The effectiveness of dental postgraduate courses--are we doing the right thing?

OBJECTIVE: To evaluate the effectiveness of dental postgraduate one-day courses in radiation protection in Wales. DESIGN: Analysis of dentists' performance pre- and immediately post-course training. SUBJECTS AND METHODS: Two hundred and eighty-five general dental practitioners took part in eight courses. Identical, validated multiple choice questionnaires were completed anonymously at the start and at the end of each course. Fifty (+62.5%) or above was regarded as a satisfactory standard. Two hundred and fifty-three (89%) paired morning-afternoon records were completed and analysed. Data was compared to that of similar courses five years earlier. RESULTS: The mean (SD) pre- and post-course percentage scores were 33.8 (13.5) and 63.6 (14.6). The mean improvement was 29.8 percentage points (SD 11.7). The pre-post correlation was +0.66. At baseline only six (2.4%) of the 253 practitioners achieved the preset standard. After the course, 146 (57.7%) did so, an improvement of 55.3% (95% CI 48.9-61.3%). The final score and score gain were slightly higher in more recent graduates. The increase in proportion attaining the standard following training was 11.9% higher for IRMER than for POPUMET (p <0.001). CONCLUSION: The level of knowledge in radiation protection was very low at baseline. Whilst attending the approved course led to considerable improvement, it did not invariably result in a satisfactory level of knowledge in fundamental radiation physics and regulations. The prescribed standard was achieved by less than 60% of the attendees. The IRMER course was significantly more effective than its POPUMET predecessor.

A 10-year review of the occurrence and treatment of central giant cell granulomas, in a District General Hospital.

BACKGROUND: There is considerable variation in the clinical presentation, behaviour and radiological appearance of central giant cell granulomas (CGCGs), for which multiple treatment modalities have been suggested. METHOD: A 10-year retrospective review of the clinical presentation, radiological features and treatment received was undertaken. RESULTS: The cohort of patients included six males and three females, with an age range of 7-61 years. Six lesions were in the mandible and three in the maxilla. Eight lesions presented with swelling, three in relation to teeth. One case was an incidental finding. Six cases were confined within the cortical plates, one involved soft tissue. Radiological presentation was diverse, but within the existing confines of CGCGs. With one exception, primary treatment was surgical resection with excisional curettage of the remaining bone; to date, none have recurred. CONCLUSION: Diagnosis relies on correct interpretation of clinical, radiographical and histopathological data. Alternative treatments are worthy of consideration, although surgical excision remains the treatment of choice.

Outcome of hospitalised anorexics and bulimics in Cape Town, 1979-1989. A retrospective study.

In a retrospective study of 73 girls and women treated in a psychiatric inpatient unit in Cape Town between 1979 and 1989, follow-up data were available for 49 (67%) of them. Internationally recommended measures were used to obtain further data, where possible, from 17 subjects (14 with anorexia, 3 with bulimia) who were 4 and more years post-hospitalisation, as well as 19 subjects (9 with anorexia, 10 bulimia) who had been out of hospital less than 4 years. Indirect information was available from 13 subjects. With regard to long-term outcome, 15 of the 17 subjects fell into the Morgan-Russell categories 'good' or 'intermediate'; in the short-term follow-up group, 14 of the 19 fell into these categories. Indirectly, we also discovered that 3 of the original subjects had died, 4 had remained ill, and 6 had recovered. These findings were similar to those from a previous study from this department and are useful feedback on the comprehensive treatment programme. They also throw light on what appears to be a culture-bound syndrome; at the time of study, the eating disorder affected mainly the middle-class white population, a pattern similar to that found elsewhere in the world.

The therapeutic sterilisation of the mentally handicapped. Experience with the Abortion and Sterilisation Act of 1975.

The Abortion and Sterilisation Act of 1975 gives legal sanction for the sterilisation of persons with a mental handicap, and by 1989, 1,817 such persons had been sterilised in South Africa. In this paper, we review our experience in investigating all 291 persons who were referred to the Pregnancy Advisory Service of Groote Schuur Hospital for this purpose. Referrals included 37 white, 233 coloured and 21 black patients. One hundred and eight (37.1%) were severely retarded, 104 (35.7%) were moderately retarded, 70 (24%) were mildly retarded and 9 (3.2%) were not testable. None could give informed consent and the applications for sterilisation came from burdened families of whom one-third were already caring for illegitimate children born to these mentally handicapped women. Of the 291 applications, 231 (79%) were recommended for sterilisation. The main issues involved in making a decision to sterilise mentally retarded individuals are the valid assessment of the degree of retardation, the availability of alternative means of fertility control, and the complex ethical factors that have to be considered with regard to the sterilisation of persons with a mental handicap.

South African psychiatrists' attitudes to the present implementation of the Abortion and Sterilisation Act of 1975.

In 1980 and 1990 reports were published in the SAMJ on the attitudes of South African gynaecologists to the present Abortion and Sterilisation Act of 1975. The proportion of respondents favouring abortion on demand in the first trimester rose from 32% to 40% over this period, while that of respondents requesting a review of the Act increased from 71% to 85%. The Society of Psychiatrists of South Africa decided to conduct a similar survey of its members using the same questionnaire with some additional questions on current psychiatric practice. Of the 50% of psychiatrists who responded, 78% were personally involved in the implementation of the Act. Some 51% of psychiatrists supported termination on request before the 12th week of pregnancy, an equal number felt that the role of psychiatrists in the implementation of the Act should be reduced, and 89% considered that the present Abortion and Sterilisation Act requires review. Thus, many psychiatrists and gynaecologists are seeking a revision of existing legislation on the medical termination of pregnancy.

Cancrum oris-like lesions.

Cancrum oris is predominantly seen in children in underdeveloped countries where widespread malnutrition, dehydration and epidemic infections are present. In the western world, it is sometimes found in immunosuppressed adults with predisposing conditions such as leukaemia and infection associated with malnutrition. Early diagnosis and an intensive therapeutic approach are the key to a favourable prognosis of noma-like necro-ulcerative lesions. The prognosis is significantly improved if the predisposing condition can be removed. Two cases are presented and the treatment is discussed.

Teenage pregnancy--need a child bear a child?

International and local evidence suggests that the incidence of unplanned pregnancy in teenage girls is unacceptably high. Obstetrical concerns centre around insufficient antenatal care; paediatric on small babies vulnerable to neglect from child-mothers and burdened grandmothers; and psychiatric and social on the trap for ill-educated, unskilled, immature child-mothers, poorly equipped to face the demands of the modern world. The experience of assessing local teenagers for therapeutic abortion on psychiatric grounds is presented. Of the 187 girls of 16 years and younger who were seen, 67 (35.8%) were granted an abortion: the remainder were counselled about alternatives. A variety of interventions are discussed: medical, educational, social and legal. These need to be comprehensive in order either to prevent pregnancy or to promote the health of a child-mother and her vulnerable infant. The role of the psychiatric services in this context needs revision.

Perspectives on anxiety.

An overview of the concept of anxiety from various perspectives, ranging from the biological through the psychological to the sociocultural, is presented.

Hypertension in the aged--psychosocial and psychiatric concomitants in a coloured community.

In a comprehensive social, psychiatric and medical survey of a random sample of aged coloured people in Cape Town, 82% were found to be hypertensive. Hypertensive subjects were compared with non-hypertensive subjects in terms of various psychosocial and psychiatric factors. A significant association between hypertension and symptoms indicative of nervous tension was found. The roles of sex distribution, class and ethnicity as contributing factors are discussed.

The coloured elderly in Cape Town--a psychosocial, psychiatric and medical community survey. Part III. A survey of physical disorders and disabilities.

A representative sample of elderly Coloured persons (over the age of 65 years) in the community underwent a medical and psychosocial assessment of prevalent physical disorders and resultant disability. This revealed that hypertension, visual impairment, osteo-arthritis and chronic lung disease were the most prevalent and disabling conditions, while hearing impairment and major neurological disorders played a lesser role. Most of the individuals claimed that they had little or no disability, while 10 felt they were only moderately disabled and 21 (14,9%) that they were severely disabled. The number of disorders ranged from 2,08 in those claiming no disability to 3,28 in those who were severely disabled. Profiles of the results of biochemical investigations resembled those of other aged populations, serum cholesterol, creatinine and alkaline phosphatase levels being raised. The pattern of medical care was also examined, including medication and the use of local facilities.

Therapeutic abortion on psychiatric grounds. Part III. Implementing the Abortion and Sterilization Act (1975-1981).

This article reviews the experience of the Pregnancy Advisory Service (PAS) of the Department of Psychiatry, Groote Schuur Hospital. Demographic and personal data from the women referred to the PAS during the period 1975-1981 (since the passing of the Abortion and Sterilization Act of 1975) are recorded. Follow-up information from many of the 1251 patients seen over this period confirms the findings of a previous report that in a significant percentage of cases in which a woman was refused legal abortion pregnancy did not proceed to term. For reasons which are not clear there has been a fall in the number of cases seen for assessment. The PAS performs a valuable function in enabling women to examine the circumstances of an unplanned pregnancy and in providing expert counselling.

Medical student training in doctor-patient communication.

Basic theories on doctor-patient communication as taught in the course on human behaviour to third-year medical students at the University of Cape Town are outlined, and it is shown how these are understood and used by medical students early in their clinical training. It is on these foundations that the later training in psychiatric interviewing and therapeutic intervention is based. The goal is to train the doctors of tomorrow to care for patients with physical and psychological distress equally effectively.

Therapeutic abortion on psychiatric grounds. Part I. A local study.

A study of 197 women referred for termination of pregnancy on psychiatric grounds was undertaken from February 1974 to May 1975 at a specially established clinic in the Department of Psychiatry, Groote Schuur Hospital, Cape Town. The personal, social and specifically psychiatric information collected from this study, which included both women who were refused and those granted termination on psychiatric grounds, was analysed. We gained enough data to focus on the psychosocial and 'hard' psychiatric data, to statistically compare the two groups, and to isolate variables which appeared to have influenced decision-making. Eighty per cent of the women were followed up for 12 - 18 months.

Therapeutic abortion on psychiatric grounds. Part II. The continuing debate.

Over the past few decades, attitudes towards therapeutic abortion have gradually changed in many countries from denial and punishment to acceptance. The debate on this emotionally laden subject still continues. In this article, we review some of the recent literature covering therapeutic abortion on psychiatric grounds, including studies of women granted termination as well as those refused. Other related areas, such as the long-term effect on children born after the refusal of termination and the relevance of this to preventative psychiatry, are also considered.