bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of endoscopic color doppler ultrasonography in endoscopic injection sclerotherapy‐resistant esophageal varices
Authors: Sato Takahiro , Yamazaki Katsu , Toyota Jouji , Karino Yoshiyasu , Ohmura Takumi , Suga Toshihiro
Published: June 2004

A 72‐year‐old man with type C cirrhosis was admitted to our hospital for refractory esophageal varices. Prophylactic endoscopic injection sclerotherapy (EIS) was performed twice in August 2000 for high‐risk esophageal varices at an outside hospital. However, a therapeutic effect was not attained. Endoscopic ﬁnding revealed F1, Cb, RC (–) at the gastroesophageal junction to approximately a 5‐cm oral site, and F3, Cb, RC (+) varices at the upper site from the 5‐cm oral site of the gastroesophageal junction. Color ﬂow images were obtained of the posterior branch of the left gastric vein and revealed an inﬂow‐type perforating vein about a site 5 cm oral from the gastroesophageal junction. Color ﬂow images of esophageal varices were detected with endoscopic color Doppler ultrasonography. Color ﬂow images of out‐ﬂowing‐type perforating veins were discerned in the middle esophagus. The vessel images of intramural esophageal varices were clearly delineated via an ultrasonic microprobe and showed a perforating vein with a diameter of 4 mm. We performed EIS with an attached balloon to occlude the out‐ﬂowing‐type perforating veins with 5% ethanolamine oleate with iopamidol. Seven days after the ﬁrst EIS, thromboses were observed in the intramural esophageal varices and in the inﬂow type‐perforating veins via ultrasonic microprobe. We exchanged the hemodynamics of this esophageal variceal case with blockade of the inﬂow‐type perforating vein. Next, we successfully performed EIS, and achieved the blockade of passageways, including the palisade veins. Forty days after EIS, endoscopic ﬁndings revealed disappearance of the esophageal varices.
Eosinophilic gastroduodenitis showing nodular lesions in the gastric antrum and duodenal bulb
Authors: Tanioka Rie , Michida Tomoki , Shimizu Kentaro , Sakamori Ryotaro , Satomi Eriko , Yamamoto Keiji , Ikeda Masahiro
Published: June 2004

A 32‐year‐old female was admitted to Osaka National Hospital for remarkable anemia. She had a history of food allergy for the past 6 years. Laboratory examinations revealed remarkable iron deﬁciency anemia and protein‐losing gastroenteropathy. On upper gastrointestinal endoscopy, multiple nodular lesions resembling verrucous gastritis were observed in the gastric antrum and the duodenal bulb. Marked mucosal eosinophilic inﬁltration was seen in the biopsy specimens. Small intestine and colon were normal by X‐ray examination and colonoscopy, respectively. She was diagnosed as eosinophilic gastritis. Her symptoms, laboratory data and endoscopic ﬁndings improved by regulation of food intake and administration of steroid. Rare endoscopic appearance of eosinophilic gastritis probably has strong correlation with food allergy.
Evaluation by biliary scintigraphy of recurrence of choledocholithiasis after endoscopic sphincterotomy
Authors: Shimura Junichi , Igarashi Yoshinori , Sakai Yoshihiro
Published: June 2004

Background:   It is difﬁcult to predict recurrence of choledocholithiasis after endoscopic sphincterotomy (EST). Because cholestasis is considered to cause recurrence of choledocholithiasis, it may be possible to predict recurrence by objective evaluation of cholestasis. The aim of the present study was to examine the relationship between cholestasis and recurrence of choledocholithiasis by biliary scintigraphy in post‐EST cases.

Methods:  Seventy‐ﬁve patients who had undergone EST were tested by biliary scintigraphy. Cases with positive and negative detection of hot spots in the duodenum within 60 min after isotope infusion were categorized as ‘maintained bile excretion’ (Group M) and ‘delayed bile excretion’ (Group D), respectively. Age, gender, biliary tract enzyme levels, diameter of the common bile duct, presence of the gallbladder, presence of juxtapapillary duodenal diverticula, and the recurrence rates of choledocholithiasis were compared between the two groups.

Results:  Seventy‐ﬁve cases were distributed into 66 cases (88%) in Group M and nine cases (12%) in Group D. There was no statistical differences in age, gender, biliary tract enzyme levels, diameter of the common bile duct, and presence of juxtapapillary diverticula. In Group D, all the cases had retained the gallbladder. Of 41 cases who had been followed up for more than 1 year, 35 cases (85%) were assigned to Group M and six (15%) to Group D. Recurrence of choledocholithiasis was observed in ﬁve cases, with two in Group M and three in Group D. The recurrence rate was signiﬁcantly higher in Group D than in Group M.

Conclusions:  Biliary scintigraphy was considered useful for objectively predicting recurrence of choledocholithiasis.
Five‐year follow‐up study on histological and endoscopic alterations in the gastric mucosa after Helicobacter pylori eradication
Authors: Oda Yoshio , Miwa Jun , Kaise Mitsuru , Matsubara Yasuo , Hatahara Trumasa , Ohta Yasuhiko
Published: June 2004

Background:  To investigate long‐term changes in the gastric mucosa after Helicobacter pylori eradication, we examined histological and endoscopic ﬁndings of the gastric mucosa before and 5 years after eradication.

Methods:  The subjects comprised 59 H. pylori‐positive patients with peptic ulcer who had been periodically followed for 5 years after H. pylori eradication. Acid‐suppressive drugs were not given after eradication, and endoscopic examination and tests for H. pylori infection (urea breath test (UBT), culture and histology) were performed before and 1 to 2 months, 1 year, and 5 years after eradication. Biopsy samples were taken from the greater curvature of the gastric antrum and upper corpus, and were scored histologically according to the Updated Sydney System. The atrophic border was evaluated endoscopically based on Kimura and Takemoto's classiﬁcation. Antral erosion and spotty redness in the corpus were also scored.

Results:  (1) Neutrophil inﬁltration was signiﬁcantly reduced 1 to 2 months after eradication and remained around the reduced level over the next 5 years. Mononuclear cell inﬁltration began to decrease 1 to 2 months after eradication and continued to subside 1 year and 5 years later. (2) Histological atrophy of the gastric glands was signiﬁcantly improved 1 year and 5 years after eradication. However, endoscopy revealed no consistent alteration in the atrophic border. (3) There was no signiﬁcant change in the degree of intestinal metaplasia for 5 years. (4) In some cases, antral erosion became more conspicuous after 5 years. Spotty redness in the corpus was observed in 15% of cases (9/59) before and 10% (6/59) 1 year after eradication, but had disappeared in all cases 5 years later.

Conclusions:  Neutrophil inﬁltration improved rapidly after H. pylori eradication in contrast with mononuclear cell inﬁltration, which decreased gradually over 5 years. Glandular atrophy improved in the long term, whereas intestinal metaplasia had not altered 5 years after eradication. Spotty redness in the gastric corpus disappeared in all cases after eradication, suggesting that it is an endoscopic ﬁnding related to H. pylori infection.
Endoscopic treatment of mucosal diaphragm with enterolith in the jejunum of an adult
Authors: Sunada Fumiko , Hanatsuka Kazunobu , Sato Shin , Okura Hisanao
Published: June 2004

An unusual case of jejunal mucosal diaphragm with enterolith causing liver dysfunction and fever in a 36‐year‐old man is reported. The diagnosis of jejunal mucosal diaphragm was made by panendoscopy. Treatment of the jejunal mucosal diaphragm was by dilatation of the diaphragm. The enterolith was removed by panendoscopy.
Integrity and moral residue: nurses as participants in a moral community
Authors: Hardingham Lorraine B.
Published: June 2004

Abstract  This paper will examine the concepts of integrity and moral residue as they relate to nursing practice in the current health care environment. I will begin with my definition and conception of ethical practice, and, based on that, will go on to argue for the importance of recognizing that nurses often find themselves in the position of compromising their moral integrity in order to maintain their self‐survival in the hospital or health care environment. I will argue that moral integrity is necessary to a moral life, and is relational in nature. When integrity is threatened, the result is moral distress, moral residue, and in some cases, abandonment of the profession. The solution will require more than teaching bioethics to nursing students and nurses. It will require changes in the health care environment, organizational culture and the education of nurses, with an emphasis on building a moral community as an environment in which to practise ethically.
Intellectual seductions
Authors: Hussey Trevor B.
Published: June 2004

Abstract  In this paper it is argued that we have three dispositions, each of which is very laudable in itself: a preference for the positive, constructive and creative aspects of human endeavours; a desire to be open‐minded and tolerant concerning ideas and beliefs; and an admiration of profundity. I have suggested that these dispositions can, if exaggerated or employed uncritically, seduce us into intellectual positions that are very dubious. These arguments are applied to some of the debates within the philosophy of nursing.
Nursing in a postemotional society
Authors: Herdman Elizabeth A.
Published: June 2004

Abstract  Globalization  is  often  seen  as  the  final  stage  in  the  transition  towards a market economy. It is argued that a side‐effect of globalization is cultural homogeneity and loss of life world, or ‘McDonaldization’. McDonaldization represents the rationalization of society in the quest for extreme efficiency. More recently, Meštrović has argued that the rationalization of emotions has also occurred and that Western societies are entering a postemotional phase. In postemotional societies there has been a separation of emotion from action. The result is synthetic, manufactured emotions manipulated and standardized for mass consumption. In this paper I explore what it means to nurse in a ‘postemotional society’ and what impact this dulling of the emotions has had on a profession that locates ‘care’ as its central defining concept. My aim is to generate critical discussion of the shape and direction of contemporary society and the role of nursing within it.
‘Double b(l)ind’: peer‐review and the politics of scholarship
Authors: Walker Kim
Published: June 2004

Abstract  The double‐blind peer‐review of manuscripts for potential publication is a longstanding tradition in the production of scholarship. Nursing has adopted this tradition to secure a place of legitimacy and authority for its scholarship amongst the other disciplines in the academy. However, despite its ubiquity and avowed utility, the peer‐review has not generally been the subject of much research let alone intense philosophical scrutiny and debate. This manuscript attempts such an engagement with a view to uncovering specific concerns about the essentially conservative and sometimes restrictive effects the double‐blind peer‐review produces. Drawing on the deconstructionist writings of Derrida and his acolytes this paper attempts to dig beneath the surface mechanics of the double‐blind peer‐review and in so doing, expose its rather shaky philosophical foundations. It is written to open debate from others who too, have harboured doubts about its adequacy and supremacy as a technology in the production of (legitimate) knowledge.
The problem of pain management among persons with dementia, personhood, and the ontology of relationships
Authors: Malloy David C. , Hadjistavropoulos Thomas
Published: June 2004

Abstract  While pain is common among seniors, it is not adequately treated or managed. In particular, pain in seniors with dementia is often undertreated and undermanaged. Although the undertreatment of pain among persons with cognitive impairments represents a serious ethical concern for pain clinicians, most writers in the area explain the undertreatment of pain by focusing on issues related to liability, fears of addiction to opioids, and erroneous beliefs that pain is a normal part of the ageing process. We argue that the philosophical notion of personhood must also be given careful attention when considering the problem of pain undermanagement. In this paper, we consider the undertreatment of pain among seniors with dementia, while focusing on the ontology of relationships and on existential philosophy. Moreover, we outline a series of recommendations to help minimize the probability of pain undertreatment in this population and to encourage considerations relating to personhood when treating people with dementia.
Medical and nursing clinical decision making: a comparative epistemological analysis
Authors: Rashotte Judy , Carnevale F. A.
Published: June 2004

Abstract The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skilful conduct of clinical decision making.
Is Natural Law a Border Concept Between Judaism and Christianity?
Authors: Novak David
Published: June 2004

With the passing of disputations between Jewish and Christian thinkers as to whose tradition has a more universal ethics, the task of Jewish and Christian ethicists is to constitute a universal horizon for their respective bodies of ethics, both of which are essentially particularistic being rooted in special revelation. This parallel project must avoid relativism that is essentially anti‐ethical, and triumphalism that proposes an imperialist ethos. A retrieval of the idea of natural law in each respective tradition enables the constitution of some intelligent common ground for ethical cooperation in both theory and practice between the traditions. This essay also suggests how the constitution of this common ground could include Muslims as well. The constitution of this common ground enables religious ethicists to present more cogent ethical arguments in secular space, but only of course, when those who now control secular space are open to arguments from members of any religious tradition.
Introduction: Parts, Wholes, and Opposites: John Milbank as Geisteshistoriker
Authors: Bowlin John
Published: June 2004

This special focus of the Journal of Religious Ethics begins with the mixture of admiration and apprehension that John Milbank's use of historical materials so often inspires and moves to specific reflection on specific figures and texts that appear in his grand story of secular modernity. Throughout, the focus is not on his moral theology per se, but rather on the way he treats certain figures, how he constructs his historical tale, and how his critical enterprise and his normative proposals depend upon his historical efforts. This introduction considers the difficulties of constructing and assessing a Geistesgeschichte, the genre of historical writing that Milbank prefers.
Splendid Vices and Secular Virtues: Variations on Milbank's Augustine
Authors: Wetzel James
Published: June 2004

John Milbank's case against secular reason draws much of its authority and force from Augustine's critique of pagan virtue. Theology and Social Theory could be characterized, without too much insult to either Augustine or Milbank, as a postmodern City of God. Modern preoccupations with secular virtues, marketplace values, and sociological bottom‐lines are likened there to classically pagan preoccupations with the virtues of self‐conquest and conquest over others. Against both modern and antique “ontological violence” (where ‘to be’ is ‘to be antagonistic’), Milbank advances an Augustinian hope for the peace that is both beyond and prior to the peace of (temporarily) repressed antagonism. One aim of this essay is to consider whether virtues conceived out of such a hope are really all that different from the virtues they are taken to replace. I take a critical look at Augustine's critique of pagan virtue, Milbank's appropriation of that critique, the applicability of that critique to Plato, and the polemical value of Augustine's notion of original sin. I end up being skeptical of the notion of a peculiarly Christian way to turn antagonistically conceived virtues into love, but I am not unsympathetic to Milbank's concerns about a loveless and self‐complacent secularity.
Naves and Nukes: John Ruskin as “Augustinian” Social Theorist?
Authors: Craig David M.
Published: June 2004

John Milbank appropriates John Ruskin as part of his “Augustinian” tradition. Milbank's selective reading, however, omits Ruskin's fixed hierarchies as well as his acknowledgment of conflict in economic life. Neither of these ideas fits the social aesthetics of harmony and difference that Milbank claims is unique to Christian theology. While Milbank's strictly theoretical portrait of theology gains critical force from Ruskin's robust account of social practices and just exchange, Milbank lacks effective historical and institutional responses to the problems in Ruskin's corpus. This deficiency undermines Milbank's dichotomy between theology and secular reason.
Inequality and Social Conflict Over Land in Africa
Authors: PETERS PAULINE E.
Published: June 2004

The paper proposes that reports of pervasive competition and conflict over land in sub‐Saharan Africa belie a current image of negotiable and adaptive customary systems of landholding and land use but, instead, reveal processes of exclusion, deepening social divisions and class formation. Cases of ambiguous and indeterminate outcomes among claimants over land do occur, but the instances of intensifying conflict over land, deepening social rifts and expropriation of land beg for closer attention. More emphasis needs to be placed by analysts on who benefits and who loses from instances of ‘negotiability’ in access to land, an analysis that, in turn, needs to be situated in broader political economic and social changes taking place, particularly during the past thirty or so years. This requires a theoretical move away from privileging contingency, flexibility and negotiability that, willy‐nilly, ends by suggesting an open field, to one that is able to identify those situations and processes (including com‐modification, structural adjustment, market liberalization and globalization) that limit or end negotiation and flexibility for certain social groups or categories.
Explaining the Diversity of Southeast Asian Shrimp Aquaculture
Authors: HALL DEREK
Published: June 2004

Despite the large amount of academic attention that Southeast Asian shrimp farming has received since the 1980s, few attempts have been made to explain the remarkable variation in the industry's organization across countries and localities. This paper compares the development of shrimp farming in Indonesia, the Philippines and Thailand, arguing that differences can be traced to variations in the initial conditions under which shrimp farming was established, the different ways that national aquacultures are embedded in the regional political economy and the ways in which different countries have responded to the characteristic environmental problems the sector causes itself.
Debating the Multifunctionality of Agriculture: From Trade Negotiations to Development Policies by the South
Authors: LOSCH BRUNO
Published: June 2004

The process of economic liberalization that began in the late 1980s has had profound repercussions on the situation of agriculture in developing countries. Market instability, aggravated competition and asymmetry between agents linked to the emergence of big transnational companies have led to greater economic risks for farmers and disparities between countries and within every national situation. In such a context, the emergence of a debate in Europe on the multifunctional character of agriculture and on its economic, social and environmental roles may seem a far cry from the concrete situations of the countries of the South, which have no resources to pay for the other functions of their agriculture. Moreover, this difficulty is intensified by the fact that the debate has been placed within the context of the WTO negotiations, which has led to the pro‐ and anti‐multifunctionality groups taking up a more radical stance. Nevertheless, the multifunctional view of agriculture does appear to be a plausible approach. It offers the possibility of going beyond the questions concerning productivity and market competitiveness towards establishing a debate in terms of strategies for sustainable development, in which the place and roles of agriculture can be thought out. Multifunctionality, founded on objectives negotiated at the local level, does seem to present an opportunity for numerous countries of the South to pursue their public policies on a new basis.
Book Reviews
Authors: MIYAMURA SATOSHI , RIGBY S. H. , SAYER KAREN , LAWRENCE PETER , YARRINGTON DOUG , KOENIG DOLORES , WOOI SYN TAN , JACOBS NANCY J. , SENDER JOHN , PINCUS JONATHAN R.
Published: June 2004

Barbara Harriss‐White, India Working: Essays on Society and Economy.

Phillipp Schofield, Peasant and Community in Medieval England, 1200–1500.

Nicola Verdon, Rural Women Workers in 19th Century England: Gender, Work and Wages.

Jonathan R. Pincus and Jeffrey Winters (eds), Reinventing the World Bank.

Julie A. Charlip, Cultivating Coffee: The Farmers of Carazo, Nicaragua, 1880–1930.

Monica M. van Beusekom, Negotiating Development: African Farmers and Colonial Experts at the Office du Niger, 1920–1960.

Abdul Rahman Embong, State‐led Modernization and the New Middle Class in Malaysia.

David M. Anderson, Eroding the Commons: The Politics of Ecology in Baringo, Kenya 1890s–1963.

Jan Breman and Gunawan Wiradi, Good Times and Bad Times in Rural Java: Case Study of Socio‐Economic Dynamics in Two Villages Towards the End of the Twentieth Century.

Mario Rutten, Rural Capitalists in Asia: A Comparative Analysis on India, Indonesia and Malaysia.
Early repair of episiotomy dehiscence
Authors: UYGUR Dilek , YESILDAGLAR Nater , KIS Saime , SIPAHI Tevfik
Published: June 2004

We retrospectively reviewed the medical records of our hospital between 1 March 2001 and 1 March 2003 for patients with episitomy dehiscence. In the study period, there were 37 patients with episiotomy dehiscence. While 12 of the patients with episiotomy dehiscence were allowed to heal by secondary intention, 25 patients underwent early repair. All the episiotomies were mediolateral. Infection was the obvious cause of dehiscence in the majority (25 out of 37) of the women. The average time from recognition of dehiscence to discharge from hospital was 5.6 ± 2.8 days for the patients with early repair of episiotomy dehiscence and 5.8 ± 2.4 days in patients allowed to heal by secondary intention. Patients were seen 2 weeks after being discharged. Among the patients treated by early repair, three patients had a superficial separation of skin edges. Healing was complete in the rest of the patients with early repair of episiotomy dehiscence. We concluded that with adequate preoperative care, primarily wound cleansing and intravenous antibiotics, early repair of episiotomy dehiscence is safe and effective.
Prospective evaluation of a first trimester screening program for Down syndrome and other chromosomal abnormalities using maternal age, nuchal translucency and biochemistry in an Australian population
Authors: SCOTT Fergus , PETERS Helen , BONIFACIO Michael , MCLENNAN Andrew , BOOGERT Antheunis , KESBY Greg , ANDERSON John
Published: June 2004

Background:  A combination of maternal age and ultrasound assessment of the nuchal translucency (NT) has been used in the first trimester to screen for chromosomal abnormality. In the United Kingdom, the addition of NT screening was shown to be beneficial.

Aims:  To report the sensitivity of combined first trimester biochemistry and ultrasound screening for Down syndrome in an Australian private practice specialising in obstetric ultrasound.

Methods:  A prospective study in a private obstetric ultrasound practice. Over 22 months, 2121 patients were screened and data was analysed for sensitivity (detection) and false positive rates for all chromosome abnormalities.

Results:  There were 17 chromosomal abnormalities, five of which were Down syndrome. Using maternal age alone or age and biochemistry, four of the Down syndrome cases were detected for a 29 and 19% false positive rate, respectively. Using age and NT or age, NT and biochemistry, all the Down syndrome cases were detected, for a false positive rate of 5.7 and 7.2%, respectively. The difference in detection rates for Down syndrome or other chromosomal abnormalities, using the four screening methods, did not reach statistical significance. However, the false positive rates in screening methods without ultrasound to assess the NT was significantly higher (P < 0.01).

Conclusions:  A combination of maternal age, NT and maternal serum biochemistry gives a high detection rate for both trisomy 21 and other chromosomal abnormalities. Down syndrome screening using either maternal age alone or age in combination with first trimester biochemistry conferred screen positive rates significantly higher than when combined with NT.
Levonorgestrel‐releasing intrauterine system for treating menstrual disorders: A patient satisfaction questionnaire
Authors: RADESIC Bruno , SHARMA Anil
Published: June 2004

Aims:  To establish the continuation and satisfaction rates and the reasons for removal of the levonorgestrel‐releasing intrauterine system (LNG‐IUS) in Palmerston North Hospital (PNH), New Zealand.

Sample and Setting:  All women (120) who had a LNG‐IUS inserted at PNH between June 1998 and June 2002 were included in the study.

Methods:  A survey questionnaire regarding bleeding patterns, side‐effects and satisfaction rates relating to the device as well as reasons for premature removal, current treatment for dysfunctional uterine bleeding (DUB) and contraception was sent to all 120 women. Seventy‐eight of the 85 women who received the questionnaire (91%) responded to it. Thirty‐five women were lost to follow‐up and the overall response rate was 65%.

Results:  The LNG‐IUS was prematurely removed from nine women and expulsion occurred in one case. The overall continuation rate was 87%. No women had LNG‐IUS removed as a result of hormonal side‐effects except for bleeding abnormalities. The overall satisfaction rate was 76%.

Conclusion:  Levonorgestrel‐releasing intrauterine system is a well‐accepted and efficacious therapy for heavy menstrual bleeding. These satisfaction and premature removal rates compare favourably with international figures. The response rate to the questionnaire was reasonably high given the highly mobile nature of the studied population.
Is placenta accreta catching up with us?
Authors: ARMSTRONG Charles A. , HARDING Steven , MATTHEWS Tom , DICKINSON Jan E.
Published: June 2004

Background:  Concomitant with the increase in Caesarean birth over the past three decades there has been an apparent rise in the incidence of placenta accreta and its variants. The sequelae of an increase in the occurrence of abnormal placentation is the enhanced potential for severe maternal morbidity.

Aim:  To determine the contempory demographics of placenta accreta over a 5‐year period in a tertiary level teaching hospital.

Methods:  A retrospective review of all cases of placenta accreta and variants during the period of 1998–2002. Individual charts review followed case ascertainment via the hospital obstetric database.

Results:  Thirty‐two women with placenta accreta (or variant) were identified. Median maternal age was 34 years, with a median parity of 2.5. Seventy‐eight percent of cases had had at least one prior Caesarean birth, and 88% of cases were associated with placenta praevia. Pre‐delivery ultrasonography was performed in all cases, providing diagnostic sensitivity of 63% and specificity of 43% with a predictive value of 76%. Hysterectomy was performed in 91% of cases with median intraoperative blood loss of 3000 mL. There were no maternal deaths in the current series.

Conclusion:  A strong association between placenta accreta, placenta praevia and prior Caesarean birth has been demonstrated. As there is the potential for significant maternal morbidity the risk of placenta accreta needs to be recognised and women at risk should be considered for delivery at an institution with appropriate expertise and resources in managing this condition.
Diagnostic radiography in pregnancy: Risks and reality
Authors: LOWE Sandra A.
Published: June 2004

Background:  The use of X‐rays, computed tomography scanning and nuclear medicine imaging in the pregnant woman is a source of great anxiety for the patient, her family and the treating doctor.

Methods:  A literature review of appropriate databases, articles and relevant institutional protocols was performed. Data was sought regarding any adverse effects of diagnostic radiation in pregnancy, fetal absorbed dose of diagnostic radiation and how the timing of exposure and form of administration might influence these effects.

Results:  The estimated radiation dose for a fetus from background sources as well as medical imaging was identified. Most diagnostic radiation procedures will lead to a fetal absorbed dose of less than 1 mGy for imaging beyond the abdomen/pelvis and less than 10 mGy for direct or nuclear medicine imaging. Potential adverse outcomes related to radiation exposure during pregnancy include teratogenicity, genetic damage, intrauterine death and increased risk of malignancy. The only adverse effect statistically proven at the dose levels associated with diagnostic radiation procedures is a very small increase in childhood malignancy, with an estimated increase of one additional cancer death per 1700 10 mGy exposures. The important exception was the risk to the fetal thyroid from radioiodine exposure after 12 weeks’ gestation.

Conclusion:  In practice, diagnostic radiography during pregnancy not involving direct abdominal/pelvic high dosage, is not associated with any significant adverse events. Counselling of pregnant women who require diagnostic radiographic procedures as well as those inadvertently exposed should be based on the available human data with an emphasis on the minimal impact of such procedures.
Hysterectomy for gynaecological cancer: A follow‐up study of subjective and objective outcome
Authors: MELTOMAA Seija S. , HIETANEN Sakari H. , TAALIKKA Mikko O. , HAARALA Mervi A. , KIILHOLMA Pentti J. A. , MÄKINEN Juha I.
Published: June 2004

Aims:  To evaluate morbidity and subjective outcome associated with hysterectomy either with or without pelvic or pelvic and para‐aortic lymphadenectomy for gynaecological cancer.

Methods:  Ninety‐nine patients who underwent hysterectomy with lymphadenectomy (n = 38) or simple hysterectomy (n = 61) for ovarian, endometrial and cervical cancer in Turku University Hospital, Turku, Finland, were followed‐up prospectively to determine the incidence of complications during a 1‐year period after operation. Subjective outcomes were assessed using two questionnaires, 6 weeks and 1 year after operation. Hospital records of the patients were reviewed up to 6 years after operation.

Results:  During their hospital stay 58% of patients in the hysterectomy with lymphadenectomy group and 56% in the simple hysterectomy group experienced some type of complication. Serious complications occurred in four patients (10.5%) in the former group and in two patients (3.3%) in the latter group. In the study population overall, the incidence of subjective complaints increased from 18% of respondents 6 weeks after operation to 55% 1 year after operation. Most patients (95 and 92%, respectively) remained satisfied with the operation at both times of evaluation.

Conclusions:  More than half of the patients experienced morbidity related to surgical treatment for gynaecological cancer. The incidence of complications and subjective complaints were unaffected by the type of operation.
Maternal and neonatal outcomes in 54 triplet pregnancies managed in an Australian tertiary centre
Authors: BARKEHALL‐THOMAS Andrea , WOODWARD Louise , WALLACE Euan M.
Published: June 2004

Background:  To provide current data on maternal and neonatal outcomes in triplet pregnancies in an Australian population.

Methods:  Retrospective case note review of all triplet pregnancies managed within a single Australian tertiary centre.

Results:  Fifty‐four sets of triplets were managed from January 1996 to October 2002. A total of 59% resulted from the use of assisted reproductive technologies. The median gestation at delivery was 32.5 weeks (range: 21–36 weeks); 14% delivered prior to 28 weeks and 43% delivered before 32 weeks. Preterm labour and preterm rupture of membranes were the most common antenatal complications occurring in 57 and 22% of pregnancies, respectively. A total of 93% of pregnancies were delivered by Caesarean section and 37% of mothers experienced at least one post‐partum complication. A total of 96% of neonates were liveborn, with a median birthweight of 1644 g (range: 165–2888 g). The two most common neonatal complications were jaundice and hypoglycaemia in 52 and 43% of liveborn neonates, respectively. A total of 28% of neonates were below the 10th centile for gestational age and sex. A total of 8% of neonates demonstrated congenital anomalies. The perinatal mortality at a gestational age of 20–24 weeks was 100%, 22% at 25–28 weeks and zero for those babies born at 29 weeks or beyond.

Conclusion:  Assisted reproductive technologies contribute significantly to the incidence of triplet pregnancies. Gestational age at delivery and perinatal mortality is comparable to published international data. Triplets born in a tertiary centre beyond 28 weeks gestation have a very favourable prognosis in the newborn period.
Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence
Authors: HIGGINS Shane P , KORNMAN Louise H. , BELL Robin J. , BRENNECKE Shaun P
Published: June 2004

Objective:  The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance.

Design, Setting and Methods:  A prospective cohort study was performed in two groups of patients at risk of cervical incompetence with singleton gestations attending the Royal Women's Hospital, Melbourne, Australia, from 1996 to 2000. The first group was managed by their obstetric carers with an elective cerclage, while the second group was managed conservatively as part of a cervical surveillance program offered to patients attending the Department of Perinatal Medicine for pregnancy care. This program consists of weekly visits from 16 weeks’ gestation and involves alternating transvaginal ultrasound assessment of cervical morphometry with cervico‐vaginal bacteriology and fetal fibronectin swabs. Empiric insertion of a cerclage is undertaken when there is evidence of significant cervical shortening (cervical canal <2.5 cm in length at ≤24 weeks).

Results:  A total of 135 patients were identified for the study. Ninety‐seven patients had an elective cervical cerclage inserted. Thrity‐eight patients were followed through the cervical surveillance program. Twelve (32%) of the surveillance patients had a cerclage inserted at a mean gestational age of 20.6 weeks. There were no statistically significant differences between the groups in terms of maternal demographics or risk assessment scoring. One out of 38 (2.6%) patients of the surveillance group and 18/97 (18.6%) of the elective cerclage group delivered before 30 weeks’ gestation (P = 0.034).

Conclusions:  Our study suggests that by only inserting a cerclage when indicated on the basis of ultrasound assessment of cervical morphometry, the number of cerclages required can be reduced while the perinatal outcome is significantly improved.
Women with low‐grade abnormalities on Pap smear should be referred for colposcopy
Authors: FAIRMAN Amanda , TAN Jeffrey , QUINN Michael
Published: June 2004

Aim:  To assess cytological, colposcopic and histological outcomes in women referred to a teaching hospital dysplasia clinic with low‐grade changes on screening Pap smear.

Methods:  Analysis of a computerised database.

Results:  Repeating the Pap test was of little value. Fifteen percent of women with low‐grade changes on the referral smear had biopsy proven high‐grade change. There was little difference in biopsy proven high‐grade change in women referred with an ‘abnormal smear of uncertain significance’ (23%) or ‘an abnormal smear of uncertain significance‐possible high‐grade change’ (24%).

Conclusions:  Given these findings and the current medico‐legal climate, immediate referral of women with low‐grade changes on routine cytology is indicated, and seems a safer option than the more conservative approach of a repeat smear in 6 or 12 months. Further study of the usefulness of separating smears of uncertain significance into high‐grade and low‐grade categories is warranted. Consumer input into recommendations for management of Pap smear abnormalities is required.
HIV and pregnancy in Australia
Authors: GILES Michelle L. , MIJCH Anne M. , GARLAND Suzanne M. , GROVER Sonia R. , HELLARD Margaret E.
Published: June 2004

It is estimated there are over 19 million women worldwide living with HIV infection. In Australia the total number of notified cases of HIV in women has been gradually increasing (the estimated number of women newly diagnosed with HIV infection was 78 in 2000 and 94 in 2001). Management of women in pregnancy and strategies to reduce perinatal transmission is critical, but differ significantly according to resource availability. The current review examines the best available scientific evidence and current guidelines for optimal management of HIV‐infected women contemplating pregnancy in Australia.
People who influence women's decisions and preferred sources of information about prenatal testing for birth defects
Authors: JAQUES Alice M. , BELL Robin J. , WATSON Lyndsey , HALLIDAY Jane L.
Published: June 2004

Background: More than half of Victorian pregnant women are undergoing prenatal testing for birth defects, although little is known about the factors that are influencing their decisions.

Aims: To examine whom women perceived as influencing their decision about prenatal testing for birth defects, with whom they would have liked to talk more, and what sources of information they preferred.

Methods: A total of 737 pregnant women aged 37 years and over, who either had or had not undergone prenatal testing (screening and/or diagnosis) completed a questionnaire in 18 hospitals throughout Victoria.

Results: Over 90% reported that they themselves had a strong influence on their decision, and 70% reported their partner as strongly influencing their decision. Approximately 30% of women who had both screening and diagnosis and more than 20% of women who had no prenatal testing, would like to have discussed prenatal testing with women who had previously had testing. Face‐to‐face counselling with a doctor or counsellor was the preferred source of information, followed by a pamphlet as the second choice.

Conclusions: Given that both tested and untested women felt so strongly that they were responsible for their own decisions about prenatal testing, it is unlikely that universal acceptance and uptake will occur, even in this group of women of advanced maternal age. A support network of women who have already had testing could supplement existing sources of support. However, there continues to be a need for face‐to‐face sessions with a doctor or counsellor in combination with printed material.
Medical professionalism and continuing professional development for medical specialists
Authors: WHITE Peter
Published: June 2004

The present paper briefly describes a growing trend in continuing professional development (CPD) for medical practitioners, examines some recent published contributions related to professionalism in medicine and describes the theoretical platform of a CPD framework based on medical professionalism that has been developed for use in a variety of medical specialties. The work arises from a project funded by The Commonwealth Department of Health and Ageing and conducted by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on behalf of the Committee of Presidents of Medical Colleges. Overall, the aim of the project was to design and develop a framework that can be considered ‘best practice’ in the field of medical specialist CPD, and which could be applicable to a wide variety of medical specialties and practice environments. The project was informed by available literature in areas such as the ways in which medical practitioners learn and the effectiveness of CPD, as well as consultations with a variety of stakeholders in the health‐care field, including medical boards, medical defence organisations, health complaints organisations, specialist medical colleges and practising specialists. Overwhelmingly, the primary purpose of specialists participating in ongoing CPD was, according to the project consultations conducted, the maintenance, development and improvement of skills that enable consumers of healthcare to be confident of the level of care that they receive. Coupled with the need to recognise CPD as contributing to the wider context of professional practice, the resulting framework is underpinned by a theoretical platform based on the concept of medical professionalism. It is this theoretical platform, which articulates the nature of and responsibilities associated with the practice of specialist medicine, that enables a CPD framework to be constructed that can accommodate a wide range of specialist disciplines and practice settings, while also framing ongoing education expectations from the viewpoint of a range of stakeholders, rather than a single perspective; that of practitioners themselves.
Toward a Typology of Business Education in the Internet Age*
Authors: Rungtusanatham Manus , Ellram Lisa M. , Siferd Sue P. , Salik Steven
Published: June 2004

Many diverse forces are motivating institutions of higher education, particularly business schools, to develop and deliver education via the Internet. As higher education institutions explore this opportunity, the question of how courses and degree programs should be designed for effective online delivery via the Internet is a nontrivial concern and challenge. To address this concern and challenge, this paper articulates, defines, and justifies a typology consisting of four types of online distance education that can be pursued by institutions of higher education. The four online distance education types—Overview Model, Overview Model with Feedback, Technical‐Skills Model, and Managerial Learning Model—can be differentiated along a number of content‐related, delivery‐related, and learning‐related issues and have applicability at various educational levels. In addition, the paper highlights and discusses five key lessons for institutions to consider in their desire to launch online distance education initiatives. These lessons provide insights not only for launch success but also for the ongoing sustainability of online distance education.
Active Learning through Modeling: Introduction to Software Development in the Business Curriculum*
Authors: Roussev Boris , Rousseva Yvonna
Published: June 2004

Modern software practices call for the active involvement of business people in the software process. Therefore, programming has become an indispensable part of the information systems component of the core curriculum at business schools. In this paper, we present a model‐based approach to teaching introduction to programming to general business students. The theoretical underpinnings of the new approach are metaphor, abstraction, modeling, Bloom's classification of cognitive skills, and active learning. We employ models to introduce the basic programming constructs and their semantics. To this end, we use statecharts to model object's state and the environment model of evaluation as a virtual machine interpreting the programs written in JavaScript. The adoption of this approach helps learners build a sound mental model of the notion of computation process. Scholastic performance, student evaluations, our experiential observations, and a multiple regression statistical test prove that the proposed ideas improve the course significantly.
A Study of the Statistical Inference Criteria: Can We Agree on When to useZVersust?
Authors: Ozgur Ceyhun , Strasser Sandra E.
Published: June 2004

Authors who write introductory business statistics texts do not agree on when to use atdistribution and when to use aZdistribution in both the construction of confidence intervals and the use of hypothesis testing. In a survey of textbooks written in the last 15 years, we found the decision rules to be contradictory and, at times, the explanations unclear. This paper is an attempt to clarify the decision rules and to recommend that one consistent rule be chosen to minimize confusion to students, instructors, and practitioners. Using thetdistribution whenever σ is unknown, regardless of sample size, seems to provide the best solution both theoretically and practically.
So What Does Dance Have to Do with It? Using Dance to Teach Students about Leadership*
Authors: Peterson Tim O. , Williams Joann K.
Published: June 2004

Dance is a common metaphor in both the change and leadership literature. However, can dance, a movement art, actually be used to learn about leadership? The answer is yes and this exercise shows you how. Dance as an instructional strategy allows the instructor to tap the cognitive, affective, and conative components of the brain.
Parochialism in the Evolution of a Research Community: The Case of Organization Studies
Authors: March James G.
Published: June 2004

The organizations research community is a multidisciplinary, multinational and multilingual association of scholars with all the paraphernalia of international exchange. Nevertheless, it is a community that is organized in a geographically fragmented way, with linguistic, national, cultural and regional boundaries separating relatively autonomous scholarly communities. Although this fragmentation limits the integration of organization studies, it serves an adaptive role in making the resistance of deviant ideas to the homogenizing tendencies of dominant scholarly groups easier. The effective use of such differentiation, however, requires linkages among the fragmented parts of the field. We consider some ways of thinking about how research boundaries can be both sustained and violated, with particular attention to the emergence of Chinese scholarship in the study of organizations.