Psychiatric disorders and general medical conditions: implications for the clinician

Patients with severe mental illness have higher than expected prevalence rates of co-morbid general medical conditions, particularly metabolic and cardiovascular disease. They are also at increased risk of contracting HIV. Conversely, these and other medical disorders also increase the risk of developing mental disorders. Mental illness and general medical conditions have mutually adverse effects on long-term outcome. This interaction of diseases contributes significantly to the excess morbidity in and higher than expected standard mortality ratios for patients with mental illness. As medical practice becomes more specialized and arguably compartmentalized it may increasingly fail to integrate health care for patients with severe mental illness. In this paper we discuss the high co-morbidity of mental illness with other medical disorders as well some of the potential mechanisms involved. We furthermore argue that the bidirectional relationship between mental and medical disorders should be considered in the planning of treatment for either group of disorders. The central role of the psychiatrist in co-ordinating and integrating the health care of patients with severe mental illness is emphasized.African Journal of Psychiatry Vol. 11 (1) 2008: pp. 18-2

Purpose-orientated stocking of procedure trolleys saves time in busy emergency centres

Background. Inefficient storage and sourcing of routinely required consumables located on procedure trolleys result in time wasted when preparing for common procedures in emergency centres (ECs), contributing to poor efficiency and quality of care.Objectives. We designed a novel purpose-orientated procedure trolley and evaluated its impact on time spent on procedure preparation and efficiency.Methods. In an urban EC, eight participants were measured each day over 24 days, once using the standard setup and once using the modified procedure setup. During each simulation, efficiency markers were assessed (time spent on procedure preparation, steps taken, stops made, and time spent opening drawers to locate required items).Results. The mean (standard deviation) time required to collect the required items for intravenous cannulation and blood sampling from the purpose-orientated trolley was 22.7 (3.66) seconds, compared with 49.2 (15.45) seconds using the standard trolley. There was a significant difference between the two trolleys in mean collection time (p<0.0005) and in all the other categories: steps taken, stops made and drawer opening (p<0.0005).Conclusions. In our setting, stocking procedure trolleys in a purpose-orientated manner has the potential to improve efficiency by reducing time spent on procedure preparation

Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry, they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that, in some cases, MUS may be ascribed to Somatoform Disorders when, fact, they are “organic” syndromes that are misdiagnosed. In developing countries, with fewer resources, MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics, referral pathway, management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5% of the total number of files reviewed. In only 38% of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28% of cases a new “organic” diagnosis was made and in 72% of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with “organic” illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA, a significant number of patients with MUS may have underlying “organic” illness, and most may have psychiatric disorders. Patients with MUS, especially older patients, should be more extensively investigated. Psychiatric referral of these patients is very appropriate.Keywords: Medically unexplained symptoms; Psychiatric disorders; Retrospective review; Somatoform disorder

Distributed manufacturing systems and the internet of things : a case study

In order to stay competitive in today's global market, manufacturing companies need to be flexible. To ensure flexible production, shorten processing times, and reduce time-tomarket, companies are utilizing the distributed manufacturing system paradigm, wherein geographically distributed, local resources are used for product development and production. In this context, the Internet of Things (IoT) has emerged as a concept which uses existing communication technologies, such as local wireless networks and the Internet to ensure visibility of anything from anywhere and at any time. In the paper, a case study of applying the IoT to the manufacturing domain is discussed. A distributed agent-based system for virtual monitoring and control of 3-axis CNC milling machine tools is designed and developed. The machines' 3D models and process states are shown through a web interface in real-time. The potential and challenges of implementing this system and the basic building blocks for decentralized value creation are discussed

Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry, they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that, in some cases, MUS may be ascribed to Somatoform Disorders when, fact, they are “organic” syndromes that are misdiagnosed. In developing countries, with fewer resources, MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics, referral pathway, management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5% of the total number of files reviewed. In only 38% of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28% of cases a new “organic” diagnosis was made and in 72% of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with “organic” illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA, a significant number of patients with MUS may have underlying “organic” illness, and most may have psychiatric disorders. Patients with MUS, especially older patients, should be more extensively investigated. Psychiatric referral of these patients is very appropriate.Keywords: Medically unexplained symptoms; Psychiatric disorders; Retrospective review; Somatoform disorder

Preventive or punitive disciplinary measures in South African schools: Which should be favoured?

Recent research shows a major paradigm shift towards preventive and positive rather than punitive disciplinary measures. Since the essence of learner discipline is correctional and educational rather than punitive, this approach seems to be the correct one – especially after the abolition of corporal punishment in South African schools. However, the question remains: is there still room for punitive and reactive learner discipline in our schools? And if so, which is the better approach, and where should the emphasis be? This article endeavours to evaluate the two approaches by means of a normative framework. Rather than ruling which approach is the more successful one, the authors argue that it is not the one or the other, but rather a combination of the two approaches. One of the guiding determinants for correct decision-making is vested in maintaining a safe, harmonious and orderly environment conducive to education and learning. The decision regarding the most effective form of discipline in a particular instance should therefore be determined by the context of the situation. For example, it depends on the seriousness of the misconduct, the attitude of the learners (e.g. was it as a result of intent or negligence?), the age of the learner, the influence it had on the teaching-learning environment, et cetera

Health care discrimination against the mentally ill - A comparison of private health insurance benefits for major depressive disorder and ischaemic heart disease in South Africa

CITATION: Oosthuizen, P. et al. 2004. Health care discrimination against the mentally ill - A comparison of private health insurance benefits for major depressive disorder and ischaemic heart disease in South Africa. South African Medical Journal, 94(10):821-823.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

An educational intervention to improve the quality of care of diabetic patients

Objective. As few studies have addressed intervention for in-hospital care of diabetes mellitus (DM) patients, we set out to investigate whether an educational intervention targeting doctors could improve the quality of care for diabetic patients.Design. An observational interventional study conducted at Pretoria Academic Hospital, a tertiary care hospital.Subjects. Doctors working in the Department of Internal Medicine were the subjects of two interventional sessions on diabetic care, and all diabetic patients admitted to the wards in the above Department were evaluated.Outcome measures. A Diabetes Attitude Scale (DAS-3) and a Diabetes Practice Scale (DPS) were completed by each doctor before and after the interventional educational sessions. Data from diabetic patients in the wards were collected for 5 weeks before and 5 weeks after the interventional training, and these two sets of data were compared to measure the effect of the interventional training.Results. Subscales of the DAS-3 showed an improvement, with a statistically significant improvement in attitude regarding seriousness of DM (P = 0.03), and a trend towards improvement in attitude regarding need for special training and patient autonomy. Most of the items on the DPS improved significantly (P < 0.05).Conclusions. A short educational intervention resulted in an improvement in attitude, knowledge and clinical management of diabetic patients

Health care discrimination against the mentally ill - A comparison of private health insurance benefits for major depressive disorder and ischaemic heart disease in South Africa

CITATION: Oosthuizen, P. et al. 2004. Health care discrimination against the mentally ill - A comparison of private health insurance benefits for major depressive disorder and ischaemic heart disease in South Africa. South African Medical Journal, 94(10):821-823.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

Phylogeographic structure of Octopus vulgaris in South Africa revisited: identification of a second lineage near Durban harbor

In a previous study that investigated genetic structure of Octopus vulgaris along the South African coast by sequencing the mitochondrial cytochrome oxidase III gene (COIII), all sequences generated were identical. Such a finding is unusual, because mitochondrial DNA mutates quickly, and several marine invertebrates present in southern Africa show considerable genetic variation and structure. We reanalysed the samples using two different mitochondrial markers, namely cytochrome oxidase I (COI) and the large ribosomal subunit (16S rRNA). Sequences of both these markers showed variation. The conclusion of the previous study, that South Africa’s O. vulgaris population is characterised by a lack of genetic structure along the coast, is rejected. Some specimens from Durban (southeast Africa) were genetically more different from those found in the remainder of the country than were specimens from other regions (Tristan da Cunha and Senegal). We suggest that the lineage in Durban may have been recently introduced