This article sets out the main provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003 of relevance to doctors in the first few years after qualification. It sets out the criteria for compulsory intervention, the main compulsory orders, requirements regarding compulsory treatment and the key safeguards, and gives some practical advice on using the Act.
Hip pain is a common complaint in both children and adolescents. The diagnostic challenge lies not only in the difficulties of history and examination in the paediatric population, and that hip pathology can be referred from other sites, but also that the differentials are broad. Although an accurate history and clinical evaluation are vital in narrowing this wide differential, imaging plays a key role in establishing an accurate diagnosis. The various imaging modalities available, together with the common causes of non-traumatic hip pain within the paediatric population, are reviewed in this article.
Dementia is an increasingly common problem in an ageing population, and poses a serious public health burden with potentially grave social and financial implications. It is now possible following the recent advancements in specialist imaging techniques to demonstrate both structural and functional changes associated with dementia. This has not only allowed the diagnosis of dementia to be made with greater confidence and substantially earlier than previously, but also, crucially, the actual subtype of dementia can often now be accurately characterized, thus facilitating the earlier introduction of newer pharmacological treatment, where appropriate.
This article covers four major topics in paediatrics. Knowledge of their management is important for any Foundation Doctor working within the paediatric department. The febrile child is a common referral to any paediatric unit. Most febrile children are suffering from simple viral illnesses, but occasionally a fever is a sign of a life-threatening illness, such as meningitis. If meningitis is suspected, it is vital to carry out appropriate investigations before treatment is started. There are multiple causes of meningitis, so accurate interpretation of investigations is important in order to manage children appropriately.
This article gives a brief history of safeguarding and promoting the welfare of children, and an overview of recognition and referral of child protection concerns. The reader is advised to refer to Trust and Local or National child protection procedures for further management.
This article reviews the clinical assessment and management of depressive disorders. Depression is a common mental illness and presents in primary and secondary care settings. Depression often arises from an interaction between genetic, psychological, biological and social factors. One in eight patients with recurrent depressive disorder commits suicide. A process for clinical and risk assessment is presented. The identification of physical illnesses which can mimic or co-exist with depression is essential. A stepped care management approach, as recommended by NICE, is also discussed.
A Foundation Doctor working in a Paediatric or Accident and Emergency department will definitely encounter children with breathing difficulties, and most of these children will have upper or lower respiratory tract illnesses, few of which may present as potentially life-threatening emergencies. It is important to remember that young children and infants may develop respiratory failure more readily than older children and adults. Some of the common respiratory conditions presenting with breathing difficulty in infants and children are bronchiolitis, croup and acute asthma. The diagnosis of all of these is clinical. This article discusses how to use the A-B-C-D-E approach when faced with a child with breathing difficulty while waiting for senior help. The clinical features of croup, bronchiolitis and acute asthma and their management are discussed, highlighting important ‘dos and don’ts’.
A large proportion of the NHS workload involves dealing with children. An understanding of the special needs of this diverse group is necessary in order to manage successfully patients and their carers. This article gives a brief overview of some communication skills for use with children. It also gives a breakdown of the legal issues surrounding consent and parental responsibility and wider issues relating to the United Nations Convention on the Rights of the Child. Some paediatric ethical dilemmas are also explored. This article is relevant to both prospective paediatricians and those aspiring to any speciality involving work with children.
This article describes the priorities in management of children and young people presenting with the oft-quoted triad of fits, faints and funny turns. It emphasizes the importance of getting an accurate history, and outlines the various diagnostic possibilities.
The Mental Health Act 1983 provides a legal framework for the assessment and treatment of mental disorder in the absence of consent. The use of the Mental Health Act in the general hospital is considered from both a legal and practical perspective. Whilst the Foundation doctor is unable to fulfil any statutory functions under the Act an awareness of the aspects of the law relevant to problems that may arise in the general hospital and practical issues about organising specialist assessment are highlighted as being essential to good patient care.
Substance misuse and intoxication is a growing problem In children and young people; the rates of substance use in this age group in the UK are the highest in Europe. This article explores the common substances of abuse, their clinical presentation and general principles of management. More information can be accessed from any good textbook of psychiatry.
Abdominal pain is a very common presenting complaint in the Paediatric age group. It is important to remember that like any other problem in paediatrics, different age groups have differing common presentations and causes. A systematic approach to the problem with good history taking and clinical examination goes a long way in management.
