bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PATIENT TRANSIT ASSISTANCE SCHEME: THE CLERK’S PERSPECTIVE
Authors: McGrath Pam
Published: March 2003

The Patient Transit Assistance Scheme (PTAS) is an important government program designed to ensure equity of access for residents in rural and remote Queensland to essential healthcare services. Where specialist services cannot be provided at recognised hospitals, PTAS ensures equity by accepting the responsibility for assisting with the transport and accommodation of patients and at times their escort, to locations where such services are available. This article presents research findings on the concerns of clerks involved in administering PTAS for patients with leukaemia and associated haematological disorders. The findings indicate that there are many problems with this scheme that need attention and can be remedied.
PREVALENCE AND TREATMENT OF PRESSURE ULCERS IN NORTHERN NEW SOUTH WALES
Authors: Pearson Alan , Francis Karen , Hodgkinson Brent , Curry George
Published: March 2003

ABSTRACT

This paper reports on a small, cross‐sectional study of 18 hospitals in northern New South Wales. The objectives of this study were to collect baseline data on: (i) the prevalence and type of pressure ulcers in a variety of rural hospitals; and (ii) the range of nursing and medical interventions that are used to prevent/treat pressure ulcers. Using a cross‐sectional design, the study found that pressure ulcer prevalence, which was 6%, was within the range found by previous reports (4–15%). Pressure ulcer prevention and treatment practices were varied, ranging from turning of the patient and occlusive dressings, to such creative methods as exposure to sunshine and airing the wound. This study demonstrates that despite years of attention to pressure sore prevention and treatment, the prevalence of ulcers is still a significant problem in northern New South Wales hospitals.
Selected Demographic, Social and Work Characteristics of the Australian General Medical Practitioner Workforce: Comparing Capital Cities with Regional Areas
Authors: Wilkinson David
Published: March 2003

The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full‐ or part‐time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26 359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part‐time work, 42% of females also reported part‐time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues.
Improving access for rural Australians to treatment for anxiety and depression: The University of Melbourne Depression and Anxiety Research AND Treatment Group–Bendigo Health Care Group initiative
Authors: Judd Fiona K. , Jackson Henry , Davis Julian , Cockram Alexandra , Komiti Angela , Allen Nicholas , Murray Greg , Kyrios Michael , Hodgins Gene
Published: March 2003

Rural Australians have limited access to care for mental health problems. We describe a collaboration between the University of Melbourne Departments of Psychology and Psychiatry and a rural Area Mental Health Service to provide a specialist anxiety and depression treatment service in rural Victoria. The clinical service and the education and training approach are described.
IMPACT OF RURAL LIVING ON THE EXPERIENCE OF CHRONIC ILLNESS
Authors: FitzGerald Mary , Pearson Alan , McCutcheon Helen
Published: March 2003

This paper concentrates on the specific impact that living in rural Australia has on the experience of chronic illness, and draws on data collected in a larger phenomenological study. Eighteen rural Australians in New South Wales described their experiences and referred particularly to issues that related to their rural context. A secondary analysis of the data revealed three sub‐themes related to the concept of rural, choice of doctor, travelling and life style. The shortfalls in service identified by these participants deserves further investigation and could become fertile ground for an expanded nursing service.
COMMUNITY VENTURES IN RURAL HEALTH: THE ESTABLISHMENT OF COMMUNITY HEALTH TRUSTS IN SOUTHERN NEW ZEALAND
Authors: Barnett Pauline , Barnett J. Ross
Published: March 2003

During the 1990s, a shortage of funds and a competitive market for public sector health services created both threats and opportunities for rural health services in New Zealand. In three of the four regional funding areas, rural health services experienced increased levels of closure or privatisation. In the fourth area, the Southern Region, the initiative of the community and the response of the funder combined to produce an alternative response; the formation of community health trusts that allowed local communities to own their own health facilities and to contract to run the services. Through a survey of community trusts this research analyses the process of trust formation and assesses the critical success factors in the community (local leadership, local financial and other commitment, involvement of local professionals, learning from each other, local operational efficiency) which allowed the trusts to survive and thrive.
ONE APPROACH TO IMPROVING INDIGENOUS HEALTH CARE THROUGH MEDICAL EDUCATION
Authors: Hays Richard
Published: March 2003

ABSTRACT: The present paper discusses some of the issues relating to the poorer health and shorter life expectancy of Australian Aboriginal and Torres Strait Islander peoples. The barriers to improvement include funding of the medical service, the nature of early contact between Indigenous peoples and the European settlers, and the complex nature of Indigenous cultures. The role of the new medical school at James Cook University is discussed in relation to its mission of meeting the health care needs of the population of tropical and rural North Queensland. Indigenous representation in the management of the Medical School, staff selection, student selection, and curriculum content are discussed, and recommendations are made for a partnership approach to achieving improvements in the functioning of the health system of the area.
Use of eye care services by older Australians: the Blue Mountains Eye Study
Authors: Wang JJ , Mitchell P , Smith W
Published: March 2003

Purpose: To assess utilization of eye care services in an older Australian population.

Methods: The Blue Mountains Eye Study examined 3654 permanent residents aged 49 years or older from two New South Wales postcode areas. At interview, we collected information about past attendance to eye care practitioners, demographic and socio‐economic status variables and past medical and eye history. Full‐time optometric and part‐time ophthalmic services were available in this community.

Results: Almost all participants (99%) had seen either an ophthalmologist or optometrist in the past, with 62, 27, 7 and 3% having last attended in the last 2, 2–5, 5–10 and >10 years, respectively. Among those participants (2251) who had been seen in the last 2 years, 50.2% (1131) last saw an ophthalmologist, 48.6% (1094) last saw an optometrist and 26 (1.2%) could not state whom they saw. After adjusting for age and sex, factors statistically significantly associated with attending an ophthalmologist included older age, female gender, higher socio‐economic status, moderate to high myopia and presence of systemic disease (diabetes, hypertension) or any significant eye pathology. Factors statistically significantly associated with attending an optometrist were younger age, living alone, not currently married, being able to go out alone, having better presenting visual acuity, hyperopia and absence of diabetes or significant eye pathology, including moderate to high myopia.

Conclusions: Findings from this study indicate that whether people use eye care services and whom they visit is mainly driven by need factors. Although there was considerable overlap, this study found relatively appropriate utilization of eye care services by this population.
Constructing Mental Illness as Dangerous: A Pilot Study
Authors: Wilson Claire , Nairn Raymond , Coverdale John , Panapa Aroha
Published: March 2003

Objective: There is a dearth of studies examining how dangerousness is constructed in media depictions of mentally ill individuals who are frequently portrayed as acting violently. The aim of the present study was to identify the contribution of diverse technical, semiotic and discursive resources utilised in portraying a character with a mental illness in a prime-time drama as dangerous.

Method: Discourse analytic techniques, involving systematic, repeated, critical viewings, were applied to a single program drawn from a sample of prime-time television drama episodes touching on mental illness.

Results: Nine devices (appearance, music and sound effects, lighting, language, intercutting, jump-cutting, point of view shots, horror conventions and intertextuality) were identified as contributing to the signified dangerousness of person receiving care in the community for a mental illness.

Conclusions: These techniques combine in signifying mental illness and a person suffering from it as dangerous. The findings suggest that mental health professionals working to reduce the stigma of mental illness need to have a reasonably sophisticated understanding of the practices and priorities of television production if they are to collaborate effectively with producers to create dramas that convey more human and sympathetic understandings of mental illness or to combat the negative effects of such portrayals.
Awareness and Unawareness of thought Disorder
Authors: McGrath John , Allman Rebecca
Published: March 2003

Objective: There is little systematic evidence to determine if patients with thought disorder are aware of their impaired communication. Awareness versus unawareness of deficit has important implications for neurocognitive models of thought disorder. The aims of this study were to assess awareness of impaired communication in patients prone to thought disorder, and to explore associations between degree of awareness of thought disorder, objective measurement of thought disorder and performance on tests sensitive to impaired executive ability.

Method: Thirty-one patients with schizophrenia, 16 patients with mania and 20 well controls were included. Subjects completed a new instrument to assess awareness of thought disorder, the Communication Awareness Scale (CAS). Thought disorder was rated from free speech samples scored with Andreasen's Scale for the Assessment of Thought Language and Communication. Four tests sensitive to impaired executive ability were administered.

Results: Subjects with higher levels of positive thought disorder had significantly higher CAS scores. Unexpectedly, those with lower scores on executive ability had significantly higher scores on the CAS.

Conclusions: The significant correlation between objective levels of positive thought disorder and higher scores on the CAS suggests that, overall, patients with thought disorder are aware of their deficit. A neurocognitive model of thought disorder is described that involves a dissociation between the ability to monitor errors (required for accurate awareness of deficit) and the ability to correct errors (required for the production of efficient communication).
An Evolutionary Approach to Psychiatry
Authors: Joness Ivor , Blackshaw Judith K.
Published: March 2003

Objective: The current mainstream approach to psychiatry, characterised as empirical and phenomenological is questioned here and a new aetiological approach based on evolutionary theory is proposed.

Method: A brief description of an evolutionary approach to animal behaviour is presented. The psychiatric states of anxiety, depression, ‘hysterical’ obsession and some aspects of psychosis are compared with related behaviours in other species.

Results: It is argued that this approach can be applied to psychiatric behaviour, that behavioural similarities exist between many psychiatric states and normal behaviour in species other than humans and many of these can be understood as adaptive. Some psychiatric states represent abnormally prominent adaptive behaviours, others represent distortions of these behaviours by a pathological process. An important line of thought in current animal behaviour research examines the concepts of self-awareness, consciousness, thought and affect in species other than man. These ideas, from an evolutionary perspective, are extended to psychiatry. A scheme illustrating this process is presented.

Conclusions: We have drawn on relevant behavioural similarities between humans and other animals to show that many psychiatric states are distortions of evolved behaviour. The implications for classification, research and treatment are considerable. In particular this approach may form a bridge between fundamental research in molecular biology and the anthropomorphic approach of psychodynamics.
ENDOSCOPIC THORACIC SYMPATHECTOMY FOR PRIMARY PALMAR HYPERHIDROSIS: INTERMEDIATE TERM RESULTS
Authors: Erak S. , Sieunarine K. , Goodman M. , Lawrence‐Brown M. , Bell R. , Chandraratna H. , Prendergast And F.
Published: March 2003

Background: The authors’ experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined.

Methods: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview.

Results: Follow‐up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner’s syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X‐ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction.

Conclusions: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.
GOOD OUTCOME FROM SURGERY FOR AMPULLARY TUMOUR
Authors: Toh S. K. C. , Davies N. , Dolan P. , Worthley C. , Townsend N. , Williams J. A. R.
Published: March 2003

Background: Ampulla of Vater tumours are rare but usually resectable. There is debate as to the better surgical approach between the standard radical procedure, which provides adequate resection margins, and local resection, which may carry a lower mortality. This study reports the 16‐year experience of a specialist unit with these tumours, and compares our results with that of recently published series.

Method: A retrospective review of patients admitted with an ampullary tumour to the Hepatobiliary and Pancreatic Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia, between January 1981 and April 1997.

Results: Twenty‐five patients (13 men, 12 women) of median age 65 years were admitted with an ampullary tumour to the unit during this period. The most common presentation was obstructive jaundice. Multiple endoscopic biopsy was found to be very reliable in distinguishing between benign and malignant tumours. Five patients, all male, had benign neoplasms: three adenomas, one carcinoid and one gangliocytic paraganglioma. Transduodenal local excision was performed in four patients. One patient had a Whipple procedure resulting in the only in‐hospital death at 3 months. Twenty patients had adenocarcinoma, of which 13 patients had a pancreaticoduodenectomy, two local excisions, two palliative bypasses, two were unfit for surgery and one declined surgery. The resectability rate was 88%, with no operative mortalities. The 5‐year actuarial survival of patients who underwent radical resection was 49%.

Conclusions: Proximal pancreaticoduodenectomy, preferably a pylorus‐preserving procedure, is safe and effective in the treatment of ampullary carcinoma, with low operative mortality and good long‐term survival. Local resection is only recommended for small benign tumours and for patients who may be unfit for radical surgery.
SURGICAL TREATMENT OF ATYPICAL MYCOBACTERIAL CERVICOFACIAL ADENITIS IN CHILDREN
Authors: Fergusson James A. E. , Simpson Erroll
Published: March 2003

Background: Atypical mycobacteria have long been recognized as a cause of cervicofacial adenitis in otherwise healthy children. The disease is nearly always localized but if left untreated the involved lymph nodes caseate and discharge. The management of this condition has been considered to be surgical with techniques including aspiration, incision and drainage, curettage and excision.

Methods: Cases of atypical mycobacterial cervicofacial adenitis treated by curettage at the Canberra Hospital, ACT, Australia, are reviewed.

Results: Ten cases successfully treated with curettage are reported. Two patients experienced delayed healing of their wounds and one required a second curettage 7 months after primary excision for recurrent disease.

Conclusion: Curettage is a safe and effective means of treating atypical mycobacterial cervicofacial adenitis in children. The primary cure rate of 70% is less than that for excision of the involved nodes (92% cure rate), which is the standard treatment for this disease.
ADULT SPLENIC INJURIES: TREATMENT PATTERNS AND PREDICTIVE INDICATORS
Authors: Sanders Mark N. , Civil Ian
Published: March 2003

Background: With the trend towards conservation in splenic trauma, the ability to identify a group of patients for whom we can safely offer conservative treatment becomes an important factor.

Methods: Data were reviewed from the trauma register at the Auckland Hospital, Auckland, New Zealand, in an attempt to isolate any predictive factors that may allow more appropriate allocation of treatment modalities in the future. Methods of treatment were determined and the success or failure of conservative management noted. Differences in the demographics, Injury Severity Score (ISS) and computed tomographic (CT) findings were particularly sought.

Results: Over a period of 111 weeks 48 patients were admitted with splenic injuries. Fifteen (31.2%) had immediate splenectomy, 27 (56.2%) were initially treated non‐operatively and six (10.1%) died pre‐operatively. Of the non‐operative group eight (29.6%) failed this management at an average of 4.125 days into their hospital stay. No differences were found in age, mechanism, gender or ISS between the failed and successfully treated group. Using the Buntain classification of CT‐graded splenic injury, 13 (87%) who had successful non‐operative treatment had a grade II or III compared with six (86%) who failed this management being grade IV.

Conclusion: Although these results did not reach statistical significance, by coupling the trends seen together with other work, CT grading of splenic injury is a predictive indicator and does appear to have a role in the early allocation of patients to appropriate treatment plans.
MANAGEMENT OF CYCLICAL MASTALGIA IN ORIENTAL WOMEN: PIONEER EXPERIENCE OF USING GAMOLENIC ACID (EFAMAST®) IN ASIA
Authors: Cheung K. L.
Published: March 2003

Background: In most Western countries gamolenic acid is the first‐line treatment for women with cyclical mastalgia.

Methods: A prospective study was carried out in the breast referral clinic of the Department of Surgery, University of Hong Kong to evaluate the treatment of cyclical mastalgia using gamolenic acid provided in evening primrose oil (Efamast®, Scotia Pharmaceuticals Ltd, Scotia House, Stirling, Scotland) as a pioneer experience in Asia. In addition, the features of cyclical mastalgia in Oriental women were studied by conducting a survey using anonymous questionnaires.

Results: Sixty‐six women with disturbing cyclical mastalgia seen by one breast surgeon were followed up with a breast pain diary. Thirty‐four women had persistently disturbing mastalgia and were commenced on Efamast®. Responses were measured at 3 and 6 months according to a standardized protocol. An overall useful response rate of 97% was observed at 6 months. Side‐effects were found in 12% but all were insignificant.

Conclusions: Efamast® may be recommended as a first‐line specific treatment for Oriental women with disturbing cyclical mastalgia.
CHOLECYSTOSTOMY: A REVIEW OF RECENT EXPERIENCE
Authors: Ghahreman A. , Mccall J. L. , Windsor J. A.
Published: March 2003

Background: Operative (OC) and percutaneous cholecystostomy (PC) are rarely undertaken for severe acute cholecystitis in patients in whom cholecystectomy is technically difficult or those with significant comorbidity.

Methods: A retrospective review was undertaken of the clinical, radiological and audit records of patients who were treated by cholecystostomy between 1988 and 1997 at Auckland Hospital.

Results: During the 10‐year period 19 patients (eight male, 11 female; median age: 70 years, range: 35–90 years) had a cholecystostomy (OC: n = 8; PC: n = 11). The main indication for PC was high anaesthetic risk (10 cases). The main indication for OC was failed cholecystectomy (six cases). The patients undergoing PC tended to have a higher American Society of Anesthesiologists (ASA) grade than patients undergoing OC. The median delay from presentation to cholecystostomy was 3 days. More than half (11/19) were done during the 3 years (1992–94) after the introduction of laparoscopic cholecystectomy. The number of tube‐related complications was significantly higher in PC patients (10/11 vs 3/8; P = 0.04), and the number of systemic complications was higher in the OC patients (4/8 vs 0/11; P = 0.018). The median duration of tube drainage was 17 days (range: 0–82 days) for OC and 24 days (range: 5–93 days) for PC. Four patients had stone extraction at the time of OC, including two who also had a partial cholecystectomy. One OC patient had stone extraction via the cholecystostomy tract. A cholecystectomy was performed in four patients.

Conclusion: The data indicate that PC is a safe approach for high‐risk patients. Operative cholecystostomy had a role following failed cholecystectomy. But PC might be safer in these patients if they could be identified pre‐operatively.
THE EARLY OPERATION FOR ACUTE SEVERE CHOLECYSTITIS: THE RIEDEL PAPER; AN INTRODUCTION AND TRANSLATION
Authors: Scheele S. , Miller D. A. , Hardy K. J.
Published: March 2003

Background: For acute cholecystitis in the latter 19th century and early 20th century, the diagnosis was difficult and the management not defined.

Methods and Results: Bernhard Riedel of Jena in Germany documented his patients, analysed his results, and described his method of cholecystectomy.

Conclusions: Riedel advocated early operation for acute cholecystitis when the conditions were favourable, as for acute appendicitis. He stressed the importance of good lighting, an experienced surgeon and trained assistants. He advocated conservative treatment for minor cholecystitis (biliary colic) until the diagnosis was certain, followed by elective cholecystectomy to reduce the risk of subsequent acute cholecystitis or bile duct stones. Caution was advised when analysing previous statistics, to ensure appropriate patient comparison.
PANCREATICODUODENECTOMY WITH PANCREATICOGASTROSTOMY: ASSESSMENT OF PATIENTS’ NUTRITIONAL STATUS, QUALITY OF LIFE AND PANCREATIC EXOCRINE FUNCTION
Authors: Ong Hock Soo , Ng Eng Hen , Heng Germaine , Soo Khee Chee
Published: March 2003

Background: The changes in digestive function of patients with pancreaticoduodenectomy (PD) and pancreaticogastrostomy reconstruction have not been well‐documented. The present study sought to assess the nutritional status, quality of life and pancreatic exocrine function in this group of patients.

Methods: The study group consisted of 11 PD with pancreaticogastrostomy patients. The control group consisted of 11 consecutive patients who had subtotal gastrectomy (SG) for distal stomach tumours.

Results: The median ages for the PD and SG groups were 57 and 59 years, respectively. The median intervals between surgery to assessment were 68 and 60 weeks, respectively. The PD group attained a mean of 92.7% of their pre‐surgery weight compared to 91.3% in the SG group. Both groups had a comparable gastrointestinal quality of life index and Visick scale scores. Exocrine insufficiency using the faecal chymotrypsin test was present in 36% of patients with PD. None of the patients in the SG group had exocrine insufficiency.

Conclusion: Pancreaticoduodenectomy patients had a significant occurrence of pancreatic exocrine insufficiency compared to the SG group. But patients with PD and pancreaticogastrostomy reconstruction maintained a nutritional status and quality of life similar to those with curative SG for stomach malignancy. Apart from exocrine insufficiency, the concomitant gastrectomy in the PD group is an important factor responsible for their inability to gain weight.
Laparoscopic Heller Myotomy For Achalasia
Authors: Hunt D. R. , Wills V. L.
Published: March 2003

Background: Laparoscopic Heller myotomy provides similar results to open Heller myotomy for the treatment of oesophageal achalasia with the advantage of quicker recovery. The present series examines the evolution of operative technique, postoperative outcome and the effect of the ‘learning curve’ in a group of 70 consecutive patients.

Methods: Between 1992 and 1999, details of all patients undergoing oesophagogastric myotomy for achalasia were prospectively entered on a database. Patients were followed with a biannual postal symptom questionnaire and scores were obtained for dysphagia, heartburn, regurgitation and chest pain. Comparison between preoperative and postoperative symptom scores, and case number and operative complications was made using Fisher’s exact test or Mann–Whitney U‐test where appropriate.

Results: The indication for surgery was as a primary procedure in 20 cases; after failed endoscopic treatment in 48 cases; and after a ‘failed’ fundoplication in two cases. Myotomy was combined with a 360° fundoplication in 57 patients and with an anterior fundoplication in 13 patients. Mucosal perforation occurred intraoperatively in 11 cases. Conversion to an open procedure was required in seven patients. Seven patients required a second operation. At a mean follow up of 2.9 years, symptom scores were significantly improved from preoperative values for dysphagia, regurgitation and chest pain (P < 0.001). There was no increase in the postoperative score for heartburn. The ‘learning curve’ contributed significantly to the length of the procedure, and the need for reoperation.

Conclusions: Laparoscopic Heller myotomy is a technically challenging procedure that provides good early palliation of the symptoms associated with achalasia.
Impact of Inadequate Fine‐needle Aspiration Cytology on outcome of Patients with Palpable Breast Lesions
Authors: Lee H. C. , Ooi P. J. L. L. , Poh W. T. , Wong C. Y.
Published: March 2003

Background: The purpose of the present study was to assess the impact of inadequate fine‐needle aspiration cytology (FNAC) breast specimens on the outcome of patients with a palpable breast lesion.

Methods: A retrospective review was carried out of inadequate FNAC specimens from the Department of General Surgery, Singapore General Hospital in 1997.

Results: One hundred and thirty‐eight (16.6%) of 831 FNAC specimens were reported inadequate, and these form the study group. Outcome analysis was divided into benign on excision biopsy (n = 38; 29.4%); benign on repeat FNAC or trucut biopsy (n = 6; 4.7%); benign on follow up (n = 46; 35.7%); malignant on histology (n = 11; 8.5%); and lost to follow up (n = 28; 21.7%). The 11 cases with breast cancer were further analysed. The mean time to treatment was 88.3 days for three patients whose tumours were not clinically suspicious of malignancy versus 20 days for six patients who were diagnosed with cancer clinically from the onset. One patient with cancer refused treatment and one absconded from treatment only to return 7 months later.

Conclusion: Breast cancer was present in 8.5% of the inadequate FNAC specimens. When clinical suspicion of malignancy is high, an excision biopsy is advised in patients with inadequate FNAC specimens. If properly managed with triple tests and good clinical judgement, the inadequate FNAC specimens do not delay treatment in patients with breast cancer.
Surgical treatment of cerebral ischaemia caused by cervical arterial lesions due to Takayasu’s arteritis: Preliminary results of 49 cases
Authors: Gu Yong Quan , Wang Zhong Gao
Published: March 2003

Background: The present paper reports the preliminary experience with surgical treatment of 49 cases of cerebral ischaemia caused by cervical arterial lesions due to Takayasu’s arteritis (TA).

Methods: Six men and 43 women were treated between June 1992 and October 1997. Their ages ranged from 15 to 42 years, with a mean of 26.5 years. Duration of symptoms was from 10 days to 8 years with a mean of 32 months. Bypasses from the ascending aorta to the axillary or subclavian artery and to the carotid artery were performed in 31 cases. Subclavian‐to‐carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in four cases.

Results: An excellent result was achieved in 28.6% of cases, a fair result was achieved in 36.7% of cases, improvement was achieved in 22.5% of cases, 2.0% of cases were unchanged, and in 10.2% of cases death occurred before discharge. During a mean follow up of 38 months these values were 26.2%, 42.8%, 16.7%, 4.8%, and 2.4%, respectively; recurrence occurred in 7.1% of cases.

Conclusion: When cerebral perfusion is jeopardized, a definitive corrective procedure is advised at a time when the patient is in a relatively stable condition. Percutaneous transluminal angioplasty is the first choice although the recurrence rate is very high, and complications such as arterial rupture and thrombosis formation are serious. Patients with occlusive lesions of all four cervical arteries usually have severe cerebral ischaemia and their distal runoff is usually unable to be visualized on angiography. But it was found that in 95% of cases the internal carotid artery is still patent (confirmed by exploration), therefore an ascending aorta‐to‐carotid bypass is feasible in most instances. Unfortunately, cerebral re‐perfusion syndrome is a serious unresolved problem.
Complex sclerosing lesion: The lesion is complex, the management is straightforward
Authors: Ung Owen A. , Lee Warwick B. , Greenberg Merle L. , Bilous Michael
Published: March 2003

Background: Complex sclerosing lesion (CSL) and its smaller counterpart, the radial scar (RS), are frequently seen pathological entities. They are clinically asymptomatic and, prior to the implementation of mammographic screening, were most commonly found incidentally during pathological examination of other biopsied lesions. Complex sclerosing lesions are being detected regularly on mammograms due to widespread screening; many of their features resemble those of malignancy. Management varies and has been controversial.

Methods: Twenty‐three cases of CSL detected during the first prevalent round of screening at BreastScreen Western Sydney (from February 1993 until June 1995) are presented and reviewed. Assessment was by a combination of radiological, clinical and cytological work‐up prior to surgical biopsy. In addition, 126 spiculated carcinomas detected in the same period were reviewed and compared.

Results: Fourteen RS/CSL (62%) had lucent centres and nine (38%) had a central mass; three had been diagnosed provisionally as RS/CSL. Spicule lengths ranged from 25 to 90 mm; central masses ranged from 5 to 50 mm; and mass:spicule length ratio ranged from 1.2:1 to 1:10. Calcification (benign or indeterminate) was present in six cases (29%). No RS/CSL contained ‘suspicious’ calcifications, whereas 120 of 126 carcinomas (95%) had a central mass and six (5%) had a lucent centre (spicule lengths: 10–90 mm; central mass: 5–40 mm; and mass:spicule length ratio: 1.1:1–1:10). Twenty‐one spiculated carcinomas (17%) contained microcalcifications (14 benign or indeterminate; seven suspicious). Provisional radiological diagnosis (PRD) after mammogram, with or without ultrasound, for histologically confirmed RS/CSL, was RS/CSL in 18 cases (78%), carcinoma in four cases (17%) and equivocal in one case (5%). For eight (6.5%) spiculate carcinomas the PRD was RS/CSL prior to histological diagnosis. The RS/CSL were detected with equal frequency in right and left breasts, and 22 (96%) lesions occurred in the upper breast. Seven RS/CSL (31%) and 83 spiculated carcinomas (65%) had been described as ‘palpable’ but most were subtle. Twelve fine‐needle aspiration biopsies were performed (six ‘palpable’ lesions (no radiological guidance); four with ultrasound guidance and two with stereotactic guidance), and five (62.5%) of eight adequate lesions were reported as benign, two (25%) were reported as atypical, and one (12.5%) was reported as suspicious.

Conclusions: Definitive mammographic and sonographic differentiation of RS/CSL and stellate‐type carcinoma is impossible. For screen‐detected lesions that may be RS/CSL, the appropriate surgical procedure is a small but adequate biopsy using guidewire or other localization methods with optimal cosmetic incision.
Surgical outcomes of a randomized prospective trial involving patients with a proximal femoral fracture
Authors: Day G. A. , Swanson C. , Yelland C. , Broome J. , Dimitri K. , Massey L. , Richardson H. , Marsh A.
Published: March 2003

Background: An orthopaedic management/patient‐focused care unit (OMPFCU) involving a dedicated orthopaedic–geriatrics liaison team was established at the Royal Brisbane Hospital in 1994 in an effort to safely accelerate rehabilitation of patients with proximal femoral fractures.

Methods: The surgical outcomes of the patients were monitored in order to determine whether accelerated rehabilitation had any significant adverse effects on the surgical outcomes, measured by mortality, readmission to hospital, deep wound infection, fracture union delay, mobility and the revision surgery rate.

Results: No significant difference was recorded in mortality and morbidity, deep wound infection and revision surgery rates between patients in the Royal Brisbane Hospital OMPFCU and those in standard care in the orthopaedic surgery wards.

Conclusion: Accelerated rehabilitation for patients with a proximal femoral fracture in a major teaching hospital can be accomplished safely.
Caseload in rural general surgical practice and implications for training
Authors: Tulloh Bruce , Clifforth Stephen , Miller Iain
Published: March 2003

Background: Despite increasing specialization within general surgery, many general surgeons, particularly in rural practice, continue to treat a wide range of conditions. The aim of the present paper was to provide accurate information on three rural surgeons’ caseloads to illustrate the spectrum of surgery encountered and to assist in the planning of rural general surgical training.

Methods: A review was conducted of a prospectively maintained database of operations performed by three rural general surgeons in different parts of Victoria, Australia over a 5‐year period.

Results: A large volume and wide range of procedures was performed by each surgeon, who averaged more than 500 operations per year (excluding endoscopies). Although most were within the range of procedures covered in the Royal Australasian College of Surgeons (RACS) Fellowship in general surgery, some encroached upon other specialties such as orthopaedics, urology, paediatric surgery and obstetrics/gynaecology. Operations outside of ‘general’ surgery reflected individual training and local community needs.

Conclusions: The current RACS Fellowship in general surgery, augmented by training in other specialties as required, will help prepare general surgeons for rural practice.
Comparison of hydrogen peroxide instillation with Goodsall’s fule for fistula‐in‐ano
Authors: Gunawardhana P. A. H. A. , Deen K. I.
Published: March 2003

Background: Identification of the internal opening is an essential step in the management of fistula‐in‐ano. The predictive accuracy of Goodsall’s rule is compared with instillation of hydrogen peroxide for fistulas‐in‐ano.

Methods: Thirty‐five patients (32 male, three female; median age 42 years; range: 6 months–70 years) were studied. Hydrogen peroxide solution was injected into the external opening of the fistula track and effervescence was observed at the internal opening within the anal canal. A fistula track was either excised or incised. Setons were placed within high fistulas.

Results: There were 24 simple fistulas, compared to 11 complex fistulas (horseshoe, n = 4; abscess, n = 4). Eighteen external openings were anterior and 17 were posterior. Thirty‐four of 35 (97%) internal openings were identified. Only 20 internal openings were in accordance with Goodsall’s rule (positive predictive value: 59%). Predictive accuracy was greater for anterior external openings (13 of 18 (72%)) versus posterior external openings (six of 17 (41%); P = 0.016). For recurrent fistulas, seven of 17 fistula tracks had an internal opening in accordance with Goodsall’s rule, resulting in a positive predictive value of 41%. (Positive predictive value: anterior 67%vs posterior 12.5%; P = 0.0009.)

Conclusion: The overall predictive accuracy of Goodsall’s rule was poor chiefly because of poor predictive accuracy in posterior and recurrent fistulas. The use of Goodsall’s rule alone in decision‐making before surgical intervention is not recommended.
Australia’s occupational therapy workforce: Jobs for the future
Authors: Millsteed Jeannine
Published: March 2003

The forces that affect the economic, technological and industrial structure of Australia in the future will also affect its occupational and educational structures. The number of people participating in the education system is expected to grow, but at a slower rate than over the past decade, and the proportion of the workforce with a qualification is expected to reach a historically high level by the year 2005. Workforce modelling projections indicate that more highly skilled occupations will have strong employment growth over the next decade. It is estimated that, in 2005, the demand for occupational therapists will represent an increase of 79.9% of the number working in 1993–94. However, the accuracy of this projection is based on a macro‐analysis of data from various sources and does not account for any analysis of factors internal to the profession that may affect its occupational structure or employment growth. The paucity of occupational therapy microworkforce data has been noted by national workforce planning agencies and regular national workforce collections will start in 1998. Inclusion of macro‐ and microfactors into a comprehensive occupational therapy workforce planning framework is essential to the development of appropriate response strategies that address demand and supply issues for occupational therapy jobs in the future.
Cost drivers of public hospital occupational therapy outpatient care
Authors: Grimmer Karen , May Esther
Published: March 2003

This study examined the associations between various patient‐related, demographic and episode‐based factors, and the length of time associated with completed episodes of outpatient (ambulatory) occupational therapy care. Data were provided over a 10‐month period by eight public hospitals in three Australian states. An episode described occupational therapy outpatient management for one patient with one condition, and consisted of start and finish dates, and all the occasions of service in between. The median value of the total patient‐attributable time of an occupational therapy episode of care was 70 min. Factors that were strongly associated with long occupational therapy episodes were age, communication issues and hospital location (metropolitan or country). This study provides the basis for future investigations into the costs of providing ‘best practice’ occupational therapy outpatient services.
Juvenile fibromyalgia syndrome: The role for occupational therapists
Authors: Brown G. Ted , Greenwood‐Klein Jennifer
Published: March 2003

Juvenile fibromyalgia syndrome, a form of nonarticular rheumatism, is a clinical condition affecting children and adolescents. To date, it has received little or no attention in the professional literature. Occupational therapists have an important role to play in the assessment and management of this paediatric client group. A literature review, the clinical symptoms, prognosis and possible aetiology of this clinical syndrome are presented. The potential role for occupational therapists with paediatric clients diagnosed with juvenile fibromyalgia syndrome is then briefly described.
The lived experience of doing a higher degree in occupational therapy from the perspective of five graduates: A phenomenological study
Authors: Dawkins Helen , May Esther
Published: March 2003

The importance of supporting research activity in occupational therapy through higher degree study is widely accepted. Although completing a higher degree is acknowledged to be a unique and meaningful experience, few studies have been conducted to explore this phenomenon. This phenomenological study aimed to reveal and describe the experience of doing a higher degree from the perspective of five recent occupational therapy graduates. One in‐depth interview was conducted with each participant. Analysis of the data revealed five themes. The results suggest that the experience of doing a higher degree was exciting and challenging but also involved personal hardship and sacrifices. Support from supervisors, family, peers, colleagues, employers and friends made completing a higher degree achievable. Doing a higher degree facilitated personal growth and professional benefits, but it was the great sense of achievement and satisfaction apparent upon completion that was most significant for participants. Implications for occupational therapy and higher education are discussed.
Application of key health care concepts in the development of a paediatric upper limb hypertonicity surgery clinic
Authors: Collis Dianne , Rae Margaret
Published: March 2003

The task of establishing and managing a paediatric Upper Limb Hypertonicity Surgery Clinic provided an opportunity to investigate key concepts in health care delivery in order to enhance the quality of the service for patients and their families. Several concepts were found to be fundamental to effective service development and delivery: client‐centred approach, collaboration, continuum of care, evidence‐based practice and outcome evaluation. This report describes the processes and protocols of the Upper Limb Hypertonicity Surgery Clinic and discusses both the positive and challenging aspects of applying key health care concepts in clinical practice.
Use of an Apprehended Violence Order to Avoid Involuntary Psychiatric Hospitalisation
Authors: Pakula Irwin , Brown Peter
Published: March 2003

Objective: To describe a patient with a delusional disorder who utilised the provisions of an apprehended violence order (AVO) to avoid involuntary hospitalisation under the 1990 NSW Mental Health Act.

Method: Case Report.

Results: The patient had a well-circumscribed paranoid delusional system involving multiple individuals in a regional centre. The patient made accusations of paedophilia, harassment, assault, bribery and corruption against numerous politicians, a local shopkeeper and several members of the community psychiatry team. The patient applied for an AVO against the Team Leader of the community psychiatry team and team staff to evade execution of a Section 27 Order of the 1990 NSW Mental Health Act, and to block any evaluation of his mental state by the community psychiatry team or others. The patient eventually withdrew the complaint. However, the Area Health Service bore all costs, which were substantial both in time for staff members and in monetary terms.

Conclusions: Any patient can attempt to prevent the enactment of the NSW 1990 Mental Health Act by using another legal manoeuvre such as an AVO. Such an action may have major implications for the operation of a community psychiatry team in relation to its functioning, the effect on staff and costs in terms of money and time.
Primary malignant mediastinal germ cell tumours: A literature review and a study of 18 cases
Authors: Kiffer John D , Sandeman Thomas F
Published: March 2003

From 1957 to 1992, 18 cases of primary mediastinal germ cell tumours were referred to the Peter MacCallum Cancer Institute (PMCI). Six were seminomas, six were mixed germ cell tumours, two were embryonal cell carcinomas, three were teratocarcinomas and one was labelled an ‘anaplastic germ cell tumour’. Two of the 18 patients were female. For seminomas, surgical (and in one case chemotherapeutic) debulking, followed by radiotherapy produced the best results. Mediastinal doses ranged from 30 to 40 Gy. Local control was achieved in those patients receiving mediastinal radiotherapy. Four patients currently survive disease‐free. The non‐seminomatous germ cell tumours showed a significantly poorer survival, and only two of 12 patients remain alive in remission at 110 and 130 months after diagnosis. Survival has been updated as of November 1997. Attention is focused on the anterior position of the primary germ cell tumours in the mediastinum. A review of the literature up to and including 1997 is presented.
Spinal Schmorl’s nodes: Sagittal sectional imaging and pathological examination
Authors: Silberstein Morry , Opeskin Ken , Fahey Vanessa
Published: March 2003

The presence, location and number of Schmorl’s nodes was determined in the thoracolumbar spines of 70 motor vehicle accident victims using radiographic examination of a midline sagittal section and subsequent pathological examinations, including histology. In 28% of spines, a greater number of Schmorl’s nodes were identified with radiography, while in 44%, pathological examination revealed a greater number of nodes. The visibility of Schmorl’s nodes was enhanced by using a sagittal radiographic approach, and, in contrast to previous work, nodes below 0.5 cm were readily detected. The results of the present study offer an additional imaging technique for postmortem analysis of the spine, and support the use of sagittal MR imaging for the evaluation of this condition.