Decedent\u27s Estates—Appointment of Successor Trustee

In re Phipp\u27s Will, 2 N.Y.2d 105, 138 N.E.2d 341 (1956)

Constitutional Law

This article is part of the District of Columbia Survey

Keep Your Differential Broad This Back Pain Season Penetrating Aortic Ulceration: A Case Report

Abstract: Keep Your Differential Broad this Back Pain Season, Kyle Diaz D.O., Anthony Colucci D.O. The chief complaint of back pain is a common occurrence in the emergency department. Our departments can often be inundated with this complaint especially now that the season of slips and falls is upon us. We are not only seeing traumatic back pain but chronic back pain and atraumatic acute back pain frequent the halls of the emergency department as well. While wading through the morass of these nonspecific and often menial complaints it may become difficult for a provider to maintain a broad differential. This case will serve as a reminder to remain vigilant while working up back pain. Additionally, information on an interesting diagnosis of aortic ulceration will be gleaned throughout the case review.The case is that of a 65 year old female with significant medical history including hypertension and remote history of smoking who presents to the emergency department complaining of back pain. The patient reports that she has been having mid thoracic back pain for the past 2-3 weeks. This pain is described as aching and is sharp with movement. Patient reports pain radiating to both sides with movement. Patient denies associated chest pain, shortness of breath, nausea, vomiting, neck pain, low back pain, sciatica, incontinence of stool, urinary retention. Patient does report that symptoms improve significantly with leaning forward.A thorough examination demonstrated Para spinal tenderness throughout the mid thoracic spine. Patient’s examination was otherwise normal save her vitals which showed hypertension to the degree of 180/95. Initial evaluation included AP chest, thoracic XR and basic lab work. Pain control was provided as well.On repeat examination patient’s back pain was well controlled however she remained hypertensive and was now having bilateral flank discomfort. At this point advanced imaging was obtained and a CTA of the chest was ordered. This demonstrate a broad based aortic ulceration about the ascending portion of the thoracic aorta.Immediate measures were taken to control patient\u27s elevated blood pressure and consultation was made to vascular surgery. Patient was admitted to the ICU for further management and evaluation. With strict impulse control repeat CTA was ordered at 48 hours. There was no progression of the disease and as such patient was discharged home with conservative medical management as she was not amenable to surgery at time of initial presentation.One month later the patient represented due to continued pain and was found to have a type B thoracic aortic dissection. At this time she underwent TEVAR and after an uncomplicated operation and post-operative course has followed with both family practice and vascular and is progressing well. As a conclusion of the case I would like to discuss the treatment and management of this finding of Aortic ulceration and the morbidity associated with this rare diagnosis. I believe that this interesting case will both add to the expansion of our differential when caring for back pain in addition to providing helpful information for diagnosis that does not have a mass of readily available data.https://scholarlycommons.henryford.com/merf2019caserpt/1087/thumbnail.jp

Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia

<p>Abstract</p> <p>Background</p> <p>The aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA) training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.</p> <p>Methods</p> <p>Respondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders. Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.</p> <p>Results</p> <p>Between pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.</p> <p>Conclusion</p> <p>A two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.</p

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in India

<p>Abstract</p> <p>Background</p> <p>This study aimed to develop guidelines for how a member of the Indian public should provide mental health first aid to a person who is suicidal.</p> <p>Methods</p> <p>The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of Indian mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. Experts were recruited by SC, EC and HM. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms.). Responses to the open-ended questions were used to generate new items.</p> <p>Results</p> <p>The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 30 new items were written based on suggestions from panel members and, of these 168 items, 71 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. Translated versions of the guidelines will be produced and used for training.</p> <p>Conclusions</p> <p>There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.</p