Assisted admissions? A national survey of general practitioner experience of involuntary admissions.

The 2001 Mental Health Act introduced in 2006, changed how a patient is admitted involuntarily to a psychiatric unit. This paper reports on a national survey of general practitioners' experience implementing the Act. Five hundred and sixty eight (568) GPs completed the survey. Twenty five percent (25%) of respondants had not used it. When used, twenty four percent (24%) report that it takes seven hours or more to complete an admission. Fifty percent (50%) of respondents are confident to complete the necessary paperwork. Overall GPs are dissatisfied with arrangements for transport of patients (mean Likert score 3.5), primarily due to the time delay. GPs believe this places risk on the patient, family and GP. Only thirty-three percent (33%) of respondents feel that the Mental Health Act has improved the patient, GP and family experience of involuntary admission.

Health system changes needed to support people consulting general practice out of hours services in Ireland.

BACKGROUND: Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties. AIM: To establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral. DESIGN AND SETTING: Descriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc). METHODS: An anonymous extraction of retrospective data from 1 year of the out of hours' electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care. RESULTS: Over a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend. CONCLUSIONS: There are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.

Trends in the spatial and temporal distribution of 129I and 99Tc in coastal waters surrounding Ireland using Fucus vesiculosus as a bio-indicator.

Spatial and temporal trends in (129)I and (99)Tc concentrations around the Irish coastline have been evaluated using Fucus vesiculosus as a bio-indicator. (129)I concentrations in a recent set of seawater samples have also been recorded and reveal an identical spatial pattern. Concentrations of (129)I in Fucus from the northeast coast of Ireland proved to be at least two orders of magnitude higher than concentrations in Fucus from the west coast. The (129)I content of Fucus increased significantly between 1985 and 2003, in line with increases in discharges of (129)I from the Sellafield nuclear reprocessing plant. Similar trends were observed in the case of (99)Tc. (129)I/(99)Tc ratios in Irish seawater were deduced from the Fucus data, and compared to ratios in discharges from Sellafield and from the French reprocessing plant at Cap de la Hague. Levels of (129)I and (99)Tc in Fucus from the west coast were found to be enhanced with respect to levels in seaweeds from other regions in the Northern Hemisphere unaffected by discharges from nuclear installations such as those referred to.

The meniscofemoral ligaments of the knee.

The meniscofemoral ligaments (MFL) of the knee have both functional and clinical importance, but have been poorly described. We examined 42 human cadaver knees: there was at least one MFL in every joint and both ligaments were present in 27. The anterior MFL was present in the knees in all 18 males and in 17 of the 24 females. The posterior MFL was present in 16 males and 22 females. Measurement of the ligaments showed that they were of significant size. The mean midpoint width for the anterior MFL was 5.09 +/- 1.41 mm in males and 2.99 +/- 1.29 mm in females. The mean width of the posterior MFL was 5.48 +/- 2.13 mm in males and 3.79 +/- 2.56 mm in females. The average length of the anterior MFL was 27.09 +/- 2.15 mm in males and 24.38 +/- 3.39 mm in females, and the posterior MFL was 31.13 +/- 2.54 mm and 27.59 +/- 3.74 mm, respectively. There were anatomical variations in 16 (38%) knees (62.5% female, 37.5% male), more commonly in the posterior ligament. We conclude that the meniscofemoral ligaments are anatomically and probably functionally important structures in the human knee.

Geochemical fractionation of plutonium in anoxic Irish Sea sediments using an optimised sequential extraction protocol.

An optimised five-step sequential extraction protocol, incorporating the use of sodium citrate to inhibit resorption, has been used to assess the solid partition of plutonium under anoxic conditions in intertidal sediments from the Ravenglass Estuary in the north-eastern Irish Sea. The data reveal that the plutonium is predominantly bound to geochemical phases targeted by the acido-soluble and the exchangeable extractants, indicating that a significant proportion of the plutonium in these and similar sediments is associated with relatively mobile geochemical phases. The results are consistent with the relatively high level of plutonium remobilisation now known to be taking place throughout the north-eastern Irish Sea.

Anatomy of the proximal musculotendinous junction of the adductor longus muscle.

Injuries to the adductor longus commonly occur in the proximal part of the muscle tendon unit, close to the insertion site on the pubic bone. Ultrasonography, magnetic resonance imaging (MRI) and surgery have been helpful in localising the lesions, but the exact anatomy of the musculotendinous junction (MTJ) and insertion of the muscle remain unclear. We studied the anatomical features of the MTJ and measured the dimensions of the tendinous insertion into the pubic bone on 37 cadavers: 18 men and 19 women. The medial boundaries were the longest part of the tendon bilaterally in women, while the lateral aspect of the left muscle was greater in men. Tendinous fibres were predominantly found on the anterior surface, while the posterior surface consisted mainly of muscle tissue. The MTJ was clearly demarcated. There were several types of anomalies present which partially explains the difficulty in localising the site of injury and highlights the importance of individualized treatment.