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Post Cards from the EDge: Replication concerns
- Dr. Mukesh Kripalani, Dr. Sagarika Nag, Lyn Williams, Dr. Amanda Gash (30 January 2008)
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Dr. Mukesh Kripalani, Specialist Registrar Northern Deanery, Dr. Sagarika Nag, Lyn Williams, Dr. Amanda Gash
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drmukesh{at}doctors.org.uk Dr. Mukesh Kripalani, et al.
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We read with great interest the recently published randomised controlled trial for hospital treated -self poisoning which was conducted in Newcastle, Australia. Given the results of the study, we would like to replicate a similar trial in our clinical setting of liaison psychiatry based in UK. But prior to proceeding, we would like to clarify certain points which were not clear from the study. This study was primarily targeted for patients who had presented with self poisoning and other forms of self harm were excluded. It was unclear about the proportion of patients who had a diagnosis of mental illness, co-morbid alcohol misuse and also had support from secondary mental health services, as this could have an impact too on repetition rates. Moreover could we clarify the proportion of both males and females who had used other self-harming techniques in the past? This is because quite a high proportion of our patients use both forms of self-poisoning and cutting. We would also like to point out those patients with a lack of family support present more often to us. Hence we believe that the control and the intervention group should have been matched for it. We would like to know the amount of work generated by people responding to receiving the post-cards in order to estimate the additional workload potentially created. Bed-occupancy criteria need further clarification. Does each episode of self-poisoning lead directly to a certain number of days the patients needs to be in hospital? There are a number of variables which have an impact on that statistic including severity of overdose, accommodation, crisis teams etc to name a few. We believe the outcome of a qualitative survey would be more beneficial to understand which bit of the entire package of intervention put in place has actually made a difference to the patient. We would welcome its findings whole-heartedly. Authors: Dr. Mukesh Kripalani, SpR; Dr. Sagarika Nag, Staff Grade; Lyn Williams, Nurse Consultant; Dr. Amanda Gash, Consultant Liaison Psychiatrist Conflict of Interest: All work for the Liaison Psychiatry team. |
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