mitogen at a concentration of 10 micrograms ml-1 while stimulatory effect was observed at lower concentrations (1 microgram and 2.5 micrograms ml-1). Whole human SP and other fractions failed to suppress the proliferation of lymphocytes in vitro. Furthermore, the effect of human SP and its fractions was also investigated on phagocytic function of polymorphonuclear leukocytes (PMNs) using luminol dependent chemiluminescence assay stimulated with phorbol myristate acetate and opsonized yeast. Fractionated SP was found to have a suppressive effect on the luminol-dependent chemiluminescence of PMNs in the whole blood.

Prediction of successful embryo implantation by measuring interleukin-1-alpha and immunosuppressive factor(s) in preimplantation embryo culture fluid.

To find a better predictor of pregnancy after in vitro fertilization (IVF), supernatant fluids from embryo culture media were analyzed after 24 hours and 48 hours for the presence of interleukin-1-alpha (IL-1), interleukin-2, and the percent of immunosuppression. The measurements were performed on 108 consecutive IVF cycles between June 1989 and October 1989. The IL-1 level +/- SD in the 24-hour aliquots of the supernatant of embryo culture fluid was 66.2 +/- 10.2 pg/mL in all viable pregnancy cycles and 35.4 +/- 9.01 pg/mL in unsuccessful cycles. The percent of immunosuppression after 24 hours was 22.06% +/- 4.5% in viable pregnancy cycles and 7.3 +/- 5.5% in unsuccessful cycles. The percent of immunosuppression 48 hours after ovum pick-up was generally decreased in all embryo culture fluid, showing 17.5% +/- 4.4% in viable pregnancy cycles and 3.8% +/- 3.6% in unsuccessful cycles. Interleukin-1 levels in the 48-hour aliquots were moderately decreased, being 39.0 +/- 6.3 pg/mL in viable pregnancy cycles and 34.3 +/- 4.7 pg/mL in the unsuccessful cycles. In 24 hours, embryo culture aliquots IL-1 level greater than 60 pg/mL was seen in 17 of 21 (80.9%) pregnancy cycles, and the combined data of IL-1 level greater than 60 pg/mL and/or greater than 20 percent of immunosuppression predicted 21 of 21 (100%) pregnancy cycles.