bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression and Smoking: Examining Correlates in a Subset of Depressed Patients
Authors: Roy Kay , Parker Gordon , Mitchell Philip , Wilhelm Kay
Published: March 2003

Objective: The objective of this study was to examine for associations between depression and cigarette smoking.

Method: A sample of 92 depressed smokers was compared with a control sample of depressed non-smokers, matched for age, gender and diagnostic variables. Comparisons were made across a range of demographic, depression, family history, developmental factors, anxiety and personality style variables, as well as use of alcohol and illicit drugs.

Results: We failed to find any difference between smokers and non-smokers in history or severity of depression. Cigarette smokers were distinguished principally by greater exposure to aversive experiences in childhood, disordered personality function, greater use of illicit drugs, anxiolytics and alcohol. Logistic regression identified dysfunctional personality ‘domains’, physical violence in childhood, long-term anxiolytic use and illicit drug use as the most significant predictor set.

Conclusions: Results favour a model of cigarette smoking and depression as linked by shared early deprivational variables, rather than cigarette smoking causing depression or the converse.
Major Depression: Does a Gender-Based Down-Rating of Suicide Risk Challenge Its Diagnostic Validity?
Authors: Blair-West George W. , Mellsop Graham W.
Published: March 2003

Objective: This paper will summarize the authors' research that disproved the accepted lifetime suicide risk in major depression. It will then explore the pivotal issue of gender in understanding suicide risk in depression and raise questions as to whether this is adequately reflected in the current diagnostic construct of this condition.

Method: The methods of two recent papers published by the authors are briefly recounted. In the first of these papers, an age-specific algorithm was developed to reflect the necessary mathematical relationship between the prevalence of major depression, total population suicide rates and suicide risk in depression. It allowed for deaths in each age group from other causes, corrected for official underreporting, and was calculated on the entire population of the USA. In the second paper this methodology was further refined and applied to gender and age data.

Results: The suicide risk in major depression as it is currently defined diagnostically is of the order of 3.4% rather than the previously accepted figure of 15%. However, a single figure is misleading as it averages two highly disparate figures of almost 7% for men and only 1% for women. In youths (< age 25) the male : female ratio is even higher (10:1).

Conclusions: Among sufferers of major depression, men and those who have been hospitalized have a much greater risk of suicide. These findings are sensitive to diagnostic inclusivity (the algorithm's denominator) which raises the question as to whether women with a depressive illness are more likely to be correctly identified than male sufferers? An argument is made for a gender-based nosological revision of the diagnostic criteria. In the interim, given the treatable morbidity of depression and the availability of safe, welltolerated antidepressants, there is a prima facie case for lowering our threshold of treatment in men and youths presenting with a history of anger dyscontrol, or substance abuse, who have decompensated from previous levels of functioning and who show features of either typical or atypical depression.
Challenges and Benefits of Assessment, Diagnosis, and Taxonomy for Clinical Practice and Research
Authors: Achenbach Thomas M.
Published: March 2003

Objective: To outline nosological (top-down) and empirically based (bottom-up) approaches to assessment and taxonomy of psychopathology.

Method: The two approaches were compared and contrasted to highlight similarities and differences between them.

Results and Conclusions: To advance services and research, we need to make optimal use of assessment data (i) to identify the distinguishing features of each case, and (ii) to link individual patterns of functioning with taxonomic constructs that can help us apply previously accumulated knowledge to new cases. The time may be ripe for integrating nosological and empirically based approaches. One way to integrate these approaches is to construct empirically based and DSM-oriented scales from the same item pools and to generate age- and gender-specific standard scores and cut-off points from the same normative samples. Integration of the approaches was illustrated with profiles of empirically based and DSM-oriented scales scored from the same item pools and quantified in relation to the same normative samples. To facilitate use by clinicians and researchers under diverse conditions, data are readily obtained on forms completed independently by parents, teachers and others. The data can be quickly scored by hand or computer. To take account of situational and informant variations, the computer software systematically compares data from multiple informants on empirically based and DSM-oriented scales.
Mind Over Matter? II: Implications for Psychiatry
Authors: Schimmel Paul
Published: March 2003

Objective: To explore concepts of causality within the mind and aetiology of psychiatric disorders in the light of the proposed formulation of the mind–brain problem.

Method: Taking the two propositions of this formulation as ‘first principles’ a logical analysis is attempted.

Results and conclusions: Neural activity cannot in principle be regarded as causing mental activity, or vice versa. Causal processes are most coherently conceptualised in terms of the ‘mind–brain’ system. Determination of causal and aetiological effects will always necessitate consideration of contextual evidence. Because of the ‘explanatory gap’ between explanation in neurophysiological terms and ‘mentalistic’ terms, whenever formulation in mentalistic terms is possible this will carry greater explanatory power; that is, it will carry meaning in the way a neural formulation cannot.
Association between Allergy and Anxiety Disorders in Youth
Authors: Kovalenko Pavel A , Hoven Christina W , Wu Ping , Wicks Judith , Mandell Donald J , Tiet Quyen
Published: March 2003

Objective: Studies have documented associations between anxiety disorders and allergy in adults, but these associations have not been studied extensively in children. The objective of this study is to examine the associations between allergy and six anxiety disorders (AD) in youth.

Method: This is a data analysis of two epidemiologic-services studies: (i) alternative service use patterns of youth with serious emotional disturbance (n = 936), and (ii) methods for the epidemiology of child and adolescent mental disorders (n = 1285). Child psychiatric diagnoses were measured by the diagnostic interview schedule for children. Allergy was assessed by the service utilization and risk factors interview.

Results: Among ADs, the strongest association found was between allergy and panic disorder (adjusted odds ratio 5.0; p ≤?0.001). Associations of allergy and the other ADs do not seem to be clinically significant.

Conclusions: Findings suggest that in some patients panic disorder may be associated with hypersensitivity of immune system. Panic disorder should be considered in anxious children reporting allergy when no organic cause of allergy is found, and likewise allergy should considered in children with panic disorder.
Alcoholism and Personality
Authors: Mulder Roger T
Published: March 2003

Objective: The search for an alcoholic personality has been pursued with varying enthusiasm throughout the 20th century. This paper reviews the methodological issues, research designs and current theories relating alcoholism and personality.

Method: A selected literature search using computerised databases was ordered via the four major research design strategies: cross sectional studies, high-risk studies, longitudinal studies and genetic epidemiology studies.

Results: Cross sectional studies have suggested that two broad bands of personality, impulsivity/novelty seeking and neuroticism/negative emotionality, are associated with alcoholism. Although high-risk studies have repeatedly shown that sons of male alcoholics are at increased risk of alcoholism, whether this risk is related to personality variables is unclear. Many authors believe that the presence of antisocial personality disorder is a confounder and that this may explain some of the contradictory findings. Longitudinal studies have consistently reported that antisocial behaviour and hyperactivity are related to later alcoholism. Negative emotionality seems to be less important and may largely be a consequence of the alcoholism itself. Genetic epidemiological studies suggest that personality measures play a modest but significant role in the genetic influence of alcoholism. The strongest relationships are with conduct disorder and antisocial behaviour. The postulated alcoholic subtypes (Type I, Type II or Type A/B) based on age of onset and personality style have been challenged by recent research. The most vulnerable to alcoholism may be those with both high impulsivity/high novelty seeking and high neuroticism/negative emotionality.

Conclusion: Antisocial behaviour and hyperactivity are the most consistent behaviours associated with alcoholism. These behaviours are not specific for alcoholism and are associated with many other psychiatric conditions. Personality variables by themselves explain only a small proportion of the risk for alcohol dependence. There is no alcoholic personality nor are there personality measures which are specific to vulnerability to later alcohol dependence. Attempting to link alcoholism with theoretical, poorly validated models of personality is premature.
Psychiatric Morbidity and Adherence to Antiretroviral Medication in Patients With HIV/AIDS
Authors: Sternhell Peter S , Corr Melissa J
Published: March 2003

Objective: To determine whether psychological morbidity is associated with poor compliance with antiretroviral medication in HIV-positive subjects.

Method: This is a cross-sectional survey of patients attending a public HIV clinic in Sydney. Volunteers completed a survey which gathered data on substance use, psychological distress, attitudes to illness and medication, and self-reported medication adherence. Psychological morbidity was assessed using the 28 question General Health Questionnaire, GHQ-28, and adherence was assessed using a combination of direct self-report and indirect questions.

Results: Forty-four per cent of subjects were identified as suffering psychological disorder on the GHQ. They reported significantly poorer adherence to antiretroviral medication than subjects not identified as ‘cases’ (odds ratio 4.5). Expressed scepticism about medication and previous use of psychotropics was also associated with poor adherence.

Conclusions: Psychological morbidity is associated with poor adherence to antiretroviral medication. It is not known whether treatment of identified psychological morbidity leads to improved antiretroviral medication adherence and better medical outcome. A longitudinal study could help answer this question.
Trauma and Posttraumatic Stress Disorder in Australia: Findings in the Population Sample of the Australian National Survey of Mental Health and Wellbeing
Authors: Rosenman Stephen
Published: March 2003

Aim: To investigate the distribution and risk factors for trauma and posttraumatic stress disorder in the Australian population sample taken for the 1997 National Survey of Mental Health and Wellbeing.

Methods: The confidentialised unit record file (CURF) was prepared by the Australian Bureau of Statistics from the survey sample of 10 641 adults. It was interrogated for the lifetime experience of specific trauma and the 12-month prevalence of posttraumatic stress disorder according to DSM-IV and ICD-10. Univariate and multivariate analyses were applied to quantify risks for traumatic experience and for DSM-IV posttraumatic stress disorder.

Results: Fifty-seven per cent of the population reported lifetime experience of the specified trauma. Men were more likely to experience most traumas and multiple traumas except for sexual assaults. The twelve-month prevalence of DSM-IV posttraumatic stress disorder in the overall adult population was 1.5%. It occurred in 3.8% of women and 2.0% of men who had experienced trauma. While female gender, youth, lower education and residence in poorer areas predicted posttraumatic stress disorder after trauma, multivariate analysis showed that the nature of trauma (especially sexual assault) predominated. Gender ceased to be a significant contributor to the risk of posttraumatic stress disorder when analysis controlled for type and number of trauma, and for the passage of time.

Conclusion: Trauma is ubiquitous in the community and posttraumatic stress disorder is comparatively less common, persisting into the past year in 2.8% of those who have experienced lifetime trauma. The conventional models of female susceptibility to posttraumatic stress disorder are not supported in this sample. The type of trauma appears the most important determinant of progression to posttraumatic stress disorder. These community prevalence statistics complement causal understanding that comes from studies of clinical and other special populations in which posttraumatic stress disorder and selection for treatment may be confounded.
Emotional and Behavioural Problems in Childhood and Distress in Adult Life: Risk and Protective Factors
Authors: Buchanan Ann , Flouri Eirini , Ten Brinke Joann
Published: March 2003

Objective: To assess the relationship between risk and protective factors and the continuity of psychological problems from age 7 to age 33.

Methods: Data on 5591 cohort members of the National Child Development Study were used to track continuity and discontinuity between internalizing and externalizing problems at age 7, as assessed by the Rutter ‘A’ Health and Behaviour Checklist, and psychological distress at age 33, as assessed by the Malaise Inventory, controlling for risk and protective groupings present at age 7.

Results: There was no association between malaise in adulthood and internalizing problems in childhood. However, people who had externalizing problems in childhood were nearly twice as likely as those without such problems to have high Malaise scores in adulthood. A grouping of risk factors (police/probation experience by family, agency referral for difficulties in school, social services involvement, domestic tension) did not predict malaise in adulthood. Also a grouping of protective factors (outings with mother, father reads to child, good creative skills, good numeric skills) predicted that women were less likely to have high Malaise scores in adult life.

Conclusions: Protective factors in childhood were strongly associated with lower Malaise scores in adulthood. Research on factors associated with discontinuity of psychological problems may prove fruitful.
Psychiatrists as a Moral Community? Psychiatry Under the Nazis and its Contemporary Relevance
Authors: Dudley Michael , Gale Fran
Published: March 2003

Objective: In Nazi-occupied Europe, substantial numbers of psychiatrists murdered their patients while many other psychiatrists were complicit with their actions. This paper addresses their motivations and actions, and with particular reference to Australia, explores issues of contemporary relevance.

Methods: The events are reviewed in their historical context using mainly secondary sources.

Results: The assumption that the term ‘Nazi’ denotes a closed and unrepeatable chapter is questioned. As with the Holocaust that followed, medical killing of psychiatric patients was an open secret with gradations of collective knowing. Perpetrators were impelled by pressure from peers and superiors, unquestioning obedience, racist ideology and careerism. Perpetrators and bystanders' denial was facilitated by use of deceptive language, bureaucratic and technical proficiency, and notions such as ‘a greater cause’ or ‘sacred mission’. Dissociation and numbing were common. Psychiatrists were the main medical speciality involved because Nazi race and eugenic ideology (accepted by many psychiatrists) targeted mentally ill people for sterilization and euthanasia, and because psychiatrists were state-controlled and tended to objectify patients. Few psychiatrists resisted.

Implications: Nazi psychiatry raises questions about medical ethics, stigma and mental illness, scientific ‘fashions’, psychiatry's relations with government, and psychiatrists' perceived core business. Psychiatric resistance to future similar threats should be based on commemoration, broad-based education and reflection on cultural values, strong partnerships between psychiatrists and patients, and willingness to question publicly policies and attitudes that disadvantage and stigmatize groups. The principle fundamental to all these practices is an orientation to people as subjects rather than objects.
What Outcomes to Measure in Routine Mental Health Services, and How to Assess Them: A Systematic Review
Authors: Slade Mike
Published: March 2003

Objective: Routine outcome assessment in adult mental health services involves the ongoing assessment of patient-level outcomes. Use of outcomes to inform treatment is widely recommended, but seldom implemented. The goals of this review were (i) to identify principles that have been proposed for implementing routine outcome assessment, (ii) to identify the full range of outcome domains that have been proposed for assessment, and (iii) to synthesize proposals for specific outcome domains into emergent categories.

Method: A systematic review of published and unpublished research was undertaken, using electronic databases, research registers, conference proceedings, expert informants and the World Wide Web. For goal (i) studies were included that proposed principles for implementing routine outcome assessment. For goal (ii) studies were included that identified at least two patient-level outcome domains for patients using adult mental health services and made some reference to a broader literature base.

Results: Six thousand four hundred publications matched initial search criteria. Seven distinct sets of principles for choosing patient-level outcomes were located, which showed a fair degree of consensus. Sixteen outcome domain proposals were identified, which were synthesized into seven emergent categories: wellbeing, cognition/emotion, behaviour, physical health, interpersonal, society and services.

Conclusions: The findings from this review were used to develop a four-step method for adult mental health services wishing to implement routine outcome assessment.
Establishment of a Disaster-Related Psychological Screening Test
Authors: Huang-Chih Chou Frank , Tung-Ping Su Tom , Ou-Yang Wen-Chen , Chien I-Chia , Lu Ming-Kun , Chou Pesus
Published: March 2003

Objective: To create a short screening scale for the detection of posttraumatic stress disorder (PTSD) and major depressive disorder (MDE) in earthquake survivors in Taiwan.

Method: Trained research assistants used the Disaster-Related Psychological Screening Test (DRPST) to assess 461 residents of a village that had experienced a major earthquake. The participants were also evaluated by psychiatrists using the Mini-International Neuropsychiatric Interview (MINI). Best subset regression analysis and the receiver operating characteristics curve were used to select a subset of items and cut-off points from the DRPST.

Results: A seven-symptom scale and a three-symptom analogue were selected for PTSD and MDE screening, respectively. Scores of three or more on the PTSD scale and two or more on the MDE scale were used to define a group of positive cases that provide useful information for the patient cohort and will be valuable in long-term follow-up studies of the prevalence of psychiatric diseases following a natural disaster. However, higher scores could also be used to define positive cases under limited psychiatric care resources.

Conclusion: The DRPST, which was administered for phase 1 of this two-phase study, may be used for effective and rapid screening for PTSD and MDE after an earthquake, despite the usual limitations on resources following a disaster.
The Subjective Experience of Patients who Received Electroconvulsive Therapy
Authors: Frank Koopowitz Leslie , Frank Koopowitz Leslie , Chur-Hansen Anna , Reid Sally , Blashki Miriam
Published: March 2003

Objective: Despite the vast amount of scientific literature available on electroconvulsive therapy (ECT), there is little qualitative focus upon the patients' subjective experience of this procedure. Using an exploratory descriptive methodology, this study aims to provide a more unique insight into what certain patients actually think of ECT.

Method: Semistructured interviews were conducted to explore eight patients' opinions and experiences of ECT. Interviews were subjected to analysis by a five-step framework approach that identified prominent themes in relation to five broad questions and in conjunction with issues raised by the subjects themselves.

Results: Eleven major themes were identified. Four of these were chosen for discussion, not only as the most prevalent themes (in terms of how frequently they were mentioned by the subjects), but also as the most striking (in regards to the intensity of emotions evoked, or their influence on their perception of ECT as a future treatment option). The four themes are fear of ECT, attribution of cognitive decline and memory loss to ECT, positive ECT experiences, and patients' suggestions.

Conclusions: Using such a qualitative approach, the depth of the information obtained has revealed new perspectives on how patients perceive the experience of ECT. Fears reported by patients present an opportunity to address specific areas of the procedure that generate the most angst. These were closely associated with recommendations that many patients proposed throughout the interviews. Patients' perceptions of the cognitive effects of ECT do not necessarily correspond with those commonly reported in the literature on ECT. Positive experiences with ECT were more complex than simply its efficacy. There is a need for future research in order to explore and address patients' experiences of ECT.
AN EASY AND EFFECTIVE METHOD OF CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY: LAPAROSCOPIC CHOLECYSTOCHOLANGIOGRAPHY
Authors: Daoud M. , Mccallum M. J.
Published: March 2003

Background: There is ample evidence that the incidence of operative cholangiography has declined since the introduction of laparoscopic cholecystectomy. It has been suggested that one of the reasons for this decline is the technical difficulty of cystic duct catheterization. A method of cholangiography which does not require such catheterization has been developed by others. This paper examines the ease and effectiveness of operative cholangiography performed by direct puncture of the gall‐bladder.

Methods: A retrospective study was made of the records of 380 consecutive patients who underwent attempted laparoscopic cholecystectomy. After exclusion of patients in whom laparoscopic cholecystectomy was abandoned in favour of open cholecystectomy and those patients in whom operative cholangiography was not attempted, the records of 325 patients were available to the study. The operation notes of each patient were studied to determine whether, in the operator’s opinion, a successful cholangiogram had been obtained.

Results: There were 290 patients in whom cholangiography was attempted using direct gall‐bladder puncture (cholecystocholangiography (CCC)). There were 35 patients in whom cholangiography was attempted via cystic duct cannulation (CDC). Cholecystocholangiography was successful in 86% of those cases in which it was attempted. Cystic duct cannulation was successful in 83% of those cases in which it was attempted.

Conclusion: Cholecystocholangiography is a valid alternative to cystic duct catheterization in its ability to achieve intra‐operative cholangiography in the setting of laparoscopic cholecystectomy.
THE EFFECT OF VAGINAL DELIVERY ON ANAL FUNCTION
Authors: Rieger Nicholas , Wattchow David
Published: March 2003

The commonest cause of faecal incontinence is considered to be childbirth. In this review we consider the available data on the prevalence of faecal incontinence in the community and the incidence of incontinence after childbirth. The results and implications of studies on childbirth using anal manometry, neurophysiological tests and anal ultrasound are discussed. The development of symptoms are more likely with a third degree tear and forceps delivery. Reduced resting and squeeze pressures are seen early after vaginal delivery with recovery noted with time. Reduced pressures have been seen in symptomatic and asymptomatic women and there is no correlation of the pressures with the presence or absence of a sphincter defect or evidence of pudendal neuropathy. Anal manometry can not be used as an indication of muscle or nerve injury. Both sphincter defects and evidence of pudendal neuropathy are common after vaginal delivery but these are not necessarily associated with symptoms. It is suggested that such occult sphincter injuries may go on to be symptomatic in later life. The number of these injuries, however, is far greater than the documented prevalence of incontinence in the community, and hence many must remain asymptomatic. Their true clinical significance remains uncertain.
RISK FACTORS FOR ANKLE FRACTURE REQUIRING OPERATIVE FIXATION
Authors: Christey G. R. , Tomlinson M.
Published: March 2003

Background: Ankle fractures are common and expensive injuries, particularly the injuries that require operative intervention. However, epidemiological research on the causative factors is sparse. This study aims to identify the groups at risk of ankle fracture requiring operative fixation, and to suggest directions for further study.

Methods: The clinical data on 336 patients with ankle fractures admitted to an urban hospital in New Zealand in 1994 were reviewed. Statistical analysis was carried out on the 252 patients with ankle fractures requiring operative fixation.

Results: Those at highest risk of ankle fracture are young male rugby players and middle‐aged women who sustain injury while walking. Young males have a similar incidence of AO Type B and C fractures, while Type B fractures predominate strongly in older women.

Conclusions: The groups at risk of ankle fracture requiring operative fixation, and the activities predisposing these groups to injury have been identified. More work is required to define the specific risk factors and biomechanical mechanisms that lead to these debilitating injuries.
BLOOD LIPID PROFILE IN ISCHAEMIA REPERFUSION INJURY
Authors: Sieunarine K. , Wangoo D. , Langton S. , Lawrence Brown M. M. D. , Prendergast F. J. , Goodman M. A.
Published: March 2003

Background: Lipid components are considered to play an important role in ischaemia reperfusion injury although the mechanism of their action remains unknown. Accumulation of lipid metabolites in ischaemic tissues is a consistent observation, but exactly how these lipids are cleared from the tissues by the circulating blood during reperfusion is still open to speculation. In the present study, levels of blood lipids (fatty acids, phospholipids, triglycerides, cholesterol, lysolecithin and lysolecithin platelet activating factor (lyso PAF)) and the enzyme phospholipase A2 were determined in an experimental animal model (dogs) of ischaemic reperfusion injury.

Methods: The injury was induced by 4 h of aortic clamping followed by 2 h of reperfusion (unclamping). Blood samples were collected before clamping and at predetermined time intervals (0, 15, 60 and 120 min) after the release of clamp. The lipid contents were analysed and compared with sham‐treated control dogs.

Results: The results showed significantly elevated levels of triglycerides and phospholipase A2, during ischaemia and reperfusion in experimental animals indicating tissue damage in the ischaemic phase continuing into the reperfusion phase and the risk of systemic damage from these toxic substances. Total fatty acid content in the circulating blood showed decreasing trends during the same time interval, which suggested possible reduced clearance of accumulated fatty acids from the affected tissues. Serum cholesterol, phospholipids, lyso PAF and lysolecithin did not show any significant variation compared with control dogs.

Conclusions: It is possible that the delayed clearance of fatty acids may be due to the presence of fatty acids binding proteins in the ischaemic tissue, which trap these fatty acids in the tissues during ischaemic reperfusion injury. The prolonged retention of the accumulated fatty acids in the tissues in association with elevated triglycerides and phospholipase A2 activity may contribute to ischaemia reperfusion injury.
WAITING TIMES FOR APPOINTMENTS WITH ORTHOPAEDIC SURGEONS IN VICTORIA: 1995–97
Authors: Feller Julian A. , Freeman Richard D. , Speck Gary R.
Published: March 2003

Background: A number of different models have been proposed for determining surgical workforce requirements.

Methods: In 1995 the Workforce Subcommittee of the Victorian Regional Branch of the Australian Orthopaedic Association commenced a prospective evaluation of waiting times for both urgent and nonurgent appointments with orthopaedic surgeons in Victoria.

Results: The results for the 3 years, 1995–97, show no significant change in the waiting time for nonurgent appointments and no difference between metropolitan and rural areas. The waiting time for an urgent appointment increased from 1995 to 1997 for the state of Victoria and for metropolitan Melbourne but not for rural areas. However, the median waiting time for an urgent appointment did not change.

Conclusion: Overall the waiting times were found to be satisfactory by previously reported standards.
PHAEOCHROMOCYTOMA: EXPERIENCE FROM A REFERRAL HOSPITAL IN SOUTHERN INDIA
Authors: Mathew Sajjan , Perakath Benjamin , Nair Aravindan , Seshadri M. S. , Shanthly Nylla
Published: March 2003

Background: Phaeochromocytoma has been traditionally called the ‘Tumour of Tens’. Many investigators have reported the prevalence of extra‐adrenal phaeochromocytoma to be more than 10%.

Methods: All consecutive adult patients diagnosed to have phaeochromocytoma by the departments of endocrinology and surgical endocrinology of the Christian Medical Hospital, India, over a period of 10 years from 1988 to 1998, were included in the study.

Results: A total of 30 patients were diagnosed to have phaeochromocytoma. Extra‐adrenal phaeochromocytoma accounted for 26.6% of cases. Ten per cent of cases were bilateral, 6.6% were malignant and one patient had a familial tumour (multiple endocrine neoplasia IIB). The tumours were localized pre‐operatively in all patients. Multicentric extra‐adrenal tumours were not found in this series. All patients except one were explored by the anterior transperitoneal approach. Persistent hypertension was noted in 30% of patients.

Conclusions: Our series shows a higher prevalence (26.6%) of extra‐adrenal tumours than the traditionally described 10%. With accurate pre‐operative localization, a transperitoneal approach may not be necessary. The laparoscopic approach needs to be evaluated in light of these findings.
BARRIERS TO PARTICIPATION IN RANDOMIZED CLINICAL TRIALS FOR EARLY BREAST CANCER AMONG AUSTRALIAN CANCER SPECIALISTS
Authors: Ellis Peter M. , Butow Phyllis N. , John Simes R. , Tattersall Martin H. N. , Dunn Stewart M.
Published: March 2003

Background: Doctors’ discomfort with the randomized trial process may significantly impact on accrual rates to clinical trials. However, there is little information regarding factors that influence accrual to clinical trials in Australia. The present study examines Australian cancer specialists’ attitudes towards and participation in current breast cancer clinical trials.

Methods: All medical and radiation oncologists across Australia and surgeons listed as participants in the Australian and New Zealand Breast Cancer Trials Group were sent questionnaires assessing attitudes towards and participation in current clinical trials for early stage breast cancer.

Results: The response rate was 71% (269/381). The mean age of respondents was 45 years and 85% were male. Respondents estimated that a mean of 5.2 (SD = 8.2) of their patients had been enrolled in a breast cancer clinical trial in the previous 12 months. Participation (in any trial) by medical oncologists (60.6%, 95%CI 54.5–66.7%) and surgeons (63.1%, 95%CI 57.1–69.1%) was significantly higher than for radiation oncologists (43.2%, 95%CI 37–49.4%, P = 0.03). The major barriers to participation in current breast cancer trials were lack of resources (44%) or issues related to specific trials (44%; e.g. relevance of the research questions or choice of standard therapies).

Conclusions: The results of this study suggest that efforts to improve doctors’ participation in clinical trials need to address a number of issues. More empirical research is needed to evaluate new strategies to raise participation in clinical trials.
SELF‐EXPANDABLE METAL STENTS FOR MALIGNANT DYSPHAGIA
Authors: Lam YUK H. , Chan Angus , Lau James , Lee Danny , Ng Enders , Wong Simon , Chung Sydney
Published: March 2003

Background: The use of self‐expandable metal stents in relieving dysphagia for patients with incurable malignant oesophageal strictures was retrospectively evaluated.

Methods: Between September 1993 and August 1996, 66 male and 16 female patients with a median age of 72 years received self‐expandable metal stents for malignant dysphagia. Six patients had concurrent tracheo‐oesophageal fistulas. All patients were stented under sedation and stent insertion was performed under fluoroscopic guidance.

Results: Stent placement was successful in 80 patients (98%). There were seven early complications (inaccurate positioning (n = 3), migration (n = 1), incomplete expansion (n = 1), intractable pain (n = 1), and perforation (n = 1)). Two complications were lethal and three were treated endoscopically. Mean dysphagia grade improved from 3.2 ± 0.7 to 1.8 ± 0.9 (P < 0.05) after implantation. All tracheo‐esophageal fistulas were successfully occluded. Upon a median follow‐up of 8 weeks (range: 2–20 weeks), 30 complications developed in 21 patients (tumour overgrowth (n = 15), food bolus obstruction (n = 7), tumour ingrowth (n = 2), buckling of stent (n = 2), tracheo‐esophageal fistula (n = 2), bleeding (n = 1), and gastric wall herniation through metal coils (n = 1)). Median survival was 13 weeks (range: 1–82 weeks).

Conclusion: Self‐expandable metal stents provide useful palliation in patients with incurable malignant dysphagia.
HOW LARGE SHOULD A SKIN TREPHINE BE FOR AN END STOMA?
Authors: Nguyen M. H. , Pittas F.
Published: March 2003

Background: Although much has been written about techniques for making a good stoma, little has been described regarding how to excise a trephine that will perfectly fit a given end stoma.

Methods A reproducible technique for making a stomal trephine to a precise fit for each stoma is described.

Results: More than 20 stomas have been made with good results.

Conclusion: The skin trephine should have a diameter approximately two‐thirds of the width of the crushed bowel end.
SHOULD NEW SOUTH WALES HOSPITAL DISASTER TEAMS BE SENT TO MAJOR INCIDENT SITES?
Authors: Garner Alan , Nocera Antony
Published: March 2003

Background: The aim of the present review was to assess the suitability of hospital disaster medical teams’ training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre‐hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed.

Methods: A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment.

Results: Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied.

Conclusion: Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter‐disaster planning as the primary source of on‐site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre‐hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.
LAPAROSCOPIC RADICAL DEROOFING OF HEPATIC CYSTS USING THE ULTRASONIC SCALPEL
Authors: Martin I. , Garden O. J.
Published: March 2003

Background: There is some debate regarding the role of laparoscopy in deroofing of liver cysts.

Methods: Three patients underwent laparoscopic deroofing by means of an ultrasonic scalpel.

Results: All three patients underwent treatment successfully with minimal postoperative morbidity and hospital stay.

Conclusions: The ultrasonic scalpel has a useful role in the laparoscopic treatment of hepatic cysts.
WHAT’S NEW IN PLASTIC SURGERY?
Authors: Hayward Peter
Published: March 2003

A review is made of the latest developments in the field of plastic and reconstructive surgery. The subspecialty divisions are more pronounced in the modern era, but are still linked by a unified approach to soft‐tissue management. Although cornerstone areas such as microsurgery have seen refinement, other fields, including aesthetic surgery, have been totally redefined by laser technology and the spread of endoscopic techniques.
A PROSPECTIVE SURVEY OF CURRENT METHICILLIN‐RESISTANT STAPHYLOCOCCUS AUREUS CONTROL MEASURES
Authors: Barakate Michael S. , Harris John P. , West Richard H. , Vickery Alison M. , Sharp Catherine A. , Macleod Colin , Benn Richard A.
Published: March 2003

Background: Methicillin‐resistant Staphylococcus aureus (MRSA) is now endemic in tertiary referral hospitals among the developed world. By prospective survey, the effect of two measures aimed to reduce the spread of MRSA was determined. First, a surgical ward with persistently high levels of MRSA detection was cleaned and renovated. Second, the medical records of all MRSA‐colonized patients were electronically flagged, facilitating immediate application of control measures on readmission.

Methods: Data were collected for 995 newly colonized patients admitted between 1 July 1995 and 31 December 1997. Methicillin‐resistant Staphylococcus aureus detection was determined before and after implementation of the interventions, along with the likely place of MRSA acquisition and the monthly incidence of MRSA detection for all inpatients. Chi‐squared testing with odds ratios and 95% confidence intervals determined associations between the effect of control measures studied and MRSA detection rates.

Results: New MRSA detection was 21.6 per 1000 admissions before refurbishment compared with 20.4 per 1000 admissions to the surgical ward after refurbishment. New MRSA detection averaged 6.4 per 1000 hospital admissions before the introduction of record flagging and patient cohorting, compared with 6.2 per 1000 admissions after.

Conclusion: Neither ward refurbishment, nor introduction of flagging, significantly reduced rates of colonization during the study period. In hospitals that receive MRSA‐colonized patients and provide intensive care facilities, spread of MRSA is a major problem. Effective containment demands separate wards for MRSA‐colonized and non‐colonized patients. The need for such containment should be considered in design of the modern hospital.
BILE DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY: A COLLECTIVE EXPERIENCE OF FOUR TEACHING HOSPITALS AND RESULTS OF REPAIR
Authors: Ooi L. L. P. J. , Goh Y. C. , Chew S. P. , Tay K. H. , Foo E. , Low C. H. , Ch’Ng H. C. , Chan S. T. S. , Soo K. C.
Published: March 2003

Background: Laparoscopic cholecystectomy has been performed in Singapore since 1990 and, up until the end of 1997, a total of 4445 procedures had been performed in the four major teaching hospitals. Although bile duct injuries were thought to have increased following the introduction of laparoscopic cholecystectomy, there have been no reviews done on the incidence of these injuries in the Singapore context.

Methods: The present retrospective review aimed to audit the rate of bile duct injuries in the four major teaching hospitals in Singapore and to document the results of management of these injuries.

Results: Of the 4445 procedures performed, there were 19 (0.43%) cases of bile duct injuries. These involved the common hepatic duct (n = 8), common bile duct (n = 10), and the right hepatic duct (n = 1). The underlying gall bladder pathology included non‐inflamed gall bladders (n = 10), acute cholecystitis (n = 4), Mirrizzi’s syndrome (n = 3) and mucocele of the gall bladder (n = 2). Transection of the duct accounted for the majority of the injuries. Eleven bile duct injuries were identified at the time of operation. These were primarily repaired over a T tube (n = 4) or by a bilio‐enteric bypass (n = 7). The remainder were diagnosed at a median of 7 days (range: 1–556 days) after surgery with a presentation of jaundice or pain. These were repaired by bilio‐enteric anastomosis (n = 7) and closure over a T tube (n = 1). Three patients developed strictures subsequently, two following bilio‐enteric repair after delayed diagnosis and one following immediate primary repair over a T tube. One patient developed intrahepatic stones and required a left lateral segmentectomy.

Conclusions: The experience of a 0.43% bile duct injury rate is comparable to the best results from most large series in the West. Inflammation at Calot’s triangle is an important associated factor for injury. Early recognition and prompt repair affords good results, and hepaticojejunostomy is recommended as the repair of choice.
VERAPAMIL REDUCES INTIMAL HYPERPLASIA IN A SHEEP CAROTID ARTERY PATCH GRAFT MODEL
Authors: Ao Peng Y. , Hawthorne Wayne J. , Vicaretti Mauro , Fletcher John P.
Published: March 2003

Background: The current study investigated the effect of verapamil on the development of intimal hyperplasia (IH) using a sheep model.

Methods: A gelatin‐sealed Dacron patch graft was implanted into the left common carotid artery in 40 adult Merino sheep. Sheep were then randomly allocated to four groups. Group 1 were controls given no treatment (n = 10). Groups 2–4 were treated with intravenous verapamil 0.5 mg/kg per day in two divided doses for different lengths of time. Group 2 (n = 10) received treatment for 1 week; group 3 (n = 10) received treatment for 2 weeks and group 4 (n = 10) received treatment for 4 weeks. All sheep were killed at 4 weeks and the grafted segments of artery were harvested for IH assessment by an image analysis system.

Results: The IH index from the three groups treated with verapamil was significantly less than that of the control (group 1, 0.287 ± 0.077; group 2, 0.205 ± 0.064, P < 0.05; group 3, 0.193 ± 0.059, P < 0.01; group 4, 0.171 ± 0.046, P < 0.01).

Conclusion: The present study suggests that verapamil inhibits the development of IH even when treatment is given for only 1 week.
MANDIBULAR RECONSTRUCTION FOLLOWING ABLATIVE TUMOUR SURGERY: AN OVERVIEW OF TREATMENT PLANNING
Authors: Dimitroulis George
Published: March 2003

Background: In the last half century the evolution of mandibular reconstruction has resulted in a multitude of surgical procedures that have been brought about by advances made in bone science, grafting techniques and materials technology. With the ever increasing number of surgical options currently available it has become essential to take stock of these achievements and reconsider the fundamental principles of reconstructive surgery.

Methods: The choice of reconstructive techniques is only part of a wider number of variables that must be considered which will ultimately determine the success or failure of the procedure.

Results: Variables likely to influence the outcome of mandibular reconstruction are the site and extent of the defect, the needs and tolerance of the patient, the timing of reconstruction and the surgical skill and techniques available.

Conclusion: By careful consideration of these cardinal variables it may be possible to formulate a treatment plan that will not only satisfy the essential needs of the patient but also help increase the likelihood of a successful outcome.
IN‐HOSPITAL MORTALITY AFTER TRANSURETHRAL RESECTION OF THE PROSTATE IN VICTORIAN PUBLIC HOSPITALS
Authors: Ansari M. Z. , Costello A. J. , Ackland M. J. , Carson N. , Mcdonald I. G.
Published: March 2003

Background: The purpose of the present paper was (i) to identify trends in in‐hospital mortality after transurethral resection of the prostate (TURP) in Victorian public hospitals; and (ii) to explore associations between in‐hospital mortality after TURP and age, adverse events, type of admission (emergency/planned), location of the hospital (metropolitan/rural), teaching status of the hospital and length of stay.

Methods: Trends in in‐hospital mortality after TURP and the associations between in‐hospital mortality and the aforementioned variables were studied using International Classification of Diseases, 9th revision, Clinical Modification (ICD‐9‐CM) coded Victorian hospital morbidity data from public hospitals between 1987–88 and 1994–95. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) were based on univariate and multivariate logistic regression, respectively.

Results: After adjustment for age, comorbidity, and other confounding variables, the trend in mortality reduction over time was highly significant (P for trend < 0.0001, 95% CI for trend: 0.84–0.95). Highly significant associations with mortality were observed for emergency admissions (OR = 1.99, P < 0.0001), presence of adverse events (OR = 2.69, P < 0.0001), length of hospital stay (P for trend < 0.0001, 95% for trend: 1.88–2.15) and age (P for trend < 0.0001; 95% CI for trend: 1.26–1.48).

Conclusions: Routinely collected data from hospitals can provide tentative evidence of improved effectiveness of a surgical treatment, provided analysis takes careful account of potential sources of bias, especially those related to possible changes in case selection over time. These kinds of data should stimulate a joint effort between clinicians, quality assurance experts and epidemiologists to confirm this attribution, and to locate the causative factors.