How secure are the secure psychiatric units in New South Wales?

Objectives:: To evaluate the therapeutic security characteristics of the secure forensic mental health inpatient units in New South Wales, Australia.

Methods:: This study evaluated all eight secure inpatient units in New South Wales using a validated tool, the Security Needs Assessment Profile.

Results:: A pattern of decreasing therapeutic security across the secure units was found, consistent with their intended security levels, from high security through to open security.

The risks, needs and stages of recovery of a complete forensic patient cohort in an Australian state.

Background: Routine outcome measures are increasingly being mandated across mental health services in Australia and overseas. This requirement includes forensic mental health services, but their utility in such specialist services and the inter-relationships between the measures remain unclear. This study sought to characterise the risks, needs and stages of recovery of an entire cohort of forensic patients in one jurisdiction in Australia.

Effect of Continued Cardiac Resynchronization Therapy on Ventricular Arrhythmias After Left Ventricular Assist Device Implantation.

Cardiac resynchronization therapy (CRT) reduces ventricular arrhythmia (VA) burden in some patients with heart failure, but its effect after left ventricular assist device (LVAD) implantation is unknown. We compared VA burden in patients with CRT devices in situ who underwent LVAD implantation and continued CRT (n = 39) to those who had CRT turned off before discharge (n = 26). Implantable cardioverter-defibrillator (ICD) shocks were significantly reduced in patients with continued CRT (1.

Relation Between Temperature Extremes and Symptom Exacerbation in Patients With Hypertrophic Cardiomyopathy.

Warm temperatures induce peripheral vasodilation, decrease afterload, and may concurrently increase the left ventricular outflow tract (LVOT) gradient. We aimed to assess the impact of subjective ambient temperature on hypertrophic cardiomyopathy (HC) symptoms and determine whether they were associated with LVOT gradient, patient quality of life (QOL), and risk of sudden cardiac death (SCD). We identified consecutive patients with HC presenting to a tertiary referral center.

Postprandial Hemodynamics in Hypertrophic Cardiomyopathy.

Objectives: Prior analysis at our institution found that patients with hypertrophic cardiomyopathy (HCM) who experience postprandial symptoms (PPS) are more likely to have resting left ventricular outflow tract (LVOT) obstruction and reduced quality of life. Our objective was to determine whether PPS in patients with HCM vs healthy subjects occur as a result of measurable hemodynamic alterations in the postprandial hemodynamic response.

Methods: We conducted a prospective cross-sectional study examining 45 patients with HCM and 10 controls who underwent fasting and postprandial 2-dimensional Doppler echocardiography.

Assessing the risk of imminent aggression in mentally ill young offenders.

Objectives: Aggression in adolescents presents a significant problem for psychiatric units. The Dynamic Appraisal of Situational Aggression (DASA) is an empirically validated measure designed to appraise the risk of imminent aggression (within the next 24 hours) in adult patients. Our aim was to examine the predictive validity of the DASA: Youth Version (DASA:YV) with youth-specific items, in young offenders hospitalised with a mental illness.

Managing aggression and violence: the clinician's role in contemporary mental health care.

Objective: From time to time misconceptions about violence risk assessment raise debate about the role mental health professionals play in managing aggression, with associated concerns about the utility of violence risk assessment. This paper will address some of the misconceptions about risk assessment in those with serious mental illness.

Methods: The authors have expertise as clinicians and researchers in the field and based on their accumulated knowledge and discussion they have reviewed the literature to form their opinions.

Advances in management of premature ventricular contractions.

Premature ventricular complexes (PVCs) are a common occurrence in clinical practice. The clinical presentation may range from asymptomatic to left ventricular (LV) dysfunction with congestive heart failure. The decision to suppress PVCs is largely based on the presence of symptoms, interference with other therapy (e.

Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block.

Background: Altered hemodynamics of a failing right ventricle (RV) may place stress on the right bundle branch and Purkinje network, which may be evident as conduction delay on surface electrocardiogram (ECG). We hypothesized that prolonged R' duration in lead V1 would be an indicator of RV dysfunction in patients with RBBB.

Methods: The Mayo Clinic Arizona echocardiography database was reviewed from 2007 to 2009 to identify patients with RV dysfunction and coexistent right bundle branch block (RBBB).

Potential role of Reynolds number in resolving Doppler- and catheter-based transvalvular gradient discrepancies in aortic stenosis.

Background And Aim Of The Study: Discrepancies in mean transvalvular gradient have been observed between Doppler echocardiography and catheter-based techniques in the assessment of aortic stenosis (AS). The Reynolds number (RE) has been shown to influence Doppler-derived gradients, and may be useful in resolving Doppler- and catheter-based gradient discrepancies in AS. The study aim was to assess the influence of the RE on such discrepancies.

Significance of postprandial symptom exacerbation in hypertrophic cardiomyopathy.

Patients with hypertrophic cardiomyopathy (HC) can experience exacerbation of exertional symptoms after a meal. The present study was designed to determine the prevalence and clinical correlates of postprandial symptom exacerbation (PPSE) in patients with HC. The records of 558 patients with HC and PPSE data who had undergone echocardiography at our institution from 2002 to 2006 were reviewed.

A Prison Mental Health Screening Unit: a first for New South Wales.

Objective: The aims of this paper are to provide a description of a newly available service the Mental Health Screening Unit (MHSU), within the NSW prison system and to present the first 12 months in terms of the patients, its adaptations and its limitations.

Methods: The first section of this paper provides a thorough description of the MHSU. The second looks at data collected for the period 1 July 2006 to 30 June 2007.

Subclavian steal and rest pain in a case of brachiocephalic artery occlusion.

A patient with multiple vessel disease presented with symptoms of significant bilateral upper extremity pain and weakness that was more significant on the right side. On carotid duplex scanning, brachiocephalic artery occlusion with retrograde flow was noted through the right common carotid and right vertebral arteries at rest. Furthermore, 50% to 90% occlusion of the left internal carotid was noted.