This new scale, while procedurally more exacting than the Waldrop scale, more clearly defines the topography of anomalies previously suspected in individuals with schizophrenia. These findings constitute direct evidence for disturbed craniofacial development in schizophrenia and indicate origins in the foetal period during which the characteristic human facial pattern evolves in close association with brain differentiation.

Purpose of review:Provision of education to inform decision making for renal replacement therapy (RRT) is a key component in the management of chronic kidney disease (CKD), yet patients report suboptimal satisfaction with the process of selecting a dialysis modality. Our purpose is to review the influencers of RRT decision making in the CKD population, which will better inform the process of shared decision making between clinicians and patients.Sources of information:PubMed and Google Scholar.Methods:A narrative review was performed using the main terms “chronic kidney disease,” “CKD,” “dialysis,” “review,” “decision-making,” “decision aids,” “education,” and “barriers.” Only articles in English were accessed. The existing literature was critically analyzed from a theoretical and contextual perspective and thematic analysis was performed.Key findings:Eight common themes were identified as influencers for decision making. “Patient-focused” themes including social influence, values and beliefs, comprehension, autonomy and sociodemographics, and “clinician-focused” themes including screening, communication, and engagement. Early predialysis education and decision aids can effectively improve decision making. Patient-valued outcomes need to be more fully integrated into clinical guidelines.Limitations:This is not a systematic review; therefore, no formal tool was utilized to evaluate the rigor and quality of studies included and findings may not be generalizable.Implications:Standardized comprehensive RRT education programs through multidisciplinary health teams can help optimize CKD patient education and shared decision making. Involving patients in the research process itself and implementing patient values and preferences into clinical guidelines can help to achieve a patient-centered model of care.

Background:Patients with chronic kidney disease (CKD) are asked to choose a renal replacement therapy or conservative management. Education and knowledge transfer play key roles in this decision-making process, yet they remain a partially met need.Objective:We sought to understand the dialysis modality decision-making process through exploration of the predialysis patient experience to better inform the educational process.Design:Qualitative descriptive study.Setting:Kidney Care Centre of London Health Sciences Centre in London, Ontario, Canada.Patients:Twelve patients with CKD, with 4 patients on in-center hemodialysis, home hemodialysis, and peritoneal dialysis, respectively.Measurements:Not applicable.Methods:We conducted semistructured interviews with each participant, along with any family members who were present. Interviews were transcribed verbatim. Conventional content analysis was used to analyze the transcripts for common themes. Representative quotes were decided via team consensus. A patient collaborator was part of the research team.Results:Three themes influenced dialysis modality decision making: (i) Patient Factors: individualization, autonomy, and emotions; (ii) Educational Factors: tailored education, time and preparation, and available resources; and (iii) Support Systems: partnership with health care team, and family and friends.Limitations:Sample not representative of wider CKD population. Limited number of eligible patients. Poor recall may affect findings.Conclusions:Modality decision making is a complex process, influenced by the patient’s health literacy, willingness to accept information, predialysis lifestyle, support systems, and values. Patient education requires the flexibility to individualize the delivery of a standardized CKD curriculum in partnership with a patient-health care team, to fulfill the goal of informed, shared decision making.

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Widespread variations in electroconvulsive therapy (ECT) prescription between and within countries have led many researchers to study professionals' attitudes to the procedure. A questionnaire looking at knowledge and attitudes was administered to 593 medical and nursing students, psychiatrists and anesthetists, and theater and psychiatric nurses. Respondents were based in 2 Irish cities, Dublin and Cork. Poorer knowledge of ECT was found in the nursing group, and this included psychiatric nurses: a third overestimate ECT mortality, most did not know if it caused permanent brain damage, and only 1 psychiatric nurse (2.9%) expressed positive attitudes to its use. Nursing students had significantly lower knowledge and more negative attitudes than medical students, and exposure to the procedure of ECT failed to improve their attitudes. The strongest predictor of better knowledge and more positive ECT attitudes was membership of the medical group. There were direct associations between better knowledge and more positive attitudes in the medical group but not among the nursing group. Low ECT knowledge among psychiatric nurses has implications in obtaining patients' valid consent. Our failure to link exposure to ECT to better nursing attitudes is discussed along with other educational lessons.

Objectives: To review the literature on older people with enduring or recurrent severe mental illness with an onset earlier than 65 years (graduates) and, in particular, to look at the specific features and needs of this group.Method: A Medline literature search produced 41 relevant papers and reports on the subject.Results: There are a substantial number of older people with severe mental illness and the number will rise in line with increased longevity. As they age these patients' psychiatric disabilities are compounded by medical and social problems. The move to community based care has largely ignored the needs of graduates who were previously cared for in psychiatric institutions.Conclusion: There is an urgent need to plan and develop adequate services for this vulnerable group.

Objectives: There has been no specific planning for older people with enduring or recurrent severe mental illness in Ireland. This survey aims to identify the number of affected over 65 year olds (graduates) and 55-64 year olds (prospective graduates) in the Health Service Executive, Eastern Region, their diagnoses and their use of psychiatric services.Method: A comprehensive survey of the ten general adult psychiatry and four old age psychiatry services in the (HSE) Eastern Region was undertaken for the year 2003 to determine the number of patients, their diagnoses and service utilisation.Results: 649 people over 65 years old were identified within the general adult psychiatry services and a further 279 within the old age psychiatry services giving a total of 928. (This number rose to 1141 after correcting for missing outpatient data.) 1,397 people between the ages of 55-64 were identified. (This number rose to 1,916 after correcting for missing outpatient data.)Conclusions: There are substantial numbers of ‘graduates’ and ‘prospective graduates’ in the Eastern Region. It is essential that services for this population are specifically planned for and further qualitative research is required to inform this process.