Accuracy of references in psychiatric literature : a survey of three journals

Comment The limitations of this audit are acknowledged. The results are dependent upon the information provided by referrers and on clinicians complet ing audit forms in a consistent and comprehen sive way. The problems referred may not necessarily be the focus of the work undertaken by CAMHS and often other problems emerge during the course of therapy. The audit has also undertaken a very pragmatic approach and has not attempted any social profiling nor focused upon matching indices of deprivation with referral patterns. Finally, in the absence of any comparable data it is not possible to determine whether these results are representative of other services. Despite these limitations the audit has pro vided a wealth of information that has been helpful for clinicians, service managers and commissioning authorities. The results have been warmly welcomed by clinicians who feel that the complexity of their work is now better understood and their contribution valued. This has prompted a number openly to question and scrutinise their work resulting in the initiation of a number of separate audit projects. The service is more visible and more easily understood enabling service managers to examine how resources are currently allocated and to clarify purchaser expectations. The process has also facilitated change and has enabled teams to explore alternative ways in which they can respond to referrer demands. A summary of the audit has been sent to each commissioning authority providing them with a clear specifica tion of the service they are currently commission ing. This in turn will provide an objective basis for future discussions about service priorities thereby enabling rational decision making about the use of existing resources. Finally, the audit has identified various shortfalls and the results may facilitate future developments and joint commissioning of services.


Comment
The limitations of this audit are acknowledged.The results are dependent upon the information provided by referrers and on clinicians complet ing audit forms in a consistent and comprehen sive way.The problems referred may not necessarily be the focus of the work undertaken by CAMHS and often other problems emerge during the course of therapy.The audit has also undertaken a very pragmatic approach and has not attempted any social profiling nor focused upon matching indices of deprivation with referral patterns.Finally, in the absence of any comparable data it is not possible to determine whether these results are representative of other services.
Despite these limitations the audit has pro vided a wealth of information that has been helpful for clinicians, service managers and commissioning authorities.The results have been warmly welcomed by clinicians who feel that the complexity of their work is now better understood and their contribution valued.This has prompted a number openly to question and scrutinise their work resulting in the initiation of a number of separate audit projects.The service is more visible and more easily understood enabling service managers to examine how resources are currently allocated and to clarify purchaser expectations.The process has also facilitated change and has enabled teams to explore alternative ways in which they can respond to referrer demands.A summary of the audit has been sent to each commissioning authority providing them with a clear specifica tion of the service they are currently commission ing.This in turn will provide an objective basis for future discussions about service priorities thereby enabling rational decision making about the use of existing resources.Finally, the audit has identified various shortfalls and the results may facilitate future developments and joint commissioning of services.

Accuracy of references in psychiatric literature: a survey of three journals L A Lawson and Ruth Fosker
Aims and method The prevalence of errors in reference citations and use in the psychiatric literature has not been reported as it has in other scientific literature.Fiftyreferences randomly selected from each of three psychiatric journals were examined for accuracy and appropriateness of use by validating them against the original sources.
Results A high prevalence of errors was found, the most common being minor errors in the accuracy of citations.Major citation errors, delayed access to two original articles and three could not be traced.Eight of the references had major errors with the appropriateness of use of their quotations.

Clinical implications Errorsin accuracy of references
impair the processes of research and evidence-based medicine, quotation errors could mislead clinicians into making wrong treatment decisions.
A high prevalence of errors has been reported in the accuracy and appropriateness of references cited in some medical literature (de Lacey et al, 1985: Eichorn & Yankauer. 1987;Hansen & Mclntire, 1994) but not yet in psychiatry.We present a survey that evaluated references in three psychiatric journals: the Psychiatric Bulle tin (Bulletin), the British Journal of Psychiatry (BJP) and the American Journal of Psychiatry (AJP).

The study
All references cited in the February 1997 issues of the three journals were numbered consecu tively and 50 chosen using a table of random numbers.These were checked for accuracy and appropriateness of their citations against the original sources obtained from the local post graduate medical library or through normal inter-library loan in the UK.References not obtainable by these routes were classified as unverifiable.
Errors were classified as described by Eichorn & Yankauer (1987) into major and minor.Major errors of citations were those that prevented immediate identification of the source of refer ence (e.g.errors in journal name, omission of year and volume and incorrect pages that did not overlap with correct pages).Minor errors in accuracy were misspellings, omissions or alter ations of words in the title, omitted or incorrect sub-titles, incorrect page numbers that overlap with correct numbers, and omitted or incorrect authors' names, initials, or suffixes.Punctuation mistakes were not counted as errors.
Minor errors in the appropriateness of quota tions included over-simplifications or general isations not directly supported by the reference being cited.Major errors occurred when quota tions were not substantiated by the original sources, contradicted them or were unrelated to them.An example of a major error occurred in a quotation that stiff baby syndrome is a severe neonatal form of hyperekplexia.This assertion was unsubstantiated by the original source which only suggested the possibility of a con tinuum between the two syndromes.In another example, a patient presented in hospital 45 minutes after an overdose of 120 2 mg risperidone tablets: the time to presentation was quoted as 45 hours which could mislead clinicians into believing that there was no urgency following the ingestion of a massive dose of risperidone.
When a reference was quoted more than once in an article, all assertions were checked for appropriateness and all errors recorded.How ever, when more than one quotation from the same reference was noted and the reference contained an error of citation, this was counted only once.All errors were otherwise counted and included in analysis.The relationship between the prevalence of errors and the number of cited references was studied using the quartile method (Eichorn & Yankauer, 1987).

Findings
Forty-eight (96%) of the 50 selected references were obtained from the AJP, 49 (98%) from the Bulletin and all 50 references from the BJP (100%).Errors in citation and quotations were found in all three journals.Table 1 shows the types and the prevalence of these errors in all the journals combined.The management of cylindrical battery ingestion in psychiatric settings

Nick Hindley, Harvey Gordon, Chris Newrith and DamiÃ¡n Mohan
Aim and method To describe physical sequelae of cylindrical battery ingestion and their management, by description of recent cases and literature review.Results X-rays should be performed to determine the position and integrity of the battery.In the absence of abdominal symptoms, immediate surgical opinion may not be indicated.Clinical implications Conservative management of battery swallowing is frequently possible.
There have been several recent episodes involving the swallowing of cylindrical batteries on the intensive care and admissions units at Broadmoor Hospital.People resident in these units have access to personal stereos which in almost all cases have been the source of the batteries which were subsequently swallowed.All episodes appear to have occurred at times of acute psychiatric disturbance and would seem to fit into the category of deliberate selfharm rather than frank suicidal intent.This particular behaviour appeared to follow a vogue over a period of two to three months before waning.
From the medical point of view, even psy chiatrists well-acquainted with deliberate selfharm may be unfamiliar with the management of battery ingestion.Ingestion of foreign objects can create considerable anxieties and it can be that considerable pressure is put on the attending doctor to 'do something'.In such situations, prior knowledge of the potential sequelae of the act together with a clear picture of what reasonably needs to be done to ensure the person's safety can do much to diffuse such anxieties and to minimise the disruption caused both to and by the individual concerned.
The incidents encountered at Broadmoor pro vide some indication of the range of sequelae of battery swallowing and the extent to which management may vary according to the particular situation.

Case illustrations
Patient 1 A man in his twenties with a diagnosis of personality disorder and a long history of severe self-harm including self-laceration and persis tent head-banging.
During a period of acute disturbance he swallowed an alkaline cylindrical battery having bitten the casing to allow release of its contents.He became immediately sympto matic with acute upper gastrointestinal pain.Abdominal X-ray (AXR) showed a damaged battery in the stomach.He was treated as a surgical emergency and underwent laparotomy with removal of the battery.On return to Broad moor he swallowed two further batteries in similar fashion resulting in a repeat laparotomy;

Table 1 .
Errors in accuracy and appropriateness of use in 147 references from three psychiatric journals HANSEN,M.E. & MCINTIRED.D. (1994) Reference citations in radiology: accuracy and appropriateness of use in two major journals.American Journal oJRoentgenology, 163.719-723.