Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities.

Background: Human decision-making involves a complex interplay of intra- and inter-personal factors. The decisions clinicians make in practise are subject to a wide range of influences. Admission to a psychiatric hospital is a major clinical intervention, but the decision-making processes involved in admissions remain unclear. Aims: To delineate the range of factors influencing clinicians' decisions to arrange acute psychiatric admissions. Methods: We undertook six focus groups with teams centrally involved in decisions to admit patients to hospital (crisis resolution home treatment, liaison psychiatry, approved mental health practitioners and consultant psychiatrists). The data were analysed using qualitative thematic analysis. Results: Our analysis of the data show a complex range of factors influencing decision-making that were categorised as those related to: (i) clinical and risk factors; (ii) fear/threat factors; (iii) interpersonal dynamics; (iv) contextual factors. Conclusions: Decisions to arrange acute admission to hospital are not just based on an appraisal of clinical and risk-related information. Emotional, interpersonal and contextual factors are also critical in decision-making. Delineating the breadth of factors that bear on clinical decision-making can inform approaches to (i) clinical decision-making research, (ii) the training and supervision of clinicians, and (iii) service delivery models.

Production of a calibrant certified reference material for determination of the estrogenic mycotoxin zearalenone.

Several previous interlaboratory studies in the field of mycotoxin analysis have revealed considerable problems, apparent as high between-laboratory standard deviations, or rather non-comparable and non-traceable results. A major reason is lack of proper calibrants for external calibration. Public awareness of substances that mimic or interfere with the activity of natural hormones (endocrine disrupters) has led to increased interest in mycotoxins with estrogenic potential, e.g. zearalenone (ZON). During a large-scale standard measurement and testing (SMT) project of the European Commission (EC) dealing with the preparation and certification of reference materials for determination of the mycotoxin ZON in maize, a ZON calibrant in acetonitrile was prepared and intensively checked for purity, homogeneity, and stability. Preparation of the material, study of its homogeneity and stability, and characterisation of the calibrant on the basis of its preparation, with discussion of the results obtained, are described in this paper. The certified value of 9.95 micro g mL(-1) for ZON in acetonitrile and its corresponding expanded uncertainty of +/-0.30 micro g mL(-1) were calculated in compliance with the Guide to the Expression of Uncertainty in Measurement (GUM).

Preparation of a calibrant as certified reference material for determination of the Fusarium mycotoxin zearalenone.

In the field of mycotoxin analysis, substantial problems shown by high between-laboratory standard deviations and noncomparable and nontraceable results have been caused by the lack of proper calibrants for external calibration. During a large-scale Standard Measurement and Testing project of the European Commission (EC) dealing with preparation and certification of reference materials for determination of the mycotoxin zearalenone (ZON) in maize, a ZON calibrant in acetonitrile was prepared and checked for purity, homogeneity, and stability. Before certification, on the basis of preparation, the calibrant was checked in a mini-interlaboratory study by UV spectrophotometric determination. The molar absorptivities of ZON in acetonitrile at 236, 274, and 314 nm were established, and as a main result, a common reference wavelength of 274 nm with molar absorptivity of 12623 +/- 111 L/mol x cm can be recommended for ZON in acetonitrile. A concentration and expanded uncertainty of the ZON calibrant of 9.95 +/- 0.08 microg/mL was calculated as a preliminary value before final evaluation through the certification panel of the EC.