Gotowa bibliografia na temat „Royal Mental Hospital, Manchester, Eng”

The enigmatic title is taken from my first professorial lecture given on 21 December 1980 at the Royal Manchester Children's Hospital. It linked psychiatry, mythology, and Christmas, bringing together three incredibles, in trying to bridge the credibility gap that makes paediatric/psychiatric liaison so tricky. The hospital psychiatrist is, like Tiresias in Sophocles' play, a bisexual (equally as available as repellent). Blinded when he once saw truth (mythically he peeped at Athena bathing), he was given the gift of prophecy by way of consolation. Tiresias, like the psychiatrist, although blind, knows all but, tiresomely, will not speak what he knows. “How does he know?” whisper the non-psychiatrists. “He is blind, he knows nothing”, they muse.

This study was primarily designed as a cost effectiveness analysis, comparing the costs and outcomes of day hospital and in-patient care for acute psychiatric illness. There are a growing number of this type of study in mental health (Knappet al., 1994; McCroneet al., 1994; Wiersmaet al., 1995; Mersonet al., 1996). The costing methodology used in such studies is becoming more consistent, but economic evaluation in mental health care is still developing and there remain several unanswered questions which will be considered in this paper. The wide variation in the costs of care of people with mental health problems is a critical factor in these studies (Grayet al., 1996).The cost effectiveness study is based on a previous randomised controlled trial conducted at Manchester Royal Infirmary which showed the feasibility and effectiveness of day patient treatment for acutely ill patients (Creedet al., 1990). In the current study 187 patients were randomly allocated, 94 to day hospital care and 93 to in-patient care. The method and results of the main cost effectiveness analysis are described in detail elsewhere (Creedet al., 1996a). This paper concentrates on reviewing the methods used to collect cost data, and further analysis of the data exploring variations in costs.

The benefaction for the award of an annual medal and prize to a member of the Royal Medico-Psychological Association was made by Mrs Elizabeth Holland, in memory of her brother, Samuel. She was herself a remarkable woman, who married a banker, had ten children, translated poetry from the German, began a social club for unemployed men, founded a cottage hospital, and was well-known for her wit, conversation and unflappability. However, she came from a remarkable family. Her older brother, William, was a noted Unitarian minister, philanthropist, and writer. Her sister-in-law, William's wife, was Mrs Elizabeth Gaskell, author of North and South, Wives and Daughters, and a celebrated, and for a season notorious, Life of Charlotte Brontë, as well as several other novels and short stories. Two of Elizabeth and William's children, Meta and Julia, were so well-loved in Manchester that flags flew at half-mast on their deaths.

Objective: There has been an accumulation of so-called ‘new long-stay’ (NLS) patients in psychiatric hospitals. To date, no Australian studies have characterised this patient group. We aimed to study the demography, and clinical and social functioning of the NLS population at Royal Park Hospital (RPH) together with patients' attitudes to treatment and views on future placement. Method: All 30 NLS patients at RPH were identified. Twenty-seven consenting patients were assessed using the following standardised instruments: Manchester Scale for psychopathology, Life Skills Profile (LSP), Physical Health Index and Patient Attitude Questionnaire. Information on past psychiatric history, past treatment and current treatment was collected. Insight and compliance were assessed. Results: The majority of patients were single men with a diagnosis of schizophrenia. Forty-one percent were detained in hospital involuntarily and 56% were considered dangerous to themselves or others. The patients were characterised by high levels of positive and negative symptoms. They were most impaired with respect to ‘social contact’ relative to the other subscales of the LSP. While 10 (48%) patients expressed a desire to leave hospital, only one patient considered that anyone would cohabit with them. Over two-thirds considered they had been unwell and that medication had helped. Staff rated one-third as having major problems with compliance. About two-thirds of patients had disability secondary to comorbid physical illnesses. Conclusion: Like other NLS patients studied in the United Kingdom and Ireland, this group had significant handicaps secondary to psychiatric illness, concomitant physical illness and disability and behaviour unacceptable in community settings. They were also characterised by significant social isolation. These factors may be important determinants of rehabilitation failure and need to be addressed in the process of de-institutionalisation as well as in longitudinal studies examining these and other factors predicting NLS status.

BackgroundPaediatric head injury is common, yet 80% are mild and require no investigation or treatment. Decision-making around neuroimaging is guided by clinical decision rules. Whether parents and clinicians interpret questions within these algorithms in the same way is not known. Understanding this is fundamental for public facing algorithms and parental guidance.We aimed to determine the inter-observer reliability of Pediatric Emergency Care Applied Research Network (PECARN) head injury algorithm completion between clinicians and parents of head injured children.We conducted a prospective, observational, feasibility study. Children over 2 years old, presenting to the Royal Manchester Children’s Hospital within 24 hours of a head injury, were recruited. Children were excluded if they required immediate resuscitation or non-accidental injury was suspected. Parents were given a questionnaire to complete whilst awaiting assessment, with the PECARN criteria in lay-man’s language. Following assessment, the treating clinician completed a similar questionnaire, blinded to the parent’s answers.57 children were included. The mean age was 5.8 years (SD 4.07). The most common mechanism of injury was a fall from standing (46%), with only 6 parents reporting a dangerous mechanism. Arrival Glasgow Coma Scale (GCS) was 15/15 in 98% of children. The inter-rater reliability for individual PECARN criteria was highly variable, with kappa values ranging from −0.10 to 1.00. There was poor agreement on whether the child was alert and acting normally (K −0.10, SE 0.49) but perfect agreement on other features of altered mental state including agitation, repeated questioning and taking longer than normal to respond (all K 1.0).The high variability in agreement between clinicians and parents when assessing PECARN criteria highlights differences in how these groups evaluate head injured children. This has significant implications for public facing algorithms, such as those used by NHS 111.

Background: COVID 19 is still presenting a clear and dynamic global threat. The United Kingdom remains one of the hardest hit countries from the pandemic. In January 2021 parliament announced that the UK will be entering a full national lockdown. This paper explores what effect lockdown measures had on rates of deliberate self-harm presentations to one NHS trust in Manchester UK.Methods: This paper compared the number of cases of deliberate self-harm which presented to the emergency department of Manchester Royal Infirmary for March-May in 2018, 2019 and 2020. This was achieved by utilising coding from emergency department data and reviewing hospital records surrounding each case.Results: 2018 recorded a total of 101 admissions as a result of DSH with all causes admissions of 8,514 making the proportions of admissions due to self-harm 1.19%. In 2019, 9,038 patients were admitted, of these, 130 (1.44%) were identified as DSH. In 2020 the total number of admissions fell to 5,676 with 118 admitted due to self-harm, representing 2.08% of admissions. The absolute number of admissions remained stable however the proportion of admissions due to self-harm was significantly higher in 2020 (p < 0.001). Other significant findings include a higher proportion of male admissions compared to females in 2020 (58.5%) and a decrease in the normal of cases relating to paracetamol overdose in 2020.Discussion: The findings demonstrated by this study do not indicate that lockdown is an absolute risk for DSH behaviours however it does illustrate the stable nature of these cases despite and dramatic decline in all cause admissions. The rate of increase of deliberate self-harm accelerated significantly between March and May in 2020. Steps must be taken to avoid a similar situation following the 2021 lockdown and beyond – focus on improving access to certain virtual services may help to achieve this goal.

Abstract Professor Hugh Freeman, DM, FRCPsych, has been Honorary Consultant Psychiatrist to the Salford Health Authority and to the Medical School of Manchester University since 1988. He took his first degree, in medicine, at the University of Oxford and was subsequently commissioned in the Royal Army Medical Corps. He then held appointments as Registrar at the Bethlem Royal and Maudsley Hospitals in London and at Littlemore Hospital in Oxford before taking up the post of Consultant Psychiatrist at Salford Royal Hospital. This began a long association with the Departments of Health and Social Services in Salford which continued until 1988. Professor Freeman has chaired or served on numerous public committees, panels, and working parties in the fields of mental health and psychiatry and is the author of a wide range of publications in these fields. He was Editor of the British Journal of Psychiatry and of Current Opinion in Psychiatry; he edited and contributed to Mental Health and the Environment, which was published in 1985.The relationship between mental health and the environment is a surprisingly neglected subject in spite of the greatly increased importance of the environment as a political and scientific issue in recent years. As a result, it is a scientific area that still lacks both adequate data and rigorously defined concepts. The problem was well expressed by the great environmentalist, Rene Dubos (1972): ‘The study of man as an integrated unit and of the ecosystems in which he functions is grossly neglected because it is not in the tradition which has dominated science since the seventeenth century’. As a result, there is now an urgent need to examine those aspects of people’s physical and social surroundings which are likely to influence mental health.