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Biomedical subjects

T Zabow

Publications and source records attributed to T Zabow.

At least 19 recordsLinked to original sources
PubMed2005

A structured assessment of newly qualified medical graduates.

INTRODUCTION: While there is extensive published experience with the assessment of procedural skills in undergraduate students, this is limited in newly qualified medical graduates at the time of entry to the pre-registration (internship) year. The few studies that have been published suggest that these skills are frequently deficient when objectively tested. We therefore chose to assess the competence of a group of South African medical graduates on entry to their pre-registration year. METHODS: A total of 58 graduates of South African medical schools were assessed. Each subject participated in a 7-station objective structured clinical examination (OSCE); 6 of these assessed individual competence in phlebotomy, intramuscular injection, female pelvic examination, bladder catheterisation, tracheal intubation and prescription writing, while competence in cardiopulmonary resuscitation was assessed in a seventh station in randomly allocated teams of 3 candidates. Candidates' opinions of their own competence was sought by questionnaire. RESULTS: There was a wide variation in competence between subjects and across the range of tasks studied. Mean scores ranged from 85.4% for phlebotomy to 55.3% for prescription writing. The average score across all stations was 67.5%, and no student obtained an overall cut-off score of 85% or more, which was established using a modified Angoff method. Subjects' assessment of their own performance was unduly optimistic; most believed that they had demonstrated competence despite clear shortcomings in technique. Objective scores for subjects who had been exposed to a structured skills laboratory programme were not significantly higher than for those who had not, although their self-assessed performance was indeed higher. DISCUSSION: Most of the South African medical graduates who participated in this study were unable to satisfactorily perform technical procedures appropriate to the house officer on entry to the pre-registration year. This is in line with the conclusions of the few studies published in other countries. We suggest that the learning outcomes of undergraduate medical programmes should include an explicit statement of the competencies required for practice in the pre-registration year, and that these should be adequately taught and rigorously assessed before graduation.

Cardiopulmonary Resuscitation↗
PubMed1998

Forensic psychiatric evaluation: clinical, ethical and procedural issues in South Africa.

Evaluations done by the Forensic Psychiatrist take place in relation to various situations and in circumstances of a statutory nature and include clinical assessments for treatment, management and rehabilitation. Numerous issues in the field of legal process and ethical dilemmas are discussed. Conflicts with the traditional role occur and continued awareness of this is relevant for the maintenance of standards in the whole of psychiatry. Advocacy for better conditions for mentally ill offenders and consultation with state legislatures regarding changes in the criminal justice system and other relevant procedures are recommended. This is most significant especially for the indigent defendant and to allay public issues of the client referred, as well as those who ultimately become patients.

Civil Rights↗
PubMed1995

Violence, sensation seeking, and impulsivity in schizophrenics found unfit to stand trial.

Many studies have confirmed an association between violent behavior, impulsivity, and sensation seeking in nonpsychotic subjects. Schizophrenic patients (n = 49) who had been found unfit to stand trial were investigated for violence, according to index offenses and longitudinal histories (before and after admission) for violence. Those charged with violent offenses were significantly more often married with children, and were equally likely to direct their assaultiveness to strangers, acquaintances, and family members. The nature of the index offense seemed to be a good indicator of general violent propensity. No significant differences were found on Barratt's Impulsivity Scale and Zuckerman's Sensation Seeking Scale, except that schizophrenic patients with negative histories of violence scored higher on the thrill and adventure subscale. No pattern of substance abuse differentiated the groups. Patients charged with violent offenses more often presented with persecutory delusions, but this did not extend to those whose histories were positive for repetitive violence. Although impulsivity and sensation seeking do not seem to cause violent behavior in this group, psychopathology can also only be regarded as a necessary but not sufficient determinant.

Adolescent↗
PubMed1993

South African psychiatrists' criteria for predicting dangerousness.

The prediction of dangerousness has emerged as one of the most controversial issues in forensic psychiatry. It is a value-laden and ambiguous concept which has not been adequately defined and operationalized by the law or psychiatry. The validity and reliability of psychiatric predictions of dangerousness have been brought seriously into question in the past few decades. The Booysen Commission appointed in South Africa relates to the problem. An exploratory survey to ascertain the variables which South African psychiatrists perceive as influencing their decisions about dangerousness and to compare these findings with those of previous research was undertaken. One hundred and thirty-eight psychiatrists were included in a survey by means of a questionnaire. Findings that clinicians' decisions were significantly influenced by patients' criminal/violent history were consistent with previous research. The article further evaluates the responses to the questionnaire variables and the degree as well as a study of detained 'dangerous' patients to assess accuracy of evaluations in practice.

Attitude of Health Personnel↗
PubMed1989

Psychiatric evidence in extenuation: assessment and testimony in homicide defendants.

The role of psychiatric evaluation and testimony on 202 cases demonstrates the participation of mental health experts in the legal process. The majority of these cases fall outside the mental abnormal groupings of 'incompetent to stand trial' or 'criminal insane'. A finding of diminished responsibility on account of mental illness provides for a finding of extenuating circumstances on account of mental illness. The numerous factors and categories influencing the defendant's behaviour are specific to each, requiring presentation for the court's discretion as to significance of psychiatric factors in extenuation of sentence. The population studies as representative of psychiatric extenuation are a personal consecutive sample of court referrals for formal evaluation undertaken in a psychiatric hospital unit. Reasons for referral all include possible psychiatric disorder. One third of referrals were accused of killing a family member. Alcohol and drugs were contributory to the behaviour in 50 per cent of cases. The contributions of witchcraft and history of head injury to the sample are evident in subgroupings. The value of psychiatric contribution to the courts is discussed in relation to South African legal process and clinical experiences.

Criminal Law↗
PubMed1983

Physical disease in the chronic mentally ill.

A group of 196 institutionalized patients with chronic mental illness was studied to determine the prevalence of unrecognized physical disease. Sixty per cent of the patients were found to have previously undiagnosed minor or major disorders, the most prevalent being scabies and fungal infections (24%), peripheral vascular disease (13%), dyskinetic movements (11%) and anaemia (5,5%). Forty-six per cent of the physical disorders were considered to be minor, and only 21% of the major disorders were likely to respond to treatment. In particular there was a striking correlation between peripheral vascular disease and Korsakoff's psychosis. This study shows that there is a need for regular on-going physical assessment of such patients.

Adult↗
PubMed1983

Clinical vampirism. A presentation of 3 cases and a re-evaluation of Haigh, the 'acid-bath murderer'.

Clinical vampirism is named after the mythical vampire, and is a recognizable, although rare, clinical entity characterized by periodic compulsive blood-drinking, affinity with the dead and uncertain identity. It is hypothetically the expression of an inherited archaic myth, the act of taking blood being a ritual that gives temporary relief. From ancient times vampirists have given substance to belief in the existence of supernatural vampires. Four vampirists, including Haigh, the 'acid-bath murderer', are described. From childhood they cut themselves, drank their own, exogenous human or animal blood to relieve a craving, dreamed of blood-shed, associated with the dead, and had a changing identity. They were intelligent, with no family mental or social pathology. Some self-cutters are auto-vampirists; females are not likely to assault others for blood, but males are potentially dangerous. Vampirism may be a cause of unpredictable repeated assault and murder, and should be looked for in violent criminals who are self-mutilators. No specific treatment is known.

Adult↗
PubMed1978

A psychophysiological investigation of the long-term effects of clozapine upon sleep patterns of normal young adults.

A 25-night single-blind cross over design was employed to determine the long-term effects of clozapine on the sleep patterns of six normal young adults. Subjects received 12.50 mg placebo on the first and last five nights, whereas on the intermediate 15 nights 12.5 mg clozapine was administered. The subjects slept in the laboratory on the third and fourth nights to obtain baseline recordings, and on the eight, twelfth, sixteenth, and twentieth nights to determine the effects of clozapine on sleep variables. Recordings on nights 21 and 25 were used to assess withdrawal effects. Percentage stage 1 sleep and indices of body movements during sleep were significantly reduced, suggesting that clozapine may have sleep-inducing properties. There were no significant rebound of stage REM sleep during drug withdrawal despite a small but significant reduction in stage REM during drug administration. Numerous side effects, indicative of sleepiness, were reported on the mornings following drug administration, and there was evidence of a rapid tolerance to clozapine. These findings may limit the efficacy of clozapine as an hypnotic agent over an extended period of time. Further research on insomniac subjects is therefore indicated.

Adult↗
PubMed1977

A psychophysiological investigation of the short-term effects of clozapine upon sleep parameters of normal young adults.

A nine consecutive night, double-blind design was used to assess the effects of a psychotropic agent (clozapine) upon sleep parameters as well as measures of mood and performance in a group of seven normal, young adults. Placebo was administered to a control group of seven subjects. EEGs and EOGs were monitored throughout the night in a laboratory environment and were scored according to standardized criteria. The administration of 25 mg clozapine/night for three consecutive nights significantly reduced stage 4 sleep on the second and third nights. Whereas stage REM sleep was not affected, a variety of REM indices were significantly increased on the third night of clozapine administration and/or on the first night of clozapine withdrawal. The number of body movements and the number of body movements/minute of sleep were significantly reduced on the three nights of clozapine administration. Numerous psychophysiological side effects were reported. These results indicate that clozapine may be a useful medication in the treatment of sleep disorders. However, the incidence of adverse side effects of represents a major limitation in the use of clozapine as an hypnotic agent at the dose-rate employed.

Adolescent↗