Abstract:
OBJECTIVE:To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN:National clinical survey. SETTING:England and Wales. SUBJECTS:A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. MAIN OUTCOME MEASURES:Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. RESULTS:10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. CONCLUSIONS:Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Appleby L,Shaw J,Amos T,McDonnell R,Harris C,McCann K,Kiernan K,Davies S,Bickley H,Parsons Rdoi
10.1136/bmj.318.7193.1235keywords:
subject
Has Abstractpub_date
1999-05-08 00:00:00pages
1235-9issue
7193eissn
0959-8138issn
1756-1833journal_volume
318pub_type
杂志文章abstract:OBJECTIVE:To study prevalence of Turner's syndrome in Denmark and to assess validity of prenatal diagnosis. DESIGN:Study of data on prenatal and postnatal Turner's syndrome in Danish Cytogenetic Central Register. SUBJECTS:All registered Turner's syndrome karyotypes (100 prenatal cases and 215 postnatal cases) during ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7022.16
更新日期:1996-01-06 00:00:00
abstract:OBJECTIVE:To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia. DESIGN:Systematic overview and meta-regression analyses of randomised controlled trials, as a basis for formal development of guidelines. SUBJECTS:12 649 patients in 52 randomised trials co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.321.7273.1371
更新日期:2000-12-02 00:00:00
abstract::South African Health Minister Dr. Manto Tshabalala-Msimang was accused of human rights abuse for refusing to supply zidovudine to all HIV-positive pregnant women. The accusations were laid by Dr. Costa Gazi, a South African doctor employed in the state health system with the Human Rights Commission. Dr. Gazi believe...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:
更新日期:2000-01-29 00:00:00
abstract:OBJECTIVES:To examine a possible effect on labour of training the muscles of the pelvic floor during pregnancy. DESIGN:Randomised controlled trial. SETTING:Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting. PARTICIPANTS:301 healthy nulliparous women randomly allocated...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38163.724306.3A
更新日期:2004-08-14 00:00:00
abstract:OBJECTIVES:To measure the potential for cadaver organ retrieval in New South Wales and to determine the reasons for potential donors failing to become actual donors. DESIGN:Prospective audit of all patients dying in five hospitals in New South Wales between 1 December 1989 and 30 November 1990; quality assurance of th...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6838.1339
更新日期:1992-05-23 00:00:00
abstract::To assess the prevalence of both diagnosed and undiagnosed diabetes mellitus in an area of predominantly Asian population the Coventry diabetes study is carrying out house to house screening for diabetes in people aged 20 and over in Foleshill, Coventry. In the first five of 12 areas to be studied 2130 of 2283 Asian (...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6665.18
更新日期:1989-01-07 00:00:00
abstract:OBJECTIVE:To study the impact of skin surgery in general practice on the workload of a pathology laboratory and to identify what further training might be helpful. DESIGN:Analysis of skin biopsy specimens from general practitioners before and after their new contract to determine numbers of specimens, changes in diagn...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6819.93
更新日期:1992-01-11 00:00:00
abstract::I have attempted to adopt the perspective of a patient--albeit one with a rather atypical background--to explore what I want from health research and researchers. This has left me with the impression that health researchers could serve the interests of the public more effectively in a variety of ways, and that they wo...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6990.1315
更新日期:1995-05-20 00:00:00
abstract:OBJECTIVE:To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. DESIGN:Prospective register linkage study. SUBJECTS:All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7251.1708
更新日期:2000-06-24 00:00:00
abstract:OBJECTIVE:To determine the incidence of cervical cancer after several negative cervical smear tests at different ages. DESIGN:Prospective observational study of incidence of cervical cancer after the third consecutive negative result based on individual level data in a national registry of histopathology and cytopatho...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1354
更新日期:2009-04-24 00:00:00
abstract::Chronic insomnia is a common condition that affects people worldwide and has negative effects on patients' health and wellbeing. The treatment of insomnia can be complex and time consuming for patients and providers. Although behavioral interventions are the first line therapy, there are barriers to access for these t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.i2123
更新日期:2016-07-06 00:00:00
abstract:OBJECTIVES:To assess the acceptability of screening newborn boys for Duchenne muscular dystrophy. DESIGN:Screening is offered on the basis of informed consent in response to an information sheet entitled "A new test for baby boys--Do you want it?" The programme includes a prospective long term evaluation of family res...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6874.357
更新日期:1993-02-06 00:00:00
abstract:OBJECTIVE:To determine whether women with atrial fibrillation have a higher risk of stroke than men. DESIGN:Nationwide retrospective cohort study. SETTING:Patients with a diagnosis of atrial fibrillation in the Swedish hospital discharge register between 1 July 2005 and 31 December 2008. Information about drug treatm...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e3522
更新日期:2012-05-30 00:00:00
abstract:OBJECTIVE:To compare the use and effect of a computer based information system for cancer patients that is personalised using each patient's medical record with a system providing only general information and with information provided in booklets. DESIGN:Randomised trial with three groups. Data collected at start of r...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.319.7219.1241
更新日期:1999-11-06 00:00:00
abstract::Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.l6983
更新日期:2020-02-13 00:00:00
abstract:OBJECTIVES:Analysis of incidence and characteristics of congenital abdominal wall defects, with special reference to the differences between the incidence of gastroschisis and exomphalos (omphalocele). DESIGN:Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7062.903
更新日期:1996-10-12 00:00:00
abstract::Care in the community for insane people today is more a matter of expert provision than communal support. In consequence, although they are no longer confined to hospital, mentally ill people largely remain marginalised in a society that does not have the resources, nor often the inclination, to take responsibility fo...
journal_title:BMJ (Clinical research ed.)
pub_type: 历史文章,杂志文章
doi:10.1136/bmj.311.7021.1708
更新日期:1995-12-23 00:00:00
abstract:OBJECTIVE:To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics. DESIGN:Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments. SETTING:20 bed unit specialising in the rehabilitation of patient...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7048.13
更新日期:1996-07-06 00:00:00
abstract:OBJECTIVES:To investigate use of commodes and attitudes of users and carers to them. DESIGN:Interview with semi-structured questionnaire of subjects supplied with commodes from Leeds community appliance centre. SUBJECTS:140 users of a commode and 105 of their carers. RESULTS:Main reasons for being supplied with a co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6914.1258
更新日期:1993-11-13 00:00:00
abstract::Molecular techniques have revolutionised our knowledge of cell and tissue function in both health and disease. We already have new and powerful treatments based on an understanding of communication between cells by messenger molecules called cytokines. Furthermore, there is great therapeutic promise in defining molecu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7075.203
更新日期:1997-01-18 00:00:00
abstract:OBJECTIVES:To determine the impact on teenage pregnancy of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the United Kingdom. DESIGN:Systematic review, including a statistical meta-analysis of controlled tr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.b4254
更新日期:2009-11-12 00:00:00
abstract:OBJECTIVE:To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care. DESIGN:24 month, multicentre, pragmatic cluster randomised controlled trial SETTING:40 general prac...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.g5392
更新日期:2014-09-10 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN:Randomised clinical trial. SETTING:Primary health care in the Netherlands. PATIENTS:256 patients with non...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.304.6827.601
更新日期:1992-03-07 00:00:00
abstract:OBJECTIVE:To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. DESIGN:Cluster randomised controlled trial. SETTING:40 public high schools in the state of Morelos, Mexico. PARTICIPANTS:10 954 firs...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38796.457407.80
更新日期:2006-05-20 00:00:00
abstract::The UN has reported that five multinational pharmaceutical companies would cut down HIV drug prices in the developing world. One of these drug companies is GlaxoWellcome, which has promised to reduce the price of zidovudine and lamivudine to US$2 in the poorest nations, a fifth of its price in the US. Although Peter ...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.320.7246.1357
更新日期:2000-05-20 00:00:00
abstract:OBJECTIVE:To measure the effect of brief behavioural counselling in general practice on patients' consumption of fruit and vegetables in adults from a low income population. DESIGN:Parallel group randomised controlled trial. SETTING:Primary health centre in a deprived, ethnically mixed inner city area. PARTICIPANTS:...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.326.7394.855
更新日期:2003-04-19 00:00:00
abstract:OBJECTIVES:To examine how insurance companies assess proposals for life assurance from applicants with raised cholesterol concentrations and to determine the excess mortality rating applied. DESIGN:Survey of 49 companies underwriting term life assurance. SETTING:United Kingdom. SUBJECTS:Four fictional men aged 30 se...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6781.891
更新日期:1991-04-13 00:00:00
abstract:OBJECTIVE:To study the association between wheezy symptoms in young children and the presence of bacteria in the airways. DESIGN:Birth cohort study. SETTING:Clinical research unit in Copenhagen. PARTICIPANTS:Children of asthmatic mothers, from age 4 weeks to 3 years, with planned visits and acute admissions to the r...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c4978
更新日期:2010-10-04 00:00:00
abstract::Physicians need to evaluate clinical research critically, and determining the power of a study is an essential component of research evaluation. This report presents a graphical aid that permits rapid power determination for clinical trials with two groups. Power curves were developed for dichotomous outcomes by setti...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6649.672
更新日期:1988-09-10 00:00:00
abstract:OBJECTIVE:To evaluate the relative efficacy of programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitors versus conventional drugs in patients with cancer that were PD-L1 positive and PD-L1 negative. DESIGN:Meta-analysis of randomised controlled trials. DATA SOURCES:PubMed, Embase, Cochrane ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.k3529
更新日期:2018-09-10 00:00:00