Search results

1 – 10 of 66
To view the access options for this content please click here
Article
Publication date: 20 February 2019

Gautam Gulati, Brendan D. Kelly, Conor O’Neill, Paul O’Connell, Sally Linehan, Eimear Spain, David Meagher and Colum P. Dunne

The assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon…

Abstract

Purpose

The assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon in such cases. The purpose of this paper is to develop a management algorithm through expert elicitation to inform the psychiatric care of prisoners on a hunger strike.

Design/methodology/approach

A Delphi method was used to elicit views from Irish forensic psychiatrists, a legal expert and an expert in ethics using a structured questionnaire. Themes were extracted from the results of the questionnaire to propose a management algorithm. A consensus was reached on management considerations.

Findings

Five consultant forensic psychiatrists, a legal expert and an expert on psychiatric ethics (n=7) consented to participation, with a subsequent response rate of 71.4 per cent. Consensus was achieved on a proposed management algorithm. Assessment for mental disorder, capacity to refuse food and motivation for food refusal are seen as key psychiatric tasks. The need to work closely with the prison general practitioner and the value of multidisciplinary working and legal advice are described. Relevant aspects of law included mental health, criminal law (insanity) and capacity legislation.

Originality/value

This study outlines a management algorithm for the psychiatric assessment and management of prisoners on a hunger strike, a subject about which there is limited guidance to date. Although written from an Irish perspective, this study outlines key considerations for psychiatrists in keeping with international guidance and therefore may be generalisable to other jurisdictions.

Details

International Journal of Prisoner Health, vol. 15 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

To view the access options for this content please click here
Article
Publication date: 5 December 2016

Geoff McCombe, Anne Marie Henihan, Jan Klimas, Davina Swan, Dorothy Leahy, Rolande Anderson, Gerard Bury, Colum Dunne, Eamon Keenan, David Meagher, Clodagh O’Gorman, Tom O’Toole, Jean Saunders, Bobby P. Smyth, John S. Lambert, Eileen Kaner and Walter Cullen

Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is…

Abstract

Purpose

Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness.

Design/methodology/approach

Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively sampled from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically.

Findings

Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced.

Research limitations/impelications

Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority.

Originality/value

To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.

Details

Drugs and Alcohol Today, vol. 16 no. 4
Type: Research Article
ISSN: 1745-9265

Keywords

To view the access options for this content please click here
Article
Publication date: 10 September 2018

Gautam Gulati, Valerie Murphy, Ana Clarke, Kristin Delcellier, David Meagher, Harry Kennedy, Elizabeth Fistein, John Bogue and Colum P. Dunne

While individuals with an intellectual disability form a significant minority in the worldwide prison population, their healthcare needs require specialist attention. In…

Abstract

Purpose

While individuals with an intellectual disability form a significant minority in the worldwide prison population, their healthcare needs require specialist attention. In Ireland, services for prisoners with intellectual disabilities need development. However, there is little substantive data estimating the prevalence of intellectual disabilities within the Irish prison system. The paper aims to discuss these issues.

Design/methodology/approach

The authors systematically review published data relating to the prevalence of intellectual disabilities in prisons in the Republic of Ireland. The authors searched four databases, governmental websites and corresponded with experts.

Findings

Little published data were elicited from searches except for one nationwide cross-sectional survey which reflected a higher prevalence than reported in international studies. Studies from forensic mental health populations are narrated to contextualise findings.

Originality/value

This study found that there is little data to accurately estimate the prevalence of intellectual disabilities in the Irish prison system and the limited data available suggests that this is likely to be higher than international estimates. The authors highlight the need for further research to accurately estimate prevalence in this jurisdiction, alongside the need to develop screening and care pathways for prisoners with an intellectual disability.

Details

International Journal of Prisoner Health, vol. 14 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

To view the access options for this content please click here
Article
Publication date: 20 February 2019

Gautam Gulati, Kizito Otuokpaikhian, Maeve Crowley, Vishnu Pradeep, David Meagher and Colum P. Dunne

The purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional…

Abstract

Purpose

The purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of individuals diverted subsequently from prison to psychiatric settings.

Design/methodology/approach

The authors conducted a retrospective review of 130 successive psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties. The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were retrospectively completed to assess security need.

Findings

In total, 8.6 per cent of all committals from liberty were referred by a general practitioner and 8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services, 51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and 59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have benefited from a low secure/intensive care setting.

Originality/value

The multifaceted need set of those referred strengthens the argument for the provision of multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons supports the need for Intensive Care Regional Units in Ireland.

Details

International Journal of Prisoner Health, vol. 15 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

To view the access options for this content please click here
Article
Publication date: 17 December 2018

Gautam Gulati, Stephen Quigley, Valerie Elizabeth Murphy, Evan Yacoub, John Bogue, Anthony Kearns, Conor O’Neill, Mary Kelly, Aideen Morrison, Gerard Griffin, Mary Blewitt, Elizabeth Fistein, David Meagher and Colum P. Dunne

Individuals with an intellectual disability (ID) form a significant minority in the Irish prison population and worldwide prison populations. There is growing recognition…

Abstract

Purpose

Individuals with an intellectual disability (ID) form a significant minority in the Irish prison population and worldwide prison populations. There is growing recognition that specialist services for such individuals are in need of development. The purpose of this paper is to propose a care pathway for the management of individuals with an ID who present in prison, based on expert elicitation and consensus.

Design/methodology/approach

A convenience sample of professionals with a special interest in forensic intellectual disabilities was invited to participate in a Delphi exercise. In total, 12 agreed to participation and 10 subsequently completed the study (83.3 per cent). Expert views were elicited using a semi-structured questionnaire. Content analysis was completed using NVivo 11 software. A care pathway was subsequently proposed, based on the outcomes of the analysis, and circulated to participants for debate and consensus. A consensus was reached on management considerations.

Findings

Ten experts across a range of disciplines with a combined experience of 187 years participated in the study. Current provision of care was seen as limited and geographically variable. The vulnerability of prisoners with ID was highlighted. The need for equivalence of care with the community through multidisciplinary input and development of specialist secure and residential placements to facilitate diversion was identified. Consensus was achieved on a proposed care pathway.

Originality/value

This study proposes a care pathway for the assessment and management of prisoners with an ID and is, therefore, potentially relevant to those interested in this topic internationally who may similarly struggle with the current lack of decision-making tools for this setting. Although written from an Irish perspective, it outlines key considerations for psychiatrists in keeping with international guidance and, therefore, may be generalisable to other jurisdictions.

Details

International Journal of Prisoner Health, vol. 14 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

To view the access options for this content please click here
Case study
Publication date: 20 January 2017

David P. Stowell and Evan Meagher

Gary Parr, deputy chairman of Lazard Freres & Co. and Kellogg class of 1980, could not believe his ears. “You can't mean that,” he said, reacting to the lowered bid given…

Abstract

Gary Parr, deputy chairman of Lazard Freres & Co. and Kellogg class of 1980, could not believe his ears. “You can't mean that,” he said, reacting to the lowered bid given by Doug Braunstein, JP Morgan head of investment banking, for Parr's client, legendary investment bank Bear Stearns. Less than eighteen months after trading at an all-time high of $172.61 a share, Bear now had little choice but to accept Morgan's humiliating $2-per-share, Federal Reserve-sanctioned bailout offer. “I'll have to get back to you.” Hanging up the phone, Parr leaned back and gave an exhausted sigh. Rumors had swirled around Bear ever since two of its hedge funds imploded as a result of the subprime housing crisis, but time and again, the scrappy Bear appeared to have weathered the storm. Parr's efforts to find a capital infusion for the bank had resulted in lengthy discussions and marathon due diligence sessions, but one after another, potential investors had backed away, scared off in part by Bear's sizable mortgage holdings at a time when every bank on Wall Street was reducing its positions and taking massive write-downs in the asset class. In the past week, those rumors had reached a fever pitch, with financial analysts openly questioning Bear's ability to continue operations and its clients running for the exits. Now Sunday afternoon, it had already been a long weekend, and it would almost certainly be a long night, as the Fed-backed bailout of Bear would require onerous negotiations before Monday's market open. By morning, the eighty-five-year-old investment bank, which had survived the Great Depression, the savings and loan crisis, and the dot-com implosion, would cease to exist as an independent firm. Pausing briefly before calling CEO Alan Schwartz and the rest of Bear's board, Parr allowed himself a moment of reflection. How had it all happened?

An analysis of the fall of Bear Stearns facilitates an understanding of the difficulties affecting the entire investment banking industry: high leverage, overreliance on short-term financing, excessive risk taking on proprietary trading and asset management desks, and myopic senior management all contributed to the massive losses and loss of confidence. The impact on the global economy was of epic proportions.

Details

Kellogg School of Management Cases, vol. no.
Type: Case Study
ISSN: 2474-6568
Published by: Kellogg School of Management

Keywords

To view the access options for this content please click here
Case study
Publication date: 20 January 2017

David P. Stowell and Evan Meagher

In recent years Lehman Brothers, one of the five largest investment banks in the United States, had grown increasingly reliant on its fixed income trading and underwriting…

Abstract

In recent years Lehman Brothers, one of the five largest investment banks in the United States, had grown increasingly reliant on its fixed income trading and underwriting division, which served as the primary engine for its strong profit growth. The bank had also significantly increased its leverage over the same timeframe, going from a debt-to-equity ratio of 23.7x in 2003 to 35.2x in 2007. As leverage increased, the ongoing erosion of the mortgage-backed industry began to impact Lehman significantly and its stock price plummeted. Unfortunately, public outcry over taxpayer assumption of $29 billion in potential Bear losses made repeating such a move politically untenable. The surreal scene of potential buyers traipsing into an investment bank's headquarters over the weekend to consider various merger or spin-out scenarios repeated itself once again. This time, the Fed refused to back the failing bank's liabilities, attempting instead to play last-minute suitors Bank of America, HSBC, Nomura Securities, and Barclay's off each other, jawboning them by arguing that failing to step up to save Lehman would cause devastating counterparty runs on their own capital positions. The Fed's desperate attempts to arrange its second rescue of a major U.S. investment bank in six months failed when it refused to backstop losses from Lehman's toxic mortgage holdings. Complicating matters was Lehman's reliance on short-term repo loans to finance its balance sheet. Unfortunately, such loans required constant renewal by counterparties, who had grown increasingly nervous that Lehman would lose the ability to make good on its trades. With this sentiment swirling around Wall Street, Lehman was forced to announce the largest Chapter 11 filing in U.S. history, listing assets of $639 billion and liabilities of $768 billion. The second domino had fallen. It would not be the last.

This case covers the period from the sale of Bear Stearns to JP Morgan to the conversion into bank holding companies by Goldman Sachs and Morgan Stanley, including the Lehman Brothers bankruptcy and the sale of Merrill Lynch to Bank of America. The case explains the new global paradigm for the investment banking industry, including increased regulation, fewer competitors, lower leverage, reduced proprietary trading, and-potentially-reduced profits.

Details

Kellogg School of Management Cases, vol. no.
Type: Case Study
ISSN: 2474-6568
Published by: Kellogg School of Management

Keywords

To view the access options for this content please click here
Article
Publication date: 27 May 2014

Jan Klimas, Kevin Lally, Lisa Murphy, Louise Crowley, Rolande Anderson, David Meagher, Geoff McCombe, Bobby P. Smyth, Gerard Bury and Walter Cullen

The purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and…

Abstract

Purpose

The purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and manage problem alcohol use among problem drug users.

Design/methodology/approach

The educational session was developed as part of a complex intervention which was informed by the Medical Research Council framework for complex interventions. A Cochrane review and a modified Delphi-facilitated consensus process formed the theoretical phase of the development. The modelling phase involved qualitative interviews with professionals and patients. The training's learning outcomes included alcohol screening and delivery of brief psychosocial interventions and this was facilitated by demonstration of clinical guidelines, presentation, video, group discussion and/or role play.

Findings

Participants (n=17) from three general practices and local medical school participated in four workshops. They perceived the training as most helpful in improving their ability to perform alcohol screening. Most useful components of the session were the presentation, handout and group discussion with participants appreciating the opportunity to share their ideas with peers.

Originality/value

Training primary healthcare professionals in alcohol screening and brief psychosocial interventions among problem drug users appears feasible. Along with the educational workshops, the implementation strategies should utilise multi-level interventions to support these activities among GPs.

Details

Drugs and Alcohol Today, vol. 14 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

To view the access options for this content please click here
Case study
Publication date: 20 January 2017

James B. Shein, Rebecca Frazzano and Evan Meagher

The case discusses the operational, strategic, and financial turnaround at Solo Cup, a manufacturer of disposable dining wares. Solo Cup’s troubles were compounded by the…

Abstract

The case discusses the operational, strategic, and financial turnaround at Solo Cup, a manufacturer of disposable dining wares. Solo Cup’s troubles were compounded by the acquisition of a larger rival, Sweetheart Company, which had its own problems and presented issues of merger integration that management could not solve. David Garfield, a managing director at turnaround consulting firm Alix Partners, must first recognize Solo Cup’s core competencies in order to determine the appropriate change in strategic course, strip out the assets that no longer support the operations necessary for that strategy, and monetize them in order to rationalize its balance sheet. This case teaches that a three-pronged approach will invariably produce greater results than any one-dimensional turnaround.

Students will learn turnaround techniques necessary to restructure a company operationally, strategically, and financially, and will learn how Alix Partners' relentless focus on “letting data rule” allowed the firm to revive a faltering company.

To view the access options for this content please click here
Article
Publication date: 1 December 1999

David Kreltszheim

eCash by DigiCash is one of a range of software‐based systems devised for payments to be made over the Internet by the use of electronic tokens or “coins” (known…

Downloads
1209

Abstract

eCash by DigiCash is one of a range of software‐based systems devised for payments to be made over the Internet by the use of electronic tokens or “coins” (known colloquially as “electronic money”). As in the case of other new electronic systems, the functioning of the system gives rise to novel and difficult legal issues, some of which have yet to be resolved. This article will consider the extent to which a user of the system whose value is stolen may use the common law and equitable tracing rules as a means of taking action against the perpetrator of the fraud.

Details

Information Management & Computer Security, vol. 7 no. 5
Type: Research Article
ISSN: 0968-5227

Keywords

1 – 10 of 66