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Discharge summaries are the mainstay of intra and inter-departmental communication, ensuring continuity of care. Local instructions fail to provide clear guidance to foundation doctors to ensure standardised discharge summaries.
The audit aimed to assess the inclusion of information within discharge summaries at Mount Carmel Hospital, Malta. A secondary objective was to update the current online discharge summary framework.
Stratified random sampling was used to select 120 discharge summaries, issued between October 2018 and September 2019. These were chosen out of a total of 956 discharge summaries issued during the period. The inclusion of information was analysed against the National Standard for Patient Discharge Summary Information issued by the Health Information and Quality Authority, Ireland. Data was collected and grouped into seven categories each containing multiple data points.
Patient details were present in all discharge summaries while no details relating to the primary care healthcare professional were documented. The average information inclusion rate regarding admission, discharge and medications was 85%. Average clinical information was documented in 50% while that of future management and person completing discharge summary was found in 41% and 28% respectively (as per Table 1). Encouragingly, discharge summaries contained mandatory information more frequently than conditional or optional information.
This audit has identified deficiencies in current discharge summary practices and gives recommendations for the development of local guidelines.
Many people think that people with mental disorders might be dangerous or unpredictable. These patients face various sources of disadvantages and experience discrimination in job interviews, in education, and housing. Mental health-related stigma occurs not only within the public community, it is a growing issue among professionals as well. Our study is the first that investigates the stigmatising attitude of psychiatrists across Europe.
We designed a cross-sectional, observational, multi-centre, international study of 33 European countries to investigate the attitude towards patients among medical specialists and trainees in the field of general adult and child and adolescent psychiatry.
An internet-based, anonymous survey will measure the stigmatising attitude by using the local version of the Opening Minds Stigma Scale for Health Care Providers. Data gathering started in July this year and will continue until December 2020.
This study will be the first to describe the stigmatising attitude of psychiatric practitioners across Europe from their perspectives.
The study will contribute to knowledge of gaps in stigmatising attitude towards people with mental health problems and will provide with new directions in anti-stigma interventions.
After developing an existential model of addiction, it became evident that there are major differences between the existential and medical models of addiction.
This research aims to investigate the boundary and overlap between the existential and medical models of addiction.
The existential model was compared and contrasted with a narrative literature review of the medical model of addiction.
Through the existential definition being-with-drug, addiction is conceptualised in terms of a relationship with the drug and the impact on one’s sense of self. The medical model focuses on diagnostic criteria, genetic and environmental risk and protective factors, and an underlying neurobiological explanation. In contrast to the prevalent disease model, the existential view maintains that drug addiction is a coping mechanism used to mitigate existential and neurotic anxiety which results from facing or avoiding the existential givens. Phenomenological research supporting existential psychotherapy in addiction is contrasted with the quantitative medical research which forms the basis for current addiction guidelines. A comparison of both models is presented focusing on the issues of coping, choice, responsibility, mandatory treatment, medication, psychotherapy and the therapeutic relationship. The biopsychosocial model is compared to van Deurzen’s modes of existence, which provides the basis for existential psychotherapeutic interventions. Furthermore, existential literature was examined to determine whether an individual can authentically choose to live addicted.
Both models fall short of giving a holistic view of addiction. A combination of models is necessary to address the diversity of issues patients present with.
Despite existentialism positing that existential concerns are universal, research into the existential issues related to addiction remains scarce. An existential model of addiction is lacking.
This research aims to develop an existential model of addiction, conceptualising the development of addiction through to authenticity.
A scoping literature review was carried out using PUBMED, reference lists and internet websites.
Psychopathology, from an existential point of view, occurs as a result of the avoidance of the existential givens which are death, freedom, existential isolation and meaninglessness. In this model, addiction is positioned as a coping mechanism to deal with the existential or neurotic anxiety which arises from facing or avoiding the existential givens. Addiction is defined as being-with-drug; a state in which our inherent relation to others is replaced by a relation with a substance. This state is understood from the ontological, axiological, ethical and praxeological levels, shedding light on the phenomenological experience of addiction. The existential dilemmas around meaning, loneliness, death, freedom, guilt and control while living with addiction are discussed. Finally, existential crises, boundary situations and secondary suffering are seen as the main motivators to overcome addiction.
Phenomenological and existential research support the fact that existential issues are relevant to addiction. This model explains the relationships between existential concepts and addiction, while providing a framework for clinicians to explore and address these issues with patients.
Patients with mental health problems (MHP) are known to have more physical comorbidities compared to the general population.
In Malta, Mount Carmel hospital (MCH) which is the main psychiatric hospital (consisting of both acute and chronic wards), is separate from Mater Dei hospital (MDH) which is the general hospital at which medical and surgical care is provided.
Such a division in healthcare may result in inadequate focus on physical health amongst patients of high demand in this regard. This subsequently puts an increased strain on the general hospital through repeated referrals.
The purpose of this study is to show that inpatients with MHP have a significant number of comorbidities and require multiple referrals to a general hospital for medical and surgical attention.
Three hundred and ninety-three inpatients at acute and chronic wards of MCH (during the first week of December 2016) were enrolled in the study.
Treatment charts and iSOFT (healthcare IT software used in Malta) were used to determine patient's diagnosed comorbidities, number and type of referrals to MDH outpatient clinics (OPC), casualty and admissions at MDH over 1 year.
Results of the audit indicate that a significant number of inpatients at MCH have medical comorbidities and the majority have been referred to MDH for OPC and casualty over the past year.
Having medical and surgical liaison teams in psychiatric hospitals may enhance patient care and reduce the pressure exerted on general hospitals.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Dimensional structures are established for many psychiatric diagnoses, but dimensions have not been compared between diagnostic groups.
To examine the structure of dimensions in psychosis, to analyse their correlations with disease characteristics and to assess the relative contribution of dimensions v. diagnosis in explaining these characteristics.
Factor analysis of the OPCRIT items of 191 Maudsley Family Study patients with schizophrenia, mood disorders with psychosis, schizoaffective disorder, and other psychotic illnesses, followed by regression of disease characteristics from factor scores and diagnosis.
Five factors were identified (mania, reality distortion, depression, disorganisation, negative); all were more variable in schizophrenia than in affective psychosis. Mania was the best discriminator between schizophrenia and affective psychosis; the negative factor was strongly correlated with poor premorbid functioning, insidious onset and worse course. Dimensions explained more of the disease characteristics than did diagnosis, but the explanatory power of the latter was also high.
Kraepelinian diagnostic categories suffice for understanding illness characteristics, but the use of dimensions adds substantial information.
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