Problems associated with the diagnosis and the prescribing of anti-psychotic medication in children and adolescents for psychiatric conditions, by non-psychiatric specialists

Aim: The objective of this study is to assess the accuracy of the diagnosis and appropriateness of antipsychotic medication prescribed to children and adolescents referred to child guidance clinic, and how many of these remained on the said medication after consultant psychiatrist and multidisciplinary team review. Method: A retrospective case notes review of all the children referred to a child guidance clinic in the period June 2005 to July 2006 were analysed, looking specifically at the referral tickets, the treatment on first interview with a member of the multidisciplinary team at the clinic, the working diagnosis of the team, and the management plan after at least six months of follow up at child guidance clinic. There was very good interrater reliability between the two observers looking at the case notes. Results: One hundred and fifty four (63.1%) out of a total of 244 children who were referred carried an admission diagnosis, which differed from the working diagnosis after 6 months. A total of 66 children (27%) were started on various types of psychiatric treatment prior to referral. Thirty (45.5%) of these were prescribed sulpiride, an atypical neuroleptic. Following review by the multi-disciplinary team, the medication of 25 (83.3%) of these children was terminated or altered. Conclusion: This report highlights the need of consultation liaison with general practitioners and also Continued Medical Education courses for general practice management in child and adolescent psychiatry. It is advisable that non psychiatric specialists limit the use of antipsychotic medication to children and adolescents without expert advice and in addition, should refer all such children with urgency.peer-reviewe

Pediatric Bipolar disorder, in Malta is it under-diagnosed?

The objective of this retrospective study was to determine the frequency of Bipolar Disorder in children and adolescents referred to the Child Guidance Clinic (CGC), St. Luke’s Hospital, Malta, over a year. Diagnostic criteria were analyzed and compared to current literature. Of 141 children, none were diagnosed with Bipolar Disorder. Further awareness of clinicians is advised, to identify Bipolar Disorder, thus limiting its long term morbidity and mortality.peer-reviewe

Excision margins in breast conserving surgery

The ideal excision margin in breast conserving surgery is still a matter of debate. The aim is to see if there is any correlation between increasing excision margin distance and local recurrence rate. Patients who had breast conserving surgery at Mater Dei Hospital in 2009 had their notes reviewed retrospectively. Patient demograpichs, including the excision margins were recorded. Local recurrences within a 3 year follow up period were noted. Chi square was used to compare categorical data and a p value of less than 0.05 was considered statistically significant. 91 patients were recruited into the study. 74 patients (81.5%) had negative margins (>1mm), 10 patients (11%) had close margins (<1mm) while 7 patients (7.5%) had positive margins. 5 patients (5.5%) had local recurrence. The highest recurrence rate (14%) was in patients with positive margins, and no statistical signficant difference in recurrence rates was noted with wider excision margins. As long as the margins are negative, increasing excision margins will not result in a better local recurrence rate.peer-reviewe

Referral tickets to secondary healthcare : is communication effective?

Communication between primary and secondary health care relies primarily on referral tickets. They determine how patients’ details are conveyed and hence the quality of care. The aim of this study was to assess the quality of referral tickets at the Surgical Outpatients at Mater Dei Hospital in Malta and to develop recommendations for improvement. Consecutive referral tickets between the 7th February and 4th March 2015 were prospectively included in the study and analysed for completeness. The data was entered into a proforma which was revised after the first ten entries. A total of 351 referral tickets were included in the study. Names and surnames were present in all reports and identification number in 99.42% of cases. 44.16% of referrals were inappropriate according to clinical details. The majority of the forms had a history of presenting complaint (98.29%) while the past history, drug history / allergies and examination findings were available in 69.23%, 67.81% and 76.64% respectively. The source of referral was not clear in 56.13%. Only 69.23% of all referral tickets were completely legible while 30.77% were partly legible. This study shows the need for an overhaul in the referral system. Recommendations include the use of electronic referrals and the introduction of feedback letters by hospital specialists.peer-reviewe

Hedge Funds: Pricing Controls and the Smoothing of Self-Reported Returns

We investigate the extent to which hedge fund managers smooth self-reported returns. In contrast to prior research on the “anomalous” properties of hedge fund returns, we observe the mechanisms used to price the fund\u27s investment positions and report the fund\u27s performance to investors, thereby allowing us to differentiate between asset illiquidity and misreporting-based explanations. We find that funds using less verifiable pricing sources and funds that provide managers with greater discretion in pricing investment positions are more likely to have returns consistent with intentional smoothing. Traditional controls, however, such as removing the manager from the setting and reporting of the fund\u27s net asset value and the use of reputable auditors and administrators, are not associated with lower levels of smoothing. With respect to asset illiquidity versus misreporting, investment style and portfolio characteristics explain 14.0–24.3% of the variation in our smoothing measures, and pricing controls explain an additional 4.1–8.8%, suggesting that asset illiquidity is the major factor driving the anomalous properties of self-reported hedge fund returns

Dentistry

The specialty of Dental Surgery has progressed from the "blood and acrylic" of the early seventies. Dentistry has undergone a quantum leap over the past twenty-five years, with improvements in both technique and technology, bringing us the sophisticated procedures used in today's practice.peer-reviewe

The matching of motivations to affordances among Maltese elected local government volunteers : implications for sustaining civil society

Purpose – The purpose of this study is to both understand the motives for volunteering in local government (a strong/structured context) and determine how such motivation and other demographics interact with organisational contexts to influence volunteering outcomes. Design/methodology/approach – The study adopts a functional approach to volunteerism. The Volunteer Functions Inventory is modified to better assess the motivations of elected local government volunteers. The responses of 152 Maltese local councillors were used to answer four research questions empirically. Findings – Exploratory and confirmatory factor analyses supported the introduction of a seventh VFI dimension, namely the political function. The study provides evidence that local councillors who received greater amounts of functionally relevant benefits reported more satisfaction and a stronger intention to continue volunteering in local government. The aggregated effect of multiple motives as well as other person-based determinants (marital status and education) produced a significant impact on volunteering outcomes in this strong/structured situational context of this public sector environment. Originality/value – This study contributes to a better understanding and assessment of the motivations of elected local government volunteers. It addresses practical recommendations for sustaining civil society, while acknowledging the potential and contribution of volunteers with various demographic characteristics

Un’esperienza nel Mediterraneo

The urban zone, now known as il-Fgura, started spreading like a fungus a few decades ago, but the appearance of the first lined houses in the area dates back two centuries. It was in the middle of the nineteenth century that this district began to develop into a marginal suburb of the harbour town of Bormla, which is one of the three towns situated in the south-east of the Grand Harbour. However, if one wants to unearth the history of il-Fguta's remote past, i.e. before the sixteenth century, one has to rely mainly on archaeological evidence and from what has been unearthed one can try to make an interpretative reading of the habitation patterns and use of the land of the area for the period which lacks written historical evidence. After all, very few, if any conclusions can be drawn from archaeology as this area has been savagely built up and like other places close to it, development was undertaken regardless of the historical remains. The latter were either destroyed or sold on the market. Thus, in the unearthing of recondite historical figures, the major evidence about il-Fgura's past can only be drawn from surviving written information and oral traditions; it should be stressed that unfortunately archaeology in this particular case cannot be used as a substitute.peer-reviewe