but it clearly demonstrates that this conclusion is not immutable. Failed vasectomies are generally categorised early or late by the time lapse from operation to observed failure and by the nature and numbers of any spermatozoa seen. This case belongs to a small subset of failures where initial sperm counts were zero and only later (in this case after the pregnancy of the man's wife) were any spermatozoa identified. Even In the four weeks before death there was no difference in the proportion of people under 35 consulting their general practitioner between suicides and controls (estimated odds ratio 1 67 (95% confidence interval 0 55 to 5 58), p=0 45). However, the patients who committed suicide when aged over 35 were significantly more likely to have consulted their general practitioner than controls (estimated odds ratio (95% confidence interval 1-27 to 6&25), p=00003).
CommentIn our study the proportion of all cases of suicide among people aged under 35 (37%) was nearly four times higher than that found in Bristol 30 years ago.' Although we have confirmed earlier findings that a substantial proportion of all suicide victims do see their general practitioner before their death (in this case 36% in the 4 weeks beforehand), this is clearly not the case for those aged under 35.
OBJECTIVES To set up and evaluate a multidisciplinary suicide assessment training course for "front-line" clinical staff. METHODS We looked at the impact of two types of training courses: full day Workshops with actors role-playing patients; and a half-day Lecture. Outcome measures included the Suicide Intervention Response Inventory Form 2, a reliable and valid measure of the ability to intervene with suicidal clients, and confidence in clinical management scales. RESULTS One hundred and seven trainees from different disciplines attended the courses. Both types of course led to improvements in the skills and confidence of the trainees which were sustained at the two month follow up. CONCLUSION Although using actors to role play was more expensive, trainees commented positively on their use. The better attendance and feedback at the sessions with actors suggest the extra expense involved in using them is worthwhile. We have shown it is feasible to run a reasonably inexpensive educational course in a Mental Health facility that provides effective training in suicide prevention to a large number of trainees.
Despite significant differences in presentation, elderly patients with schizophrenia and very late onset schizophrenia-like psychosis have much in common. Both groups are vulnerable with high levels of psychopathology, poor insight, sensory impairment and social isolation. The needs of older people with schizophrenia must be taken into account when services for older adults are planned.
Aims and methodA 4-month pilot was conducted to assess whether the clinical librarian model, which has been successfully used within acute hospitals, would work in a mental health setting. A librarian attended weekly clinical team meetings in two community mental health teams to help generate clinical questions. A summary of the evidence on each topic was then presented the following week. An evaluation of the pilot was carried out using a questionnaire survey, focus groups and interviews.ResultsResults suggest that the project had produced a positive impact within the teams and begun the process of embedding evidence-based information within clinical practice.Clinical implicationsWith some adaptations, the clinical librarian model can be an effective method of implementing evidence-based practice and addressing continuing professional development needs within mental health clinical teams.
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