118 research outputs found
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
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