General hospital services for deliberate self-poisoning: an expensive road to nowhere?

Abstract:

:This study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current self-harm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were admitted were nearly twice as likely to receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be offered follow-up. In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and after-care. This state of affairs cannot be justified on financial or clinical grounds.

journal_name

Postgrad Med J

authors

Kapur N,House A,Creed F,Feldman E,Friedman T,Guthrie E

doi

10.1136/pgmj.75.888.599

subject

Has Abstract

pub_date

1999-10-01 00:00:00

pages

599-602

issue

888

eissn

0032-5473

issn

1469-0756

journal_volume

75

pub_type

杂志文章,多中心研究
  • Intracoronary ultrasound.

    abstract::Although contrast angiography is important in the diagnosis and treatment of atherosclerotic disease, it does have limitations. Intracoronary ultrasound more accurately assesses the amount of atherosclerosis and has given us new insights into the pathophysiology of coronary plaque accumulation and remodelling. It also...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.74.874.468

    authors: Hammond C,Causer JP,Perry RA

    更新日期:1998-08-01 00:00:00

  • Elevated serum parathyroid hormone related protein and 1,25-dihydroxycholecalciferol in hypercalcaemia associated with adult T-cell leukaemia-lymphoma.

    abstract::Hypercalcaemia occurs in up to 80% of patients with adult T-cell leukaemia-lymphoma (ATLL) associated with human T-cell leukaemia virus-1 infection. Elevated serum levels of 1,25-dihydroxycholecalciferol, implicated in the pathogenesis of hypercalcaemia in lymphoma, and of parathyroid hormone-related protein (PTHrP), ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.68.803.753

    authors: Johnston SR,Hammond PJ

    更新日期:1992-09-01 00:00:00

  • Assessing clinical competency in medical senior house officers: how and why should we do it?

    abstract::Most consultants are involved in the training and assessment of several grades of doctors in training especially senior house officers (SHOs) and specialist registrars. In the medical and other specialties there is an increasing trend towards assessing junior doctors' competency using the record of in-training assessm...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.2003.011718

    authors: Carr SJ

    更新日期:2004-02-01 00:00:00

  • Staphylococcus aureus endocarditis presenting as acute scrotal pain.

    abstract::A previously healthy 17 year old boy had Staphylococcus aureus endocarditis presenting as acute scrotal pain. There was no trauma or evidence of scrotal or epididymal infection. The pain subsided after therapy for endocarditis was started. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.63.741.585

    authors: Watanakunakorn C

    更新日期:1987-07-01 00:00:00

  • Post-exposure prophylaxis for blood borne viral infections in healthcare workers.

    abstract::Healthcare workers have a high risk of occupational exposure, more so in developing countries, with high incidence of blood borne diseases and prevalence of unsafe practices. Among the various blood borne diseases, the most common and important ones are HIV infection, hepatitis B, and hepatitis C. Most of the occupati...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.79.932.324

    authors: Varghese GM,Abraham OC,Mathai D

    更新日期:2003-06-01 00:00:00

  • Cerebral scintigraphy--the phoenix rises again.

    abstract::This paper reviews the development of cerebral scintigraphy from its early days of planar imaging with simple technetium-99m labelled compounds to the recent revival of the technique in the form of positron-emission and single-photon emission tomography. A short explanation of instrumentation and radiopharmaceuticals ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.64.747.4

    authors: Shepstone BJ

    更新日期:1988-01-01 00:00:00

  • Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features.

    abstract::Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression an...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.70.819.10

    authors: Daly BD,Chow CC,Cockram CS

    更新日期:1994-01-01 00:00:00

  • Focused assessment with sonography in trauma (FAST): should its role be reconsidered?

    abstract::Focused assessment with sonography in trauma (FAST) is a limited ultrasound scan performed in the emergency department to assess patients admitted with blunt abdominal trauma (BAT). It is normally undertaken by emergency physicians in order to identify the presence of free fluid, which may represent haemoperitoneum. T...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2008.076711

    authors: Smith J

    更新日期:2010-05-01 00:00:00

  • Vertebral osteomyelitis due to Pseudomonas aeruginosa.

    abstract::A case of vertebral osteomyelitis due to Pseudomonas aeruginosa is described and the problems of diagnosis and treatment discussed. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.53.620.347

    authors: Denham MJ,Goodwin CS

    更新日期:1977-06-01 00:00:00

  • Eosinophilic gastroenteritis mimicking pancreatic cancer.

    abstract::Eosinophilic gastroenteritis is a condition characterised by eosinophilic infiltration of the gastrointestinal tract. Biliary obstruction is an unusual presentation. A case where the initial investigations were consistent with carcinoma of the head of pancreas but the resection specimen showed no malignancy is present...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pmj.78.922.498

    authors: Christopher V,Thompson MH,Hughes S

    更新日期:2002-08-01 00:00:00

  • A clinicopathological classification of granulomatous disorders.

    abstract::Granulomatous disorders comprise a large family sharing the histological denominator of granuloma formation. A granuloma is a focal compact collection of inflammatory cells, mononuclear cells predominating, usually as a result of the persistence of a non-degradable product and of active cell mediated hypersensitivity....

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.76.898.457

    authors: James DG

    更新日期:2000-08-01 00:00:00

  • Bacteraemia after manipulation of the urinary tract. The importance of pre-existing urinary tract disease and compromised host defences.

    abstract::The factors related to the occurrence of bacteraemia following urinary tract manipulation were studied in a large community hospital. During a 3-year period, forty-six of 326 episodes of hospital-acquired bacteraemia were associated with urinary tract manipulation. All thirty of forty-six cases felt to be definitely r...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.54.636.668

    authors: Quintiliani R,Klimek J,Cunha BA,Maderazo EG

    更新日期:1978-10-01 00:00:00

  • Roth's spots: an unusual presentation of HIV.

    abstract::A 46 year old Nigerian man presented with a four week history of progressive bilateral visual loss. He had been unwell, with weight loss, fever, and night sweats for six months. Dilated fundoscopy revealed macular haemorrhages and diffuse Roth's spots. The patient was found to be severely anaemic and a bone marrow asp...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pmj.79.928.108

    authors: Vose MJ,Charles SJ

    更新日期:2003-02-01 00:00:00

  • Severe acute respiratory syndrome (SARS): epidemiology and clinical features.

    abstract::Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a significant morbidity and mortality. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache, and dyspnoea. Older subjects may present without the typical febrile response. Common lab...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2004.020263

    authors: Hui DS,Chan MC,Wu AK,Ng PC

    更新日期:2004-07-01 00:00:00

  • The Blo-Bag, a disposable spacer.

    abstract::" Blo -Bag", a new disposable spacer device, has been tested in conjunction with Duovent metered dose inhaler. Duovent produced a significant bronchodilatation for the duration of the study. When delivered by the " Blo -Bag" it produced a significantly greater increase in peak expiratory flow rate than when delivered ...

    journal_title:Postgraduate medical journal

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Woodcock A,Humberstone A,Kendall J,Pierce A

    更新日期:1984-01-01 00:00:00

  • Variations in the provision of resuscitation equipment: survey of acute hospitals.

    abstract:BACKGROUND:There are wide variations in survival after cardiopulmonary resuscitation. The aim of this survey was to describe how equipment provision of resuscitation trolleys was deployed in a range of clinical ward areas. METHODS:The equipment in randomly selected resuscitation trolleys in all 14 South West Thames Re...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,多中心研究

    doi:10.1136/pgmj.2004.026930

    authors: Hogh L,Kane I,Bhalla A,Ward MC

    更新日期:2005-06-01 00:00:00

  • Placebo.

    abstract::Placebo, used here to mean an inert treatment given as if it was a real treatment, means lots of different things to different people. The structure of the article is that it begins by talking about the technical use of placebos in clinical trials, and the extent of the placebo response, then about the mechanism--"How...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2004.024737

    authors: McQuay HJ,Moore RA

    更新日期:2005-03-01 00:00:00

  • Ventricular fibrillation and initial plasma potassium in acute myocardial infarction.

    abstract::In a retrospective review of patients admitted to a coronary care unit, 809 patients had a definite myocardial infarction and plasma potassium was measured within 48 hr. The mean (+/- s.d.) plasma potassium was 4.04 (+/- 0.56) mmol/litre. A potassium concentration of less than 4.0 mmol/litre was found in 383 patients,...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.59.692.354

    authors: Thomas RD

    更新日期:1983-06-01 00:00:00

  • Vasodilator therapy of dilated cardiomyopathy.

    abstract::Vasoconstriction increases impedance to ventricular ejection and impairs the performance of the dilated myopathic heart. Vasodilator drug therapy by reducing vascular resistance, increasing vascular compliance and increasing vascular capacitance improves cardiac function and relieves the signs and symptoms of congesti...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.62.728.599

    authors: Cohn JN

    更新日期:1986-06-01 00:00:00

  • Evaluation of renal function in elderly heart failure patients on ACE inhibitors.

    abstract::A total of 187 heart failure patients aged 65-92 years, with pretreatment serum creatinine levels below 200 mumol/l, were monitored for more than 12 months on angiotensin-converting enzyme (ACE) inhibitor therapy. Optimal ACE inhibitor dosage was found in 27% of patients, while a significant deterioration in renal fun...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.75.883.275

    authors: Jolobe OM

    更新日期:1999-05-01 00:00:00

  • Chronic hepatitis B in hepatocarcinogenesis.

    abstract::Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and has a wide geographical variation. Eighty per cent of HCC is attributed to hepatitis B virus (HBV). The predominant carcinogenic mechanism of HBV associated HCC is through the process of liver cirrhosis, but direct oncogenic effects of HB...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2006.047431

    authors: Park NH,Song IH,Chung YH

    更新日期:2006-08-01 00:00:00

  • Interventions for smoking cessation in patients admitted with Acute Coronary Syndrome: a review.

    abstract::Tobacco smoking contributes to about six million deaths per year and is predicted to increase in the future. Several pharmacological interventions are used for smoking cessation. Trials using nicotine replacement therapy (NRT) in acute coronary syndrome (ACS) showed inconclusive results. Furthermore, three trials usin...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/postgradmedj-2017-135040

    authors: Chehab OM,Dakik HA

    更新日期:2018-02-01 00:00:00

  • Blind drunk: alcoholic pancreatitis and loss of vision.

    abstract::Acute loss of vision and alcoholic intoxication suggests the possibility of methanol poisoning. In this report we describe an alcoholic patient who complained of blindness after recovering from alcoholic pancreatitis and delirium tremens. Visual acuity was severely impaired and fundoscopy revealed florid bilateral cot...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.69.808.151

    authors: Steel JR,Cockcroft JR,Ritter JM

    更新日期:1993-02-01 00:00:00

  • Iron deficiency in pernicious anaemia: a neglected diagnosis.

    abstract::In 114 patients (52 males and 62 females) with long-standing pernicious anaemia, hypoferritinaemia was found in 27 (23.7%) and hypochromic microcytic anaemia in 19 (16.6%). Our findings indicate that iron deficiency is a common yet neglected complication of long-standing pernicious anaemia and warrants greater diagnos...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.64.748.110

    authors: Atrah HI,Davidson RJ

    更新日期:1988-02-01 00:00:00

  • Villous adenoma of the rectum with electrolyte depletion, diabetes and hypogonadism.

    abstract::The case of a woman with a large benign villous papilloma of the rectum, presenting with sodium and water depletion and later complicated by persistent hypokalaemia, is described. The patient also suffered from primary hypogonadism and diabetes. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.41.474.186

    authors: Bamford JK,Galbraith HJ,Pender BW

    更新日期:1965-04-01 00:00:00

  • The implementation of cardiac arrest treatment recommendations in English acute NHS trusts: a national survey.

    abstract:PURPOSE OF THE STUDY:There are approximately 35 000 in-hospital cardiac arrests in the UK each year. Successful resuscitation requires integration of the medical science, training and education of clinicians and implementation of best practice in the clinical setting. In 2015, the International Liaison Committee on Res...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/postgradmedj-2016-134732

    authors: Carberry J,Couper K,Yeung J

    更新日期:2017-11-01 00:00:00

  • Secondary hypertension: a condition not to be missed.

    abstract::Hypertension is a chronic disorder which often entails debilitating cardiovascular and renal complications. Hypertension mostly arises as a complex quantitative trait that is affected by varying combinations of genetic and environmental factors. Secondary hypertension has been encountered with increasing frequency. Th...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2011.118661

    authors: Sukor N

    更新日期:2011-10-01 00:00:00

  • Leuco-erythroblastosis following withdrawal from glucocorticoid therapy.

    abstract::Leuco-erythroblastosis has many known associations (Burkett, Cox and Fields, 1965; Weick, Hagedorn and Linman, 1974; Retief, 1964), but the only ones related to drug therapy are the well established response to haematinics (Burkett et al., 1965) and one possible case following anti-epileptic therapy (Retief, 1964). Th...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.53.621.391

    authors: Trenchard PM,Wells CE,Jarriwalla AG

    更新日期:1977-07-01 00:00:00

  • Bacterial calcification in infective endocarditis.

    abstract::The present report is the first description to our knowledge of a clinical case of bacterial calcification in human infective endocarditic vegetations. Partial calcification of bacteria within vegetations may be a further mechanism of bacterial protection from host defences and antibiotics. Similar calcification has r...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.65.767.665

    authors: Poller DN,Curry A,Ganguli LA,Routledge RC

    更新日期:1989-09-01 00:00:00

  • A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis.

    abstract:BACKGROUND:Despite the importance of timely management of patients with inflammatory arthritis (IA), delays exist in its diagnosis and treatment. OBJECTIVE:To perform a systematic literature review to identify strategies addressing these delays to inform an American College of Rheumatology (ACR)/European League Agains...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/postgradmedj-2011-201063rep

    authors: Villeneuve E,Nam JL,Bell MJ,Deighton CM,Felson DT,Hazes JM,McInnes IB,Silman AJ,Solomon DH,Thompson AE,White PH,Bykerk VP,Emery P

    更新日期:2013-04-01 00:00:00