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Medical Reports (medical + report)
Selected AbstractsAre psychiatrists affecting the legal process by answering legal questions?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2008Timothy 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] Pervasive developmental disorders in individuals with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2009AYSE KILINCASLAN MD The aim of the present study was to describe the prevalence and associated factors of pervasive developmental disorders (PDD), including autistic disorder and PDD not otherwise specified (NOS), in a clinical sample of 126 children and adolescents (75 males, 51 females; age range 4,18y, mean 8y 8mo, SD 3y 8mo) with tetraplegic, hemiplegic, diplegic, dyskinetic, or mixed types of cerebral palsy (CP); 28% could not crawl or walk even with support, 29% could move with support, and 43% walked independently. Participants were examined for PDD in two stages. In the first stage, probable participants were determined by direct observation, Autism Behavior Checklist score, and medical reports. In the second stage, those with ,probable' symptoms underwent psychiatric examination and their autistic symptoms were scored on the Childhood Autism Rating Scale. The final diagnosis of autistic disorder or PDD-NOS was given according to DSM-IV criteria. Fourteen (11%) and five (4%) of the participants met the criteria for autistic disorder and PDD-NOS respectively. Children with CP and PDD differed from those without PDD in terms of type of CP (p=0.02), presence of epilepsy (p<0.001), intellectual level (p<0.001), and level of speech (p<0.001). PDD was more common in children with tetraplegic, mixed, and hemiplegic CP, and in children with epilepsy, learning disability,, and low level of speech. The findings corroborate the notion that CP is a complex disorder, often associated with additional impairments. PDD is not rare in CP and should be considered in patients with comorbid conditions such as epilepsy, learning disability, and language delay and in the presence of tetraplegic, mixed, and hemiplegic CP types. [source] Hypercalcaemia of malignancy: an undiagnosed and undertreated diseaseJOURNAL OF INTERNAL MEDICINE, Issue 1 2001O. Lamy Lamy O, Jenzer-Closuit A, Burckhardt P (University Hospital, Lausanne, Switzerland). Hypercalcaemia of malignancy: an undiagnosed and undertreated disease. J Intern Med 2001; 250: 73,79. Background.,Hypercalcaemia of malignancy, a relatively frequent phenomenon, seems to be insufficiently recognized and treated. Its symptoms are not specific, but they affect the quality of life. Methods.,A prospective study to analyse the influence of symptoms caused by hypercalcaemia on the decision of the admitting physician, the motivation for treatment, and the effect of the treatment on the given symptoms in hospitalized patients with oncologic disease in progression, where confounding causes of similar symptoms such as cerebral metastasis, radiotherapy, treatment with opioids, etc., were excluded. Results.,A total of 71 patients, mean age 65 + 11 years, fulfilled the strict inclusion criteria. About 42% were hospitalized because of symptoms caused by hypercalcaemia, but none of the medical reports mentioned hypercalcaemia as reason for hospitalization. Specific antihypercalcaemic therapy was given to only 37% of patients, and only 25% got an adequate rehydratation. Antihypercalcaemic treatment was guided by the severity of hypercalcaemia (>3.00 mmol L,1), not by the symptoms. Polyuria-polydipsia, nausea-vomiting and constipation were correlated with hypercalcaemia. These symptoms, as well as confusion-stupor and bone pains improved significantly when calcaemia was normalized. Patients with calcaemia normalized returned home most frequently (P < 0.03). Conclusions.,Malignant hypercalcaemia remains mostly undiagnosed in medical praxis. Specific treatment occurs in too small fractions of the patients. As the normalization of calcaemia significantly improves the symptoms because of hypercalcaemia and the quality of life, rapid rehydration and specific calcium lowering treatments should be part of palliative measures in all patients with malignant hypercalcaemia. [source] Septic arthritis in patients followed-up in neonatal intensive care unitPEDIATRICS INTERNATIONAL, Issue 6 2002Sevki Kabak Abstract Background: Septic arthritis is an uncommon, but serious disorder in neonates. Most patients survive with permanent handicaps. Due to the rarity of this condition in neonates and paucity of signs and symptoms, the diagnosis of septic arthritis in newborns is more difficult than in older children. Methods: Septic arthritis or suppurative arthritis is an infection of the joint by a variety of microorganisms, including bacteria, viruses, mycobacteria and fungi. Purulent synovial fluid, positive culture and positive Gram stain were accepted as a gold standard for exact diagnosis. Fourteen neonates who were followed-up in a neonatal intensive care unit, with septic arthritis, were included in a study based on a review of medical reports and a long-term clinical and radiological follow-up. Clinical symptoms, bacteriology, risk factors and outcomes are discussed. Results: Staphylococcus aureus was the predominant causative organism. Risk factors for septic arthritis were prematurity (4/14), umbilical catheterization or venous catheterization (3/14), sepsis (3/14), perinatal asphyxia (2/14) and difficult birth (1/14). All cases of septic arthritis in neonates were improved without squealae except in two patients. One patient died and one patient had severe squealae. In these two patients, the duration of disease from clinical onset to initiation of therapy was long. Conclusion: The most important prognostic factor in predicting a favorable outcome in neonatal septic arthritis is early diagnosis and therapy. When appropriate treatment is delayed, catastrophic sequelae are inevitable. Early diagnosis of the condition and rapid removal of pus are mandatory for the survival of the joint. Long-term follow-up may reveal effects of epiphyseal damage, early degenerative changes and limitation of the range of motion. [source] | ||||||||||