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About cmo

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  1. I can only say how things work where I am. The trust I am in operates on two sites. It used to be that eight trainees covered the night shift on one site with seven on the other. Now with reduction in numbers ten cover one site at night the other site is covered by advanced nurse practitioners. The ANP's work within the hospital at night scheme with a range of other staff medical and nursing. If a psychiatric assessment is requested they go to A+E to undertake it. It's probably too early to say how good it works but I know most of the nurses involved as the were all part of the liaison service or have undertaken joint assessments with me in the past. I have no concerns about their ability to undertake assessments, most of them are excellent with years of experience and it's no crazier than letting a Doctor with little or no psychiatric experience do it in the first week of their rotation. As to admissions they write all the paperwork and undertake the physical examination for which they have received additional training. If they have any concerns about the physical condition of someone they can seek advice or request a doctor to attend. Emergency detentions if required are completed by doctors within the emergency department. They are have all been on prescribers courses and are cleared to prescribe a limited number of psychotropic medications as appropriate. That's how it works. I don't think it's dangerous, they operate within boundaries and have been trained to work in those boundaries. If anything happens outside of that then they always have a Doctor available to give advice or intervene where necessary. My concern is of course about how we train the Doctors if most of the assessments are being undertaken by nurses but I guess if we wanted reduced working hours then we can't have everything.
  2. I liked the bit where the government said they were releasing the files because they were three years old and it was an old policy. No, you released the files because the information commissioner told you to. They can't be seen to lose face in any way can they?
  3. Don't know if this would be any use to you Abstract A retrospective suicide study revealed that the Forestry Commission car parks in the New Forest in southern England were a previously unrecognized magnet for nonlocal suicides, attracting as high a proportion of “visitors” (35/43 in 1993–97) as among suicides who jumped from the cliffs at the infamous Beachy Head (39/48 in 1993–97). Over 95% of the car park suicides died from car exhaust gas poisoning. A multiagency initiative aimed to reduce the number of suicides in the 140 New Forest car parks where restricting access was impossible, and environmental issues paramount. Signs displaying the Samaritans' national telephone number were erected in the 26 car parks in which 50% of the car park suicides had occurred. Numbers, location, and residence of all car park deaths were monitored for 3 years. Corresponding changes in other forest registration districts were also monitored. During the 3-year intervention period the number of car park suicides fell significantly from 10/year, 1988–1997, to 3.3/year. The average annual total number of suicides in the New Forest registration district also decreased. No significant changes were found in comparable forest districts. The number of suicides in the New Forest car parks remained low during the 2 years following the evaluation.
  4. Can I just say that it was also lovely in the South-West today. But I'm not going to complain about bias as the weather here is normally mince.
  5. I have to say I'm intrigued. What exact use are you talking about? I'm a bit more positive about the pound yes it might fall some more but I still think it's undervalued. Yes the Government is taking on lots of debt to bail out the banks but the UK national debt as a proportion of GDP is still behind most of Europe, the United States, even India. I'm not disagreeing about gold, that's why I said currency market. Gold will still be a safe bet to rise.
  6. Gold is traded like any other commodity. Just search for it and you will find gold traders. The time to buy is when the economy is just starting to turn as when people sense trouble they come out of stocks and into gold (the physicality of gold seems to be behind it) pushing the price of gold upwards. When the economy turns (still some time away) the price falls again as people sell to put their money back into the markets which are rising again. As to the credit rating question. Having a card will improve your rating provided you make the payments on time. This is because having a card on which you make regular payments means that the company can see that you are reliable with your payments. If you have no history of using credit facilities then lenders sometimes become concerned because they have no idea about your ability to manage credit. Having said that I still wouldn't recommend using borrowed money to play the stock, currency or any other market. If you can afford to do that then use your own money.
  7. It would be a brave man that would bet money that doesn't belong to them on currency at the moment. Yes the pound could fall further but there is an argument that it is undervalued against economies that have many of the same problems that the UK does. It could easily correct in the other direction.
  8. I don't think it's a trick the idea is just to tailor the therapy to the patient and build up from there. If she can already go to the bus stop then she should be looking to do the next thing on her hierarchy. So you could suggest either that she get on the bus for as long as she could tolerate with her partner or that she goes to the bus stop herself. Whichever one she would find the less anxiety provoking should be the next step. If she can't go to the bus stop then you say could you go with her to her husband or if he can't then could we arrange someone from the MDT to go out to the house and go with her. As to her coming to the hospital it doesn't need to be that formal. Really she just needs to work out what things she finds anxiety provoking and work her way through them. It would helpful if someone could teach her relaxation techniques to use as well while she is challenging her anxieties. The role of the partner depends on what he want to do but hopefully he would be willing to support the process. Finally if her husband won't do anything, she won't allow anyone in the house, and she can't go out on her own then you are, as you point out, in an impossible situation. I think your job then is to very clearly point that out to her (and him) in those terms and challenge her a bit as to how she is planning to take things forward. In that situation I think you would have to question how much she wants to beat her anxiety given that she is doing nothing to make any progress and setting up barriers to reasonable suggestions. Sympathise that it must be very difficult, but at the same time be clear that unless she is willing to accept help and challenge herself a bit then nothing will change.
  9. Nope so sounds like there is an opportunity there to do some if that's what you're thinking
  10. Here is what I found in five minutes, the most recent data comes from the independent police complaints. Lynch, R M; Simpson, M; Higson, M; Grout, P Section 136, The Mental Health Act 1983; levels of knowledge among accident and emergency doctors, senior nurses, and police constables. Emergency Medicine Journal. 19(4):295-300, July 2002.
  11. I agree with you completely Chris but adults with incapacity will not authorise to treat if the person is actively resisting. This is why if there is an underlying mental disorder my preference is always to use the mental health act. I accept that this might be because I'm more familiar with that act so am more comfortable rather than it being better. This is from the mental welfare guidance and explains why when they are actively resisting I prefer the MHA above adults with incapacity.
  12. Honestly I would be inclined to use the mental health act. The fact he is actively attempting to leave hospital, he appears to have a delirium which is a mental disorder and he requires treatment. The medical treatment in this case would be authorised by the act. This is the Scottish act though I don't know if the English act is any different. This is from the code of practice The fact that your staff may be physically preventing him from leaving and the underlying confusion appears related to a delirium makes me more inclined to use the mental health act.
  13. Nice of you to notice eu, I'm still around and look in regularly but just don't post as much as I used to.
  14. There are courses run in London through the institute of psychiatry, just keep an eye on their website and courses come up now and again. If you are further north then there is a company called northern networking who run PCR-R and RSVP courses at least twice a year in Edinburgh. Failing that just google the course you are looking for and you should get a list from somewhere.
  15. I would agree with the person who said that you should contact the solicitor and ask them exactly what they want you to cover. Lawyer reports can be different from court reports in that they very often don't want as much detail. Clarify any fees before you give them the report as dependent on the case there may be a limit to what you are allowed to charge them.