International review of psychiatry
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A concussion results from a force to the brain that results in a transient loss of connectivity within the brain. Sport psychiatrists are increasingly called to be part of the concussion team and need to be prepared to manage issues related to concussion and its behavioural sequelae. Objectively, the best evidence available suggests that deficits in attention and/or in balance are the most reliable objective findings that a concussion has occurred. ⋯ Neither head CT nor MRI are sufficiently sensitive to diagnose the type of injuries that pre-dispose patients to the neurobehavioural sequelae that have been associated with a concussion; confounding this is the finding that many of these signs and symptoms associated with concussion occur in other types of non-head injuries. Brain biomarkers and functional MRI (fMRI) hold promise in both diagnosis and prognosis of concussion, but are still research tools without validated clinical utility at this time. Finally, neurocognitive testing holds promise as a diagnostic criterion to demonstrate injury but, unfortunately, these tests are also limited in their prognostic utility and are of limited value.
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Mental ill health is a universal phenomenon: that is, it is seen across all cultures and societies, even though the presentation may be culture-specific and affected by cultural norms and more. Governments have a moral and ethical duty to develop mental health services which are accessible, appropriate, and non-discriminatory. Equity in funding mental health services is critical. ⋯ In this endeavour primary care services have a major role to play. Training and clinical decision-making must be part of the change in service delivery. It is imperative that every effort is made to keep the population mentally as well as physically healthy, and people who develop mental illness must have access to evidence-based treatment at the earliest possible opportunity.
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Medical conferences create an opportunity for lifelong learning for healthcare practitioners. The use of Twitter at such conferences continues to expand. ⋯ It also addresses the potential utility of Twitter chats and journal clubs in the promotion of lifelong learning. The impact of Twitter use in healthcare in general, and specifically at conferences, and how it can be measured, is discussed.
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The journal club offers a model for lifelong learning and maintenance of certification (MOC) for residents and faculty staff. First, it sharpens participants' critical appraisal skills by providing a space to discuss relevant medical literature. Second, it motivates participants to seek new medical literature on their own using technology. ⋯ In most academic settings category 1 continuing medical education (CME) credits can be awarded so journal club can have the added benefit of satisfying maintenance of certification CME credits. From journal club both residents and faculty can learn what is new and learn to apply this new information in their practice. Finally, because technology creates an overabundance of relevant medical literature, participants using our model can develop strong critical appraisal skills and methods for organizing the information they find that make this information readily available for future use and retrieval.
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I have been actively learning and teaching psychiatry since starting residency in 1966. Over the decades my educational endeavours have been guided by a fairly consistent set of operating principles. ⋯ Readers may wish to try out some of these ideas. They have worked for me, and they may work for others as well.