Case Files (case + file)

Distribution by Scientific Domains

Selected Abstracts

Advanced Opportunities for Student Education in Emergency Medicine

Charissa B. Pacella MD
Abstract Many medical students are excited about emergency medicine (EM) following a standard clerkship and seek out additional learning opportunities. An advanced EM elective may accomplish several educational goals, including development of clinical skills in evaluating the undifferentiated patient, broader exploration of the field of EM, and more focused study of one particular aspect of EM. Previously cited examples include pediatric EM, medical toxicology, occupational medicine, sports medicine, and EM research. Numerous other EM specialty courses for senior medical students are emerging, as reflected in the "Undergraduate Rotations" listings on the Society for Academic Emergency Medicine. A few examples drawn from the list include emergency ultrasound, international EM, wilderness medicine, disaster medicine, geriatric EM, and hyperbaric medicine. Educators aspiring to develop, or in the process of developing, an advanced EM elective may benefit from a brief overview of necessary course considerations, including didactic format, the clinical role of the medical student in the emergency department, and involvement with patient procedures. Suggestions are made regarding additional educational opportunities, including follow-up of patients seen in the emergency department and development of an emergency department radiology case file. This article also addresses several related concerns, including suggested prerequisites, administration and cost considerations, appropriate didactic topics, and methods for evaluating students. Several EM subspecialty areas, namely pediatric EM, medical toxicology, and out-of-hospital care, are specifically discussed. Formal advanced cardiac life support training is also often included in an advanced EM elective and is briefly discussed. The overall intent of this article is to provide medical student educators with resources and ideas to assist them in developing a unique advanced EM elective. [source]

Let's find the evidence: an analogue study of confirmation bias in criminal investigations

Eric Rassin
Abstract People involved in criminal proceedings (e.g. police officers, district attorneys, judges, and jury members) may run the risk of developing confirmation bias, or tunnel vision. That is, these parties may readily become convinced that the suspect is guilty, and may then no longer be open to alternative scenarios in which the suspect is actually innocent. This may be reflected in a preference for guilt-confirming investigation endeavours, as opposed to investigations that are aimed at confirming, or even excluding, alternative scenarios. In three studies, participants read a case file, and were subsequently instructed to select additional police investigations. Some of these additional endeavours were guilt-confirming (i.e. incriminating), whereas others were disconfirming (i.e. exonerating). Results suggest that additional investigation search was guided by an initial assessment of the suspect's guilt (Study 1). Furthermore, participants' tendency to select incriminating investigations increased with increased crime severity, and with the strength of the evidence present in the case file. Finally, the selection of incriminating investigations was associated with conviction rates (Study 3). However, in general, participants did not favour incriminating endeavours. That is, in the three studies, the percentages of selected incriminating endeavours did hardly or not exceed 50%. Copyright © 2010 John Wiley & Sons, Ltd. [source]

,I was running away from death', the pre-flight experiences of unaccompanied asylum seeking children in the UK

S. Thomas
Abstract Objective To collect information about the pre-flight experiences of unaccompanied asylum seeking children (UASC) in the UK to increase the understanding of support needed on arrival in the UK. Methods Retrospective social services case file and legal statement review and semi-structured in-depth interviews with 100 UASC. Results Nearly half of all UASC have experienced separation from or loss of parents and/or family members (47%), and a further 41% had personally experienced or witnessed violence. Sexual violence (such as rape) was reported by 24% of African girls. Many children reported complex journeys to the UK. Conclusions UASC arrive in the UK with a variety of potentially traumatic experiences. Whilst research is starting to identify some of the experiences of UASC, further culturally appropriate research is needed to identify their health and social needs after arrival. Further research will help to identify the specific experiences of UASC, indicating where services should be improved to deal with their complex and diverse needs. [source]

Are psychiatrists affecting the legal process by answering legal questions?

Timothy Hardie
Background,Psychiatrists are often asked to answer legal questions. The extent to which they answer strictly legal rather than medical matters is not known. Aim,To investigate how strongly psychiatrists in England and Wales express opinions on one legal question , that of diminished responsibility in respect of a murder charge, and how this is related to outcome in court. Method,Our data were extracted from psychiatric reports and case files supplied by the then Department of Constitutional Affairs (now the Ministry of Justice) on cases heard in the Crown Courts between 1 January 1997 and 31 December 2001 in which the defence of diminished responsibility had been raised. The cases had been selected by the Law Commission in their earlier review of partial defences to murder. We devised a reliable system of rating the presence/absence and strength of expression of a legal opinion in the medical reports. We tested the data for relationship between nature and strength of opinion and progression to trial and verdict. Results,Psychiatric reports were available on 143 of 156 cases in which diminished responsibility was considered. They yielded 338 opinions on at least one aspect of diminished responsibility. In 110 (93%) of the 118 cases in which there was a diminished verdict, this was made without trial and, therefore, without reference to a jury. In only eight (27%) out of the 30 cases that went to trial, was a diminished responsibility verdict made. Half of the reports (169) gave a clear opinion on diminished responsibility, a third (121) invited the court to draw a particular conclusion and only 11% (36) provided relevant evidence without answering the legal questions. When there was an opinion or an invitation to make a finding on the legal question, a trial was less likely. A trial was also less likely if reports agreed on what the verdict should be. Conclusions,Psychiatrists frequently answer the legal question of diminished responsibility. The judiciary and medical experts should join in research to examine the consequences of different styles or approaches in presentation of essentially similar evidence in court. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Functional consistency across two behavioural modalities: fire-setting and self-harm in female special hospital patients

Sarah Miller
Background,Fire-setting and self-harm behaviours among women in high security special hospitals may be understood using Shye's Action System Theory (AST) in which four functional modes are recognized: ,adaptive', ,expressive', ,integrative', and ,conservative'. Aims,To test for relationships between different forms of fire-setting and self-harm behaviours and AST modes among women in special hospital, and for consistency within modes across the two behaviours. Method,Clinical case files evidencing both fire-setting and self-harm behaviours (n = 50) were analysed for content, focusing on incident characteristics. A total of 29 fire-setting and 22 self-harm variables were analysed using Smallest Space Analysis (SSA). Chi-square and Spearman's rho (,) analyses were used to determine functional consistency across behavioural modes. Results,Most women showed one predominant AST mode in fire-setting (n = 39) and self-harm (n = 35). Significant positive correlations were found between integrative and adaptive modes of functioning. The lack of correlation between conservative and expressive modes reflects the differing behaviours used in each activity. Despite this, significant cross-tabulations revealed that each woman had parallel fire-setting and self-harm styles. Discussion,Findings suggest that, for some women, setting fires and self harm fulfil a similar underlying function. Support is given to AST as a way of furthering understanding of damaging behaviours, whether self- or other-inflicted. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Factors associated with seclusion in a statewide forensic psychiatric service in Australia over a 2-year period

Stuart D.M. Thomas
ABSTRACT Despite seclusion being described as one of the most ethically- and legally-controversial management options available, it remains a widely-used clinical strategy for managing disruptive, aggressive, and violent behaviour. This study sought to determine how frequently seclusion was used, the common characteristics of those secluded and not secluded, and the degree to which the Level of Service Inventory , Revised: Screening Version (LSI-R: SV) could predict seclusion. The study was retrospective, covering the first 2 years of operation of a statewide forensic psychiatry hospital in Victoria, Australia. Data were collected from individual case files, electronic databases, and paper copies of records pertaining to violent incidents and episodes of seclusion. Eighty five (44%) of the 193 patients admitted during this period were secluded. Those secluded were significantly younger and had a more established psychiatric history. LSI-R: SV scores were significantly and positively associated with being secluded. A statistical model containing three LSI-R: SV items, along with age on admission and psychiatric history, achieved an area under the curve of 0.74. Seclusion is used on a regular basis in response to a range of different forms of aggressive behaviour of different severity. The LSI-R: SV demonstrated moderate-to-good accuracy in predicting seclusion and warrants further research using detailed prospective methodologies. [source]

Predicting the Postmortem Submersion Interval for Human Remains Recovered from U.K. Waterways,

Vivienne Heaton M.Sc.
Abstract:, This article aims to increase accuracy in estimating the postmortem submersion interval (PMSI) for bodies recovered from rivers in the United Kingdom. Data were collected from closed case files, crime scene reports, and autopsy files concerning bodies recovered over a 15-year period from the River Clyde, Scotland, and the River Mersey and canals in northwest England. One hundred and eighty-seven cases met the study criteria and were scored by quantifying the overall amount of decomposition observed in each case. Statistical analysis showed that the duration of a body's submergence in water and the temperatures to which it was exposed, as measured in accumulated degree days (ADD), had a significant effect on the decay process. Further analysis indicated that there were no significant differences in decomposition between the waterways. By combining the data from all study samples, it was possible to produce a single linear regression model for predicting ADD from observed decomposition. [source]

A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability

A. J. Esbensen
Abstract Background Life events have consistently been found to be associated with behaviour problems and depression among individuals with intellectual disability (ID). However, prior findings have typically been based on correlational or retrospective analyses of case files. The current study attempted to replicate prior findings from life events with concurrent data and extend them to the prospective prediction of behaviour problems and depression. The influence of impact ratings of life events was also explored. Methods Seventy-four informants rated 104 adults with ID on measures of life events, behaviour problems and depressive symptoms. Life events were rated as having either a positive, negative or no impact on the life of the individual with ID. Measures were completed twice, at a 4-month interval. Results Behaviour problems were both correlated with and predicted by frequency counts of life events and life events perceived as negative. However, the predictive ability depended on which measure of problem behaviour was selected. Positive life events were not associated with concurrent behaviour problems. Depressive symptoms were correlated with all life changes, but only predicted by frequency counts of life events and life events perceived as negative. Again, the predictive ability depended on which measure of depression was selected. Findings were corroborated with a group of individuals with clinical diagnoses of major depression. Conclusions Frequency counts of all life events and life events perceived as negative play a role in the development of behaviour problems and depressive symptoms among adults with ID. The results have implications for interventions for behaviour problems following a life event, and for reducing depressive symptoms for adults with mild ID. [source]

Public Special Services Provided to People With Intellectual Disabilities in Sweden: A Life-Span Perspective

Õie Umb-Carlsson
ABSTRACT This study describes public special services, support, and health care provided to an administratively defined county sample of people with intellectual disabilities from early childhood to adult age. Comparisons were made on the variables year of birth, sex, and assessed level of intellectual disabilities in 1974. Information was obtained from case files and included the period from year of birth of the participants (between 1959 and 1974) to 2005. All participants were provided public special services, support, and health care either periodically or throughout the study period. Changes in legislation were reflected in the type of services, support, and health care provided to the target group. Type and amount of special services and support were related to year of birth. Only a few differences were related to sex and level of intellectual disabilities. These results indicate that public special services, support, and health care provided to people with intellectual disabilities reflect disability policy, legislation, and professional attitudes over different periods. It is suggested that measures were tailored to meet general needs considered to be shared by all people with intellectual disabilities rather than individual choices and wishes. The interaction among professionals emerged only to a limited extent. However, deficient information in the case files does not imply absence of contact between professional groups, but, if continuity in services, support, and health care is to be attained, significant improvement in documentation is required. [source]

Primary hyperparathyroidism in 29 dogs: diagnosis, treatment, outcome and associated renal failure

R. N. A. Gear
Objectives: To review the records of 29 dogs diagnosed with primary hyperparathyroidism and see if any factors correlate with renal failure. Methods: Dogs were selected retrospectively from case files from the QVSH and the QMH. Results: The majority of dogs were middle-aged and four were keeshonds. The primary presenting complaints were polyuria and polydipsia. All dogs had an elevated total and ionised plasma calcium concentration. Plasma phosphate concentrations were variable. Ultrasonography of the parathyroid gland revealed nodular enlargement which was found to correlate well with surgical findings. The majority of dogs underwent surgical parathyroidectomy. Five cases were treated by ultrasound-guided chemical ablation of the parathyroid gland, of which only two cases showed a partial response. Three dogs were euthanased within a week of presentation. Seven other dogs had renal failure diagnosed either at presentation or up to six months after parathyroidectomy. The development of renal failure was correlated with total calcium concentration but did not correlate with any other factor, including the calcium phosphate product. Thirteen treated dogs were known to be alive at the time of writing, which was six months to 3.5 years after parathyroidectomy. Clinical Significance: Primary hyperparathyroidism cases with high total calcium were more likely to develop renal failure in this group of dogs; however, the calcium phosphate product did not seem to be a useful predictor. Ultrasound-guided chemical ablation seemed to have limited advantage over surgery. [source]

When Businesses Sue Each Other: An Empirical Study of State Court Litigation

LAW & SOCIAL INQUIRY, Issue 3 2000
Ross E. Cheit
Using a mixture of court docket data and case files, we construct a data set of business litigation in Rhode Island Superior Court during 1987 and 1988. Business litigation is defined as a suit involving an economic firm as both a plaintiff and a defendant. The empirical analysis complements recent scholarship providing answers to descriptive questions about the frequency, nature of, parties to, and intensity of the business litigation docket. Using Standard Industrial Classification (SIC) codes, indicators of industry participation in litigation are developed, and positive analysis undertaken to explain variation across industries. Several hypothesis are developed and tested using quantitative analysis. We conclude that contextual economic conditions favoring the creation of long-term business relationships help prevent litigation between firms. [source]

Factors Associated With the Adjustment of Foster Children in the Netherlands

Johan Strijker PhD
Information obtained from 419 case files was used to investigate the associations between the foster child's adjustment to the foster family and factors in the histories of the child and the parents, as well as factors in the relationship between foster children and their biological parents while they are placed in foster care. Problems in the foster child's prior history, particularly attachment disorders and the experience of replacements, affect the extent of adjustment to the foster family. In-home visits by the child and the absence of parental permission to stay with the foster family are two factors related to the parent-child relationship that impeded adjustment. In general, parental problem factors did not affect adjustment. The fact that many foster children come from problem-laden backgrounds raises the question of whether foster parents are always sufficiently equipped to cope with these problems. [source]

Potential school violence: Relationship between teacher anxiety and warning-sign identification

Julia H. Robinson
This study examined the relationship between teacher anxiety and their identification of warning signs of student violence. Fifty-six public school teachers, 22 male and 34 female, between the ages of 23 and 60 participated. Participants identified warning signs in five fictional student case files created for this study and completed the State-Trait Anxiety Inventory and a demographic survey. The case files included positive and negative information, and high- and low-severity warning signs. Neither state (r = .02) nor trait (r = .04) anxiety was significantly correlated with high-severity warning-signs identification. Low-severity warning-signs identification was positively correlated with state anxiety (r = .28, p < .05) but not trait anxiety (r = .18, p > .05). False positive identification was not significantly related to state anxiety (r = .07) or trait anxiety (r = .06). The findings indicate that teachers who experience higher levels of state anxiety when confronted with warning signs of potential violence are better able to identify low-severity warning signs than do their less anxious counterparts, without over-identifying nonthreatening information as potential warning signs. © 2005 Wiley Periodicals, Inc. Psychol Schs 42: 623,635, 2005. [source]

Disproportionately High Rate of Epileptic Seizure in Patients Abusing Dextropropoxyphene

Debasish Basu MD
Dextropropoxyphene (DPP), a weak opioid, is often abused as a psychoactive substance. In this retrospective chart review to document, characterize and put in perspective the often-obtained history of epileptic seizures in patients with DPP abuse, we analyzed the case files of all patients with DPP abuse registered in our center (a tertiary-care drug de-addiction clinic in north India) from May 1, 2001 until April 30, 2007 and those with use of other opioids during the same period. Non-drug-related seizures were excluded from analysis. Out of 312 patients with DPP abuse, 63 (20.2%) had epileptic seizures related to DPP use, in contrast to 0.4% ,4.2% of other opioid users. The seizures were mostly characterized as generalized tonic-clonic seizures (87.3%), occurring around two hours following a higher-than-usual dose of DPP. Those with seizures had significantly greater duration of DPP use and higher rates of medical comorbidity compared to patients without seizure. Age, duration of use and medical comorbidity were better predictors of seizure than dosage of drug or use of multiple drugs. Thus, DPP-induced epileptic seizures are common (one in five), and much more frequent than seizures in patients using other opioids. The awareness of this phenomenon has implications for diagnosis and management, as well as for drug regulation policy. [source]

Implementing Racial Anti-vilification Laws in New South Wales 1989-1998: A Study

Katharine Gelber
Anti-vilification laws in Australia now have a decade-long history, yet remarkably little research has been conducted into their operation, nor has there been any systematic collation of outcomes. This paper seeks to fill this gap in the available research and also to make some proposals as to how to improve the legislation in practice. The paper reports on 10 years of complaints lodged under the NSW racial anti-vilification legislation, the oldest in Australia enacted in 1989. Other similar legislation followed in WA, SA, Tasmania. The results of all finalised case files from NSW since its inception in 1989 to the end of 1998 (568 cases) are examined. The research combines quantitative and qualitative methodologies. Some statistical data are provided, which are not relative; that is, there is no meaning available or implied between the different categories of outcome and each case has been interpreted separately. The qualitative method used provides an in-depth examination of specific case study outcomes in order to provide an accurate and sensitivepicture of the legislation in practice. The study may also be of use to researchers in other complaints-driven systems of regulation designed to support beneficial legislation. [source]

Identifying and assessing cases of child neglect: learning from the Irish experience

Jan Horwath
ABSTRACT Although child neglect is arguably the most prevalent form of maltreatment in the western world, studies of social work practice in cases of child neglect are limited. This paper seeks to add to the body of knowledge by describing a small-scale study completed in the Republic of Ireland of social work assessments in cases of child neglect. The findings are based primarily on an analysis of case files, but reference is also made to practitioners' and managers' responses to a postal questionnaire and focus groups. The study findings highlight that social workers interpret the assessment task and process in different ways. Variations in the interpretation of the task appear to be influenced by workload pressures, resources and local systems, with teams focusing either on immediate safeguarding issues or on both safeguarding and the longer-term welfare of the child. Individual variations amongst workers irrespective of team were more apparent in the way practitioners approached the assessment task. For example, practice varied regarding which professionals and family members were contacted as part of the assessment, the type of communication workers had with children and carers, and the use the social workers made of information on case files. The paper concludes with a discussion of the role of the team in determining the focus of assessments and the subjective factors which impact on the way the individual social worker works with children, families and other professionals. [source]

Breakdown of teenage placements in Swedish foster and residential care

Marie Sallnäs
ABSTRACT This article deals with the problem of breakdown in different types of out-of-home care (foster care/residential care) for Swedish teenagers. How often are such placements prematurely terminated against the wishes and intentions of child welfare authorities? Which factors appear to increase or decrease the risk of placement breakdown? The sample consists of a national cohort of 776 youths who started 922 placements during 1991. Every placement was followed in municipal case files for a maximum period of five years. Between 30 and 37% of all placements were prematurely terminated, the exact figure depending on whether a narrow or wide definition of breakdown was applied. The lowest rates of breakdown were found in kinship care and secure units, the highest in non-kinship foster homes. Teenagers who display antisocial behaviour and/or have mental health problems constitute a high-risk category for most types of out-of-home care, but especially in non-kinship foster homes. Risk factors in relation to breakdown were analysed in the four main forms of Swedish out-of-home care separately (foster homes, privately/publicly run residential care and secure units). The analysis pointed out that risk factors are not the same in all types of care, but antisocial behaviour at time of placement increased the risk in most forms of care. Prior research indicates that placement breakdown is a major problem of child welfare in other countries, and this study found that Sweden is no exception. [source]