This study aimed to examine the practice of psychiatrists in a large learning disability service in recording capacity to consent to treatment and side effect discussion, and the impact of measures aimed at improving this. Three audit cycles were completed between 2007 and 2009, each examining 26 case notes selected at random. Information was gathered on recording of capacity and documentation of explanation of potential side effects. Changes in practice following the introduction of a rubber stamp in 2008, as a visual prompt for clinicians, were examined. Rates of recording of capacity rose from 30% in 2007 to 51% in 2009 (P = 0.000006). Capacity was more likely to have been recorded if the stamp was present (odds ratio 13.5, p < 0.0001). Recording of side effect discussion was consistently higher than that of capacity and showed little change between cycles. We conclude that the use of a rubber stamp in case notes was associated with improvements in the recording of capacity assessments.

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Introduction: Arthrocentesis is an effective, diagnostic and therapeutic modality for internal derangement of temporomandibular joint. Sodium Hyaluronate has been proposed as an alternative therapeutic agent with similar therapeutic effects. The aim of the study was to evaluate the role of Sodium Hyaluronate as an adjunct in treatment of patients with internal derangement of temporomandibular j oint.Methodology: A comparative study on 40 patients between the age group 20-64 years with internal derangement of temporomandibular joint was undertaken to evaluate the role of sodium hyaluronate as an adjunct in treatment.These patients were diagnosed clinically and radiographically with temporomandibular joint internal derangement who failed to respond to conservative treatments. They were divided in two groups randomly, each comprising of 20 patients. Group A comprised of patients who underwent arthrocentesis with Ringer Lactate and followed by injection with Sodium Hyaluronate. Group B were patients who underwent arthrocentesis with Ringer Lactate only. Results were evaluated on the parameters of pain, mouth opening, clicking, deviation, determination of range of lateral and protrusive movements and other complications. They were evaluated on pre -operative day, immediate post operative day and first, third and sixth month post operatively.Results: There was marked difference in all symptoms viz. of pain, mouth opening, clicking, deviation, determination of range of lateral and protrusive movements in group A as compared to group B with group A showing better response. Conclusion: Sodium Hyaluronate injection is thepreferred treatment for patients suffering with temporomandibular joint internal derangement who were refractory to corroborative methods.