Compulsory psychiatric treatment checklist: Instrument development and clinical application.

Instruments designed to evaluate the necessity of compulsory psychiatric treatment (CPT) are scarce to non-existent. We developed a 25-item Checklist (scoring 0 to 50) with four clusters (Legal, Danger, Historic and Cognitive), based on variables identified as relevant to compulsory treatment. The Compulsory Treatment Checklist (CTC) was filled with information on case (n=324) and control (n=251) subjects, evaluated under the Portuguese Mental Health Act (Law 36/98), in three hospitals. For internal validation, we used Confirmatory Factor Analysis (CFA), testing unidimensional and bifactor models. Multilevel logistic regression model (MLL) was used to predict the odds ratio (OR) for compulsory treatment based on the total scale score. Receiver Operating Characteristic analysis (ROC) was performed to predict compulsory treatment. CFA revealed the best fit indexes for the bifactor model, with all items loading on one General factor and the residual loading in the a priori predicted four specific factors. Reliability indexes were high for the General factor (88.4%), and low for specific factors (<5%), which demonstrate that CTC should not be performed in the subscales to access compulsory treatment. MLL reveals that for each item scored in the scale, it increases the OR by 1.26 for compulsory treatment (95%CI 1.21-1.31, p<0.001). Based on the total score, accuracy was 90%, and the best cut-off point of 23.5 detects compulsory treatment with a sensitivity of 75% and specificity of 93.6%. The CTC presents robust internal structure with a strong unidimensional characteristic, and a cut-off point for compulsory treatment of 23.5. The improved 20-item version of the CTC could represent an important instrument to improve clinical decision regarding CPT, and ultimately to improve mental health care of patients with severe psychiatric disorders.

Using Google Translate

INTRODUCTION: Doctor-patient communication is essential to the establishment of a therapeutic relationship and to the clinical improvement of the patient. Medical Interpreter Services (MIS) allow the doctors to communicate with patients that do not speak the same language of the clinical staff. However, MIS are not always available and when that happens it is of the upmost importance to find alternatives. OBJECTIVES AND METHODS: Presentation of a clinical case in which Google Translate^© (GT^©) was used as a translation tool to communicate with a patient. Discussion of the utility and validity of GT^© as a translation tool in Medicine. A Pubmed search for articles concerning the use of technological innovations as translation tools was performed using the key words: GT^©, language barriers, foreign language, and communication barriers. RESULTS: In the reported clinical case, GT^© allowed the translation and the establishment of communication with a foreign patient. The Pubmed search found two articles concerning the use and validity of GT^© as a translation tool in Medicine. CONCLUSIONS: GT^© is the most readily available and free initial mode of communication between a doctor and a patient when language is a barrier. Nonetheless, GT^