bluuebunny/crossref_metadata_2025 huggingface dataset:
DEVELOPMENT OF SMALL DIAMETER INTRAMEDULLARY NAILS MADE FROM ISO 5832–9 STAINLESS STEEL
Authors: Ingman A. M.
Published: March 2003

Background: In order to improve strength in small diameter intramedullary nails, a system was designed in which the implants were manufactured from 30% coldworked ISO 5832–9 stainless steel.

Methods: Nail diameters were 9 and 10 mm for the femur, and 8 and 9 mm for the tibia. The nails were solid rods and the screws were partially threaded. Pre‐clinical bending yield tests established that the 8‐, 9‐ and 10‐mm diameter rods had strengths comparable, respectively, with 10‐, 12‐ and 14‐mm diameter Grosse–Kempf nails. Forty‐eight femoral and 98 tibial shaft acute fractures were treated with this system. Postoperatively, patients were allowed to gently bear weight as tolerated.

Results: There was one broken nail, occurring 10 months after femoral nailing. There were six broken screws, occurring between 3 and 6 months postoperatively in two patients and after more than 6 months in four patients. The broken screws had no adverse clinical effect. Five patients required late bone grafting or exchange nailing, and 15 patients required dynamization.

Conclusion: This design of small diameter locked intramedullary nails was strong enough to allow early weightbearing.
Sir William Manchester Memorial Lecture 1999: The influence of one man on plastic and reconstructive surgery in New Zealand
Authors: Williams J. H.
Published: March 2003

Sir William Manchester occupies an unique position in New Zealand plastic and reconstructive surgery. He was responsible for setting up the first civilian plastic surgical units in the New Zealand Public Hospital Service, first at Burwood Hospital near Christchurch, and later at Middlemore Hospital in the Auckland area, where he spent most of his professional life. This paper provides a brief account of the early Manchesters, immigrant settlers from England, then summarizes William H. Manchester’s influential achievements. Mention is made of his war service, his cleft lip and palate surgery, his service in the interests of the Royal Australasian College of Surgeons and the International Confederation for Plastic and Reconstructive Surgery and his energetic interest in teaching plastic surgery to local and international trainees.
Neck dissection and ipsilateral radiotherapy in the management of cervical metastatic carcinoma from an unknown primary
Authors: Mcmahon J. , Hruby G. , O’Brien C. J. , Mcneil E. B. , Bagia J. S. , Clifford A. R. , Jackson M. A.
Published: March 2003

Background: In a small proportion of patients presenting with metastases to cervical lymph nodes the primary cancer remains occult despite thorough evaluation. The present report examines patterns of failure and outcome following an initial treatment strategy directed principally at the clinically involved side of the neck.

Methods: From a prospectively compiled computerized database 38 patients were identified with metastatic squamous cell carcinoma from an occult primary site. These patients were evaluated with respect to initial treatment, subsequent detection of a primary tumour, neck recurrence and survival characteristics.

Results: Thirty‐seven of 38 patients were treated with curative intent and all had neck dissection. Adjuvant radiotherapy was given to 34 of the 37 (90%; 32 postoperatively and two pre‐operatively). Radiotherapy was directed at the ipsilateral neck alone in 24 patients while 10 received comprehensive treatment to both sides of the neck and potential occult primary sites. The rate of control of disease in the ipsilateral neck was 91% while the failure rate in the contralateral neck was 16% (six patients). A primary cancer was ultimately identified in five patients (13%). Disease‐specific survival was 63% at 4 years. Clinical N3 stage, extracapsular tumour extension and involved surgical margins predicted for poorer survival on univariate analysis. Analysis using multiple risk factors found that only involved surgical margins predicted for treatment failure.

Conclusions: Despite generally advanced disease at presentation, patients presenting with cervical metastasis from an unknown primary carcinoma have a reasonable survival expectation and aggressive treatment is warranted, but approximately half will develop recurrent disease. Careful follow‐up is required if effective salvage treatment is to be instituted.
Rectal cancer in the kingdom of saudi arabia: the king faisal specialist hospital experience
Authors: Isbister William H. , Murad Mona , Habib Zakaria
Published: March 2003

Background: No survival data have yet been published from the Kingdom of Saudi Arabia for patients with rectal cancer. The present paper reports experience with these patients over an 8‐year period.

Methods: All patients referred to the King Faisal Specialist Hospital (KFSH) between March 1990 and February 1998 for the primary management of rectal cancer were entered into a computerized database. Prior to 1993 patients did not receive adjuvant therapy. Kaplan–Meier survival curves and the log–rank test were used to compare outcome data.

Results: There were 70 men (average age: 55.6 years) and 75 women (average age: 52.8 years). Twelve per cent of patients admitted a family history of colorectal carcinoma (CRC). Twenty‐seven per cent of tumours were circumferential. Most tumours were larger than 4 cm and the lowest edge of the majority of tumours was less than 6 cm from the anal verge. Fifty‐four per cent of tumours were fixed; 69% of patients received either pre‐operative or postoperative radiotherapy. A total of 106 patients underwent ‘curative’ surgery. Equal numbers of patients had abdomino‐perineal resection (APR) and anterior resection (AR) of the rectum. Thirty‐five patients received blood peri‐operatively (APR, 34%; AR, 12%). Major anastomotic leakage following AR occurred in two patients. Two patients died within 30 days of surgery. Ten patients were lost to follow‐up. Following curative AR, eight patients had a distal resection margin of < 2 cm and two patients (Dukes’ C) developed local recurrence (25%); 37 patients had a margin > 2 cm and seven developed local recurrence (18.9%). A total of 48 patients underwent curative APR, and four patients developed local recurrence (8.3%). Overall local recurrence was tumour stage‐dependent (Dukes’ B, 8.8%; Dukes’ C, 29.3%). Recurrence was local in 13 patients. Pre‐operative radiotherapy seemed to reduce average tumour size (3.6 vs 4.3 cm). The crude overall 5‐year survival rate was 39%. The 5‐year survival rate for patients with Dukes’ stage C cancers following ‘curative’ surgery was 25%.

Conclusion: Curative surgery can be performed with a relatively low requirement for blood transfusion, a low mortality and morbidity, and comparable outcomes to Western studies in spite of the large, low and often advanced stage of the tumours managed. Local recurrence rates following curative resection and re‐anastomosis for low rectal cancers may be reduced by resisting patient pressure to avoid stomata.
Study populations and casemix: influence on analysis of postoperative outcomes
Authors: Isbister William H.
Published: March 2003

Background: The importance of patient casemix as a determinant of surgical outcome is now being recognized. The present study was undertaken in order to compare the presentation and outcomes in colorectal patients managed surgically by the same surgeon, in the same way, in different settings.

Methods: Colorectal outcome data from the University Department of Surgery in Wellington and the King Faisal Specialist Hospital in Riyadh were analysed in order to determine casemix differences between the two hospitals. Data relating to the type of surgery, the surgeon, the patient’s disease, the operation performed and the postoperative complications were compared. Specific colorectal clinical indicators were compared for two commonly performed operations for rectal cancer: anterior resection and abdomino‐perineal resection of the rectum.

Results: Wellington patients were slightly older and there were more females. Emergency surgery was more frequent in Wellington. Left hemicolectomy, sigmoid colectomy, abscess drainage and pilonidal surgery were more common in Wellington whereas abdomino‐perineal resection and anterior resection of the rectum, stoma closure, fistula surgery, seton insertion, restorative proctocolectomy and ileostomy were undertaken more frequently in Riyadh. More complex anal fistulas were managed in Riyadh. Condylomata accuminata, pilonidal abscess, anorectal abscess, rectal prolapse and diverticular disease were rarely seen in Riyadh. There were more postoperative pulmonary and cardiac complications in Wellington. Patients having anterior resection of the rectum were younger in Riyadh and there were proportionally more females. There were some obvious numerical outcome differences in postoperative atelectasis, wound infection, anastomotic leak and deep vein thrombosis rates but none of these reached statistical significance except atelectasis. In Riyadh the usual male‐to‐female ratio of patients undergoing abdomino‐perineal resection was reversed but, again, none of the numerical outcome differences observed reached statistical significance except postoperative atelectasis and intra‐abdominal abscess.

Conclusion: Although not statistically significant, the results of the present study suggest that when the same surgeon operates using the same technique in different communities, the outcomes may be different. Care should thus be taken when comparing different populations with different casemixes before definitive conclusions are made in comparative studies.
BLUNT TRAUMA TO THE SPLEEN
Authors: Aseervatham R. , Muller M.
Published: March 2003

Background: The management of splenic injury resulting from blunt trauma in adults is controversial, with an increasing trend towards non‐operative management and conservation of the spleen. A retrospective review was performed on adult patients treated in a single institution for splenic injury resulting from blunt trauma in an attempt to identify factors important in selecting an appropriate management option and predicting the success of that option.

Methods: Associated injuries (standardized using Injury Severity Scores), clinical signs at presentation, computed tomographic grading of splenic injury, and transfusion requirements were documented. Statistical analysis was performed using non‐parametric Mann–Whitney, Chi‐squared, Kolmogorov–Smirnov and multivariate logistic regression tests.

Results: Eighty‐five patients were identified. Non‐operative management was used on 39 patients, splenic conservation on 14 patients, and splenectomy on 32 patients. The mean Injury Severity Score was significantly lower in the non‐operative group. Computed tomographic grading of the splenic injury was not found to correlate well with intraoperative findings. Transfusion requirements were lower in the non‐operative group. Non‐operative management failed in four patients; two had continued splenic bleeding, and two required surgery for other intra‐abdominal injuries. Overall mortality was 7%. There was one death in the splenic conservation group, unrelated to the splenic injury, and two patients required a second laparotomy and splenectomy for persistent splenic bleeding. There were five deaths in the splenectomy group, only one of which was related to the splenic surgery.

Conclusion: Management of blunt splenic injury remains controversial. The decision to pursue non‐operative management rather than splenic conservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic conservation, particularly in younger, stable patients with single organ injury.
Rectal Cancer: Changing Patterns Of Referral For Radiation Therapy 1982–1997
Authors: Stevens Graham , Firth Ian , Solomon Michael , Saw Robyn , Glenn David , Eyers Anthony , West Richard
Published: March 2003

Background: The purpose of the present study was to evaluate the changing role of radiation therapy in rectal cancer and to determine the patterns of referral of patients during a 15‐year period.

Methods: From 1982 to 1997, 464 patients with carcinoma of the rectum were referred to the Department of Radiation Oncology, Royal Prince Alfred Hospital; 79% of patients had locoregional disease alone and 21% had distant metastasis. Radiation therapy consisted of irradiation (definitive or palliative) alone to the primary tumour in 9.7% of cases; preoperative radiation in 7.3% of cases; preoperative chemoradiation in 7.5% of patients; postoperative radiation in 15.3% of patients; postoperative chemoradiation in 12.3% of patients; treatment of pelvic recurrence in 23.5% of patients and treatment of metastases in 9.1% of patients. The remainder were treated elsewhere (1.9%) or not treated (13.4%).

Results: There was an average annual 14% increase in referrals over the accrual period. Recurrent rectal cancer decreased from approximately 30% of referrals during 1982–91 to approximately 10% in 1995–7. The use of postoperative adjuvant radiation reached a peak of 50% in 1993. The use of preoperative radiation increased suddenly in 1994 from < 10% to a sustained rate of approximately 30% of referrals. The use of chemoradiation commenced in 1990 for postoperative adjuvant treatment and in 1994 for preoperative treatment. The median survival time from initial diagnosis was 35 months, with 2‐ and 5‐year survival rates of 62 and 28%, respectively. Survivals at 5 years for patients treated with preoperative and postoperative radiation (with or without chemotherapy) and with recurrent disease were 56, 44 and 21%, respectively.

Conclusions: The present study illustrates the changing role of radiation therapy in the management of rectal cancer. The increase in referrals over the observation period was due to increased multidisciplinary input into the initial management of these patients, based on reported clinical trials. The steady increase in the use of adjuvant therapy has paralleled a decrease in referrals for treatment of recurrence and reflects current clinical results. The sequencing of adjuvant therapy is changing currently, with greater emphasis on preoperative adjuvant treatment. Currently most adjuvant therapy includes chemotherapy.
Early Discharge Following Breast Surgery: Assessing Care, Support, And Informational Needs Of Women With Early Breast Cancer In Australia
Authors: Davis Cindy , Williams Philippa , Redman Sally
Published: March 2003

Background: The overall aims of the present study were to identify differences among women with early breast cancer who were discharged early from the hospital (within 48 h) and those who remained for routine admission in relation to demographic variables, informational needs, supportive needs, complications and satisfaction with care.

Methods: A random sample of 544 women diagnosed with early breast cancer was recruited to participate in a telephone survey via State and Territory cancer registries.

Results: Findings revealed little significant difference among women participating in early discharge and routine care in relation to demographics variables, informational needs, complication and satisfaction with care. Women participating in early discharge, however, were significantly less likely to be seen by a specialist breast care nurse or a volunteer with breast cancer.

Conclusions: Prior to establishing early discharge as routine care, it is essential to establish clear health policy relating to early discharge and adequate follow‐up services for women with breast cancer.
A Randomized Controlled Trial Comparing Cholecystocholangiography With Cystic Duct Cholangiography During Laparoscopic Cholecystectomy
Authors: Wills Vanessa L. , Jorgensen John O. , Hunt David R.
Published: March 2003

Background: The rate of intraoperative cholangiography fell after the advent of laparoscopic cholecystectomy due to the perceived difficulty of cystic duct cannulation. It is suggested that cholecystocholangiography (CCC) is a valid and easier alternative. The present study compares cystic duct cholangiography (CDC) to CCC with evaluation of procedural time, success rate, image quality, cost and radiation exposure.

Methods: Patients undergoing laparoscopic cholecystectomy were randomized to CCC (n = 40) or CDC (n = 36). Details of operative times, radiation exposure, and use of disposable equipment were recorded prospectively. Cholangiograms were performed using image intensification and were scored from 0 to 6 according to adequacy of images. Data were analysed on an intention‐to‐treat basis with the chi‐squared test, t‐test or Fisher’s exact test.

Results: The success rate for CDC was 100% and for CCC it was 72% (P = 0.0005). Patients with a failed CCC went on to have CDC for a success rate in the CCC arm of 92.5%. Comparing CDC to CCC, there was no significant difference in cost ($30.16 vs $33.36; P = 0.11), operative time (1 h 13 min vs 1 h 3 min; P = 0.19) or cholangiogram time (8 vs 9 min; P = 0.39). There was a significant difference in screening time (0:41 vs 1:33 min; P < 0.0001), adequate image quality (100 vs 72.5%, P = 0.0005) and procedure‐related complications (0 vs 5; P = 0.03).

Conclusions: A significant number of CCC fail. Successful CCC provides inferior image quality and greater radiation exposure. It provides no benefit in time or cost and cannot be recommended for operative cholangiography.
Clinical Review Of The ‘Snodgrass’ Hypospadias Repair
Authors: Holland A. J. A. , Smith G. H. H. , Cass D. T.
Published: March 2003

Background: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994 based on the concept of hingeing the incised urethral plate. The use of this technique allows a vertically orientated glanular meatus to be produced. A retrospective review of patients who had this procedure for the primary repair of distal hypospadias at New Children’s Hospital was performed to objectively assess the cosmetic and functional outcomes of this technique.

Methods: All patients having a TIP urethroplasty for the primary repair of distal hypospadias between 1996 and 1998 were requested to attend for review in an independent clinic. The parents were interviewed and the patient was examined to determine meatal location, meatal size, glanular configuration, urinary stream, straightness of erections, cosmesis, and the presence or absence of cutaneous sinus tracts or a urethral fistula.

Results: Sixty patients were identified. Forty‐nine were reviewed in person, 10 were reviewed by telephone and one could not be traced. The median age at surgery was 13 months (range: 6–144 months), with a median follow up of 27 months (range: 2–33 months). A glanular meatus was achieved in 57 patients (97%) and a conical glanular configuration was achieved in 58 patients (98%). The urinary stream and erections were straight in 54 (89%) and 58 patients (98%), respectively. Suture sinus tracts were present in 14 (24%) patients. Six patients (10%) developed a urethral fistula and three (5%) developed meatal stenosis. A good or satisfactory final cosmetic and functional result was achieved in 58 patients (98%).

Conclusions: The results of TIP urethroplasty are satisfactory at New Children’s Hospital with the benefit of a cosmetic final outcome similar to a circumcised penis.
Duels, Doctors And Death
Authors: Magee Reginald
Published: March 2003

Duelling as a method of settling disputes between gentlemen was practised in the British Isles and on the Continent from the 16th to the beginning of the 20th century. In early duels the victory would go to the better swordsman, but the use of pistols not only made the contest more deadly, but also more democratic. The social aspects, the indications for a challenge, the material and methods and the mortality and morbidity of the contest are considered. Mention is made of a case in which John Hunter was consulted. Its management, progress and autopsy findings are described together with Hunter’s thoughts about it and the management of similar wounds.
Local Recurrence after Mastectomy and Adjuvant CMF: Implications for Adjuvant Radiation Therapy
Authors: Rangan Anna M. , Ahern Verity , Yip Desmond , Boyages John
Published: March 2003

Background: The purpose of the present study was to evaluate the patterns of failure in a series of patients with node‐positive breast cancer that was treated by total mastectomy and adjuvant chemotherapy.

Methods: A retrospective review was undertaken of 217 patients with node‐positive breast cancer who were referred to the oncology departments of Westmead and Nepean Hospitals following total mastectomy between January 1980 and December 1991. The majority of patients (82%) were pre‐ or peri‐menopausal and all underwent chemotherapy with cyclophosphamide, methotrexate and 5‐fluorouracil (CMF) by either an oral or intravenous regimen. No patient received adjuvant radiation therapy.

Results: After a median follow up of 8.7 years, 19% of patients had developed a loco‐regional recurrence (LRR). The majority of LRR (79%) occurred within the initial 3 years after mastectomy. The risk of LRR was positively associated with the size of the tumour (11% for T1vs 53% for T3, P < 0.001) and axillary nodal status (16% for three or fewer positive nodes vs 31% for four or more positive nodes, P = 0.017). Patients with T1 or T2 tumours and 1–3 positive nodes had the lowest rate of LRR (11%) while those with T3 tumours or 4–10 positive nodes had the highest rates, ranging from 23 to 75%. Relapse at the chest wall and supraclavicular fossa (SCF) accounted for 46 and 35%, respectively, of all LRR; relapse at the internal mammary chain and axilla was uncommon.

Conclusion: The data suggest that patients with T3 tumours (> 5 cm) and any nodal involvement or patients with four or more involved axillary nodes, regardless of T stage, are at a high risk of LRR and will benefit from adjuvant radiation therapy to the chest wall and SCF.
Hugh Berchmans Devine: Surgical Visionary and Great Australian
Authors: Vellar Ivo D.
Published: March 2003

It is now 75 years since a letter signed by Sir George Syme, Hamilton Russell and Hugh Devine was sent to leading surgeons in Australia and New Zealand inviting them to form an Australasian Association of Surgeons, a body dedicated to improving the standard of surgery as practised in the two countries. This letter proved to be the catalyst that led to the formation of what eventually became the Royal Australasian College of Surgeons, after a previous attempt to form such an Association in 1920 by Professor Louis Barnett had failed. It was Hugh Devine, returning from America in 1925, who played a leading role in the foundation of the College and it is not inappropriate in the year 2000, 75 years after the letter was drafted, to reappraise the life and achievements of this great Australian surgeon.
To Study the Healing Art
Authors: Beasley A. W.
Published: March 2003

The present paper traces the careers of two men: Dominique, Baron Larrey, and Sir James McGrigor, and examines their contributions to military medicine in the Napoleonic period.
Gastric tube graft interposition as an oesophageal substitute
Authors: Samuel Madan , Burge David M. , Moore Isabelle E.
Published: March 2003

Background: Use and techniques of oesophageal replacement for long gap oesophageal atresia are still evolving. Gastric tube graft interposition as an oesophageal substitute was evaluated on an animal model.

Methods: Twenty‐three postweaned, 28‐day‐old‐piglets were used as the experimental animals. Isoperistaltic gastric tube interposition based on the right gastroepiploic vessels was performed at 28 days of life. Postoperative evaluation included weekly measurement of weight, clinical assessment for gastrointestinal and respiratory complications and deglutition difficulties. Haemoglobin, serum ferritin, albumin, globulins, total proteins and red cell folate were assayed. Pigs were killed and analysed histopathologically following a maximum observation period of 149 days.

Results: Growth of the pigs was normal. Deglutition was not impaired in 16 pigs (89%). Minor leak was diagnosed in three pigs (17%), which was successfully managed conservatively. Anastomotic stricture was seen in two pigs (11%). Graft necrosis was not seen. Gross histology showed the absence of hypertrophy, redundancy and kinking of the interposed gastric tube graft. Microscopically non‐erosive oesophagitis was seen in three pigs (17%), ulcerative oesophagitis was seen in two pigs (11%) and submucosal fibrosis was seen in seven pigs (39%). Dysplasia or Barrett’s oesophagitis was not observed at the end of animal growth.

Conclusions: Gastric tube graft interposition is an immediate ideal oesophageal substitute due to fewer complications, probable absence of gastro‐oesophageal reflux in the majority by histology, and absence of dilatation and redundancy of the interpose tube. The oesophageal substitute adequately met the nutritional needs for growth and development in the animal model.
The development of undergraduate curricula in surgery: I. General issues
Authors: Hamdorf Jeffrey M. , Hall John C.
Published: March 2003

Undergraduate surgical education is evolving in line with societal changes, the growth of information technology, developments in educational processes, and shifts in the health‐care industry. The underlying principles include the establishment of a strong linkage between the objectives and content of curricula, the identification of core knowledge and appropriate attitudes, achieving competence in basic skills, the creation of greater integration, and the promotion of study in depth. The aim of the present paper was to provide surgeons with an overview of these developments.
Treatment of anal fissure with glyceryl trinitrate in patients referred for surgical management
Authors: Skinner S. A. , Polglase A. L. , Le C. T. , Winnett J. D.
Published: March 2003

Background: A number of recent studies indicate that anal fissure may be treated by applying glyceryl trinitrate (GTN) ointment. The present study aims to determine the effectiveness and patient acceptability of GTN treatment for patients referred to a consultant surgeon.

Methods: A prospective study of 65 consecutive patients referred to one surgeon (ALP) over a 12‐month period was undertaken. All patients were offered 0.2% GTN ointment to be applied intra‐anally four times daily for 4 weeks. Informed consent was obtained and review planned for 4 weeks.

Results: Fourteen patients declined treatment and nine of the 14 (64%) subsequently underwent lateral sphincterotomy. Twelve of the 51 patients (18.5%) who accepted treatment could not complete it due to headache or persisting severe anal pain. Thirty‐nine of the 51 patients (77%) were able to complete 4 weeks of treatment. Twenty‐two of the 39 reported an improvement in symptoms. A total of 22 patients (43%) who started GTN treatment subsequently underwent lateral sphincterotomy.

Conclusions: Evidence from the present study suggests that GTN ointment has a place in the management of referred patients with severe and/or chronic anal fissure, but sphincterotomy remains an important treatment option for the majority.
Quality assurance in a multidisciplinary symptomatic breast assessment clinic
Authors: Kollias James , Bochner Melissa A. , Gill P. Grantley , Malycha Peter , Coventry Brendon J.
Published: March 2003

Background: Although quality assurance guidelines for surgeons have been issued and adopted for use in population‐based breast screening programs in Australia, similar guidelines are unavailable for women referred with symptomatic breast problems.

Methods: Six hundred and ninety‐six women who attended the Royal Adelaide Hospital Women’s Health Centre between February and November 1998 for investigation and management of a new breast‐related complaint were prospectively evaluated. Investigation strategies and outcomes of the initial consultation were determined and the results compared with the performance quality standards for symptomatic breast disease according to the British Association of Surgical Oncology (BASO) Breast Surgeons’ Group.

Results: A breast lump was the presenting symptom in 45%, while breast pain was present in 26%. Ninety per cent of women referred with breast symptoms were given a definitive benign or malignant diagnosis at the initial clinic visit. Although the median time delay between the date of general practitioner referral and breast clinic appointments for all patients was ≤ 7 days, the time delay for ‘urgent’ cases was not met according to BASO performance indicators. All other Royal Adelaide Hospital Breast Clinic audit data were within the range suggested by BASO performance indicators for new consultations in a symptomatic breast assessment clinic.

Conclusions: A multidisciplinary breast clinic in a public hospital setting is able to provide clinical services to symptomatic women, with the majority of patients obtaining a confident diagnosis at the first presentation. Performance indicators for symptomatic breast disease are useful in identifying inadequacies at the clerical or clinical level which, following the implementation of subsequent changes, may lead to improvement in patient outcomes.
A simple technique for closure of the last laparoscopic working port
Authors: Kanchanabat Burapa , Siddins Mark , Rao M. Mohan
Published: March 2003

Closure of the last laparoscopic working port can be frustrating, particularly in the very obese. A technique is described that simplifies this procedure, using a grasping forcep to transfer the abdominal wall suture.
Embryos of occupational therapist paradigms: An exploratory study of Swedish occupational therapy students’ perceptions of occupational therapy
Authors: Björklund Anita
Published: March 2003

The present study is an exploratory study of newly enrolled Swedish occupational therapy students’ world view and field of action view of occupational therapy during their introductory week at the Occupational Therapist Educational Program at the University College of Health Sciences, Jönköping, Sweden, in the autumn of 1995. The study has its starting point in Törnebohm’s theory of paradigms. The students answered essay questions on paradigmatic matters and the data were analysed qualitatively. Three themes were identified in the data: (i) notions of some concepts fundamental to occupational therapy; (ii) notions of the ‘setting’ of occupational therapy reality; and (iii) notions of the operational reality of occupational therapy. With their limited personal experience of occupational therapy, the students’ perceptions reflected interested outsiders’ views on the topic, influenced by information available in society and the questions given. They were shown to possess relevant and varied information about occupational therapy, but had difficulties in joining the information together in a coherent unity.
Reliability of occupational therapists in determining safe, maximal lifting capacity
Authors: Gardener Lisa , McKenna Kryss
Published: March 2003

Determination of an individual’s lifting capacity is an important component in Functional Capacity Evaluation, which is widely used to delineate potential for work. Despite a recent surge in the number and types of Functional Capacity Evaluations, and therefore in approaches to determining lifting capacity, there has been limited research to support the reliability and validity of their use. This study evaluated the inter‐rater reliability of five occupational therapists in determining safe maximal lifting capacity using a biomechanical approach. In addition, the use of an operational definition of a safe lift was examined to determine its effect on therapists’ decision‐making process and therefore the reliability of their ratings. The use of an operational definition was found to significantly affect therapists’ decision‐making process in differentiating safe from unsafe lifts, with all raters showing highly significant improvements in their ability to determine the safety of lifts from pre‐ to postdefinition ratings, according to McNemar’s χ2 statistic. The provision of a definition also enhanced therapists’ reliability of ratings, with kappa values that ranged from 0.47 to 0.74 predefinition changing to 0.56–0.82 postdefinition. Possible explanations for the change in decision‐making are discussed and the need for ongoing evaluation of procedures used in Functional Capacity Evaluation, particularly with regard to the determination of lifting capacity, are highlighted.
A Comparison of Private and Public Psychiatry in Three Hospitals
Authors: Rischbieth Sally C , Goldney Robert D
Published: March 2003

The nature of healthcare provision in Australia in both the private and public sectors is changing rapidly. In the mental health area there has been a dearth of studies examining what actually occurs within the two sectors, and few direct comparisons have been made. Such a lack of data has not prevented suggestions that private psychiatric hospitals ‘skim the cream’ off the market for acute health care, by providing the most profitable services for the best-paying patients [ 1 ].
The Faculty of Psychiatry of Old Age
Authors: Snowdon John , Draper Brian
Published: March 2003

Since the first day of IYOP (International Year of Older Persons, 1999) the College has had a Faculty of Psychiatry of Old Age. A submission from the Section in Psychiatry of Old Age for a change to Faculty status was considered and approved by our College Council in late 1998.
Adequate Housing for People with a Serious Mental Illness: Policy Obstacles and Practice Solutions
Authors: Thomas Kay L. , McCormack Carmel
Published: March 2003

People with a serious mental illness are severely disadvantaged in terms of housing, which is a right for all. They are at greatly increased risk of homelessness. The disability brought about by mental illness means that they need support to acquire suitable housing and ongoing support for many tasks of daily life. To achieve the same level of housing for this group as others requires a great deal more resourcing and coordination of social housing and support services. It need not be assumed that there is one solution suitable for all with mental illness.
Adaptive, Eclectic and Democratic: An Alternative Year 2020 Vision of the Place of Psychiatry
Authors: Hall Kathryn
Published: March 2003

It was the end of the academic year in 2020. On the third floor of the Southern Health University's administrative building, the five Vice-Chancellors of the Health Universities were gathering. Outside it was raining, but the patter of drops on the window only served to enhance the coziness of the meeting room. This annual event would take three days. The Vice-Chancellors enjoyed this meeting. They seldom saw each other during the busy academic year and under Professor Hope Brightview's 6 years of chairmanship they had been able to work well together to formulate a rational and profitable distribution of teaching, research and consultation services.
A Schizophrenia and Depression Training Workshop for Psychiatrists from Asian Countries
Authors: Minas Harry , Singh Bruce
Published: March 2003

We have previously reported the establishment of the Asia Pacific Forum for International Mental Health Cooperation [ 1 ], an initiative of the University of Melbourne Department of Psychiatry and the Centre for Cultural Studies in Health. The intent of the Forum is to promote cooperation in mental health development in the Asia Pacific region. The specific goals and strategies of the forum may be found by visiting the Forum web site at: http://www.apacforum.unimelb.edu.au/
Want to know How to Conduct a Survey but too Afraid to Ask? A Step-by-Step Guide
Authors: Walter Garry , Cleary Michelle , Rey Joseph M.
Published: March 2003

Most of us are busy in our work – patients to see, reports to write, meetings to attend, students to teach etc. Then another questionnaire crosses our desk, sometimes prettied up, e.g. with a tea-bag stapled to it so you can complete the survey ‘over a cuppa’ or a ‘smiling face’ sticker attached or the offer of money on the questionnaire's return. The second last thing you feel like doing is completing the wretched thing, whether over a cup of tea or something stronger. The very last thing you feel inclined to do is conducting a survey yourself. Nevertheless, surveys can provide valuable information for consumers, clinicians, administrators and policy-makers. Surveys are often more popular to carry out than other studies and, for would-be researchers, can be a gentle introduction to research. Nevertheless, conducting a survey does not amount to thinking up a list of questions on a rainy day and inflicting them on your colleagues; skills and etiquette are required. As with all research, there are problems and pitfalls. Here is a step-by-step guide, based on the authors' experience [e.g. 1–6] and reading [e.g. 7–12], which should make your survey easier to conduct, and more palatable for the would-be respondent.
The Comparative Effectiveness of Fixed and Stimulus Dosing Forms of Electroconvulsive Therapy for the Treatment of Unipolar Depression: A ‘Quality Assurance’ Study
Authors: Walker Kipling , Mitchell Philip
Published: March 2003

While the necessity for suprathreshold dosing has become widely accepted as the most effective means of administering ECT, there are differing schools of thought regarding the utilisation of this approach in day-to-day clinical practice. Abrams [ 1 , 2 ] and Fink [ 3 ] support fixed dosing whereby patients receive a fixed dose of about 2.5 times the average population seizure threshold (approximately 375–500 mC). On the other hand, Sackeim [ 4 ] developed the technique of stimulus dosing with which individual seizure thresholds and suprathreshold doses are determined. Both the American, and Australian and New Zealand Psychiatric Associations [ 5 , 6 ] view both fixed and stimulus dosing in ECT as appropriate and acceptable alternatives. This has also been endorsed in recent literature [ 7 ].
Community Treatment Orders: Clinical Versus Administrative Role
Authors: Jaworowski Sol , Guneva Rumiana
Published: March 2003

In Victoria, there is insufficient integration of community treatment orders into patients' clinical management. As a result, the clinical role of CTOs is often overshadowed by administrative issues relating to their implementation and review.
Through the Glass Darkly: Deaf Children From Non-English Speaking Background Families
Authors: Tong Chiwai , Cornes Andy , Wiltshire Catherine
Published: March 2003

This paper is an attempt to explore the psychiatric and psychological issues associated with being deaf or hearing impaired and from a minority culture. The need for and provision of mental health services for deaf children from non-English speaking backgrounds (NESB), and the adequacy of these services, will be assessed. In this paper, we aim to briefly explore psychiatric and psychological aspects of hearing impairment in children as revealed by a literature review and selected case vignettes. During this process, some of the mental health needs of deaf children and their families, and the best means of meeting these needs will be highlighted. In particular, children from NESB and their particular needs and vulnerabilities will be discussed. Brief mention will also be made of the current services available in Sydney and the adequacy or otherwise of these services. The exploration of Deaf NESB populations is the second in a series of snapshots to illustrate mental health issues for the Deaf community in Australia.
Emotional Gear Shifting
Authors: Pridmore Saxby , Madden John
Published: March 2003

Emotional gear shifting (EGS) is a potential tool for the management of low mood in normal individuals and dysthymia and a potential adjunct in the management of major depressive episode. It calls for elevating mood by conscious effort. It is based on neuroimaging and the manual gear box of the automobile.
Patterns of use of Antipsychotic Medication in a Regional Community Mental Health Service
Authors: Callaly Tom , Trauer Tom
Published: March 2003

Objective: To audit the use of antipsychotic medications in a regional community mental health service.

Method: In April 1999 each case manager of the adult and aged care community mental health service documented all medications being prescribed for patients in their care.

Results: Out of a total of 792 patients, 572 (72.2%) were prescribed antipsychotic medication. Of those prescribed antipsychotic medication, 67.1% were prescribed atypical or novel antipsychotics, 14.3% were prescribed conventional oral antipsychotics and 23.6% were prescribed a depot antipsychotic preparation. Of the 456 patients prescribed oral antipsychotic medication, 84.2% were prescribed atypical antipsychotics (38.6% were prescribed clozapine, 28.7% olanzapine and 18% risperidone).

A total of 100 patients were on a community treatment order (CTO): 40% of patients on a CTO who were prescribed antipsychotics, were prescribed a depot antipsychotic medication compared with 13.7% of patients prescribed antipsychotics who were not on a CTO.

Conclusion: The pattern of antipsychotic medication use in this regional community service shows that atypical antipsychotic medication was used more commonly than conventional antipsychotic medication. Over 30% of the use of atypical antipsychotic medication in this service was for conditions other than schizophrenia.
One Hundred Years Ago in New South Wales
Authors: Shea Peter
Published: March 2003

Objective: To review the way in which psychiatric patients were managed around the turn of the last century, in the context of the institutions, legislation and knowledge and understanding of the nature of psychiatric illness that existed at the time.

Conclusions: In 1900 not a great deal was known about the nature of psychiatric illness, treatments were limited, non-specific and, at times, potentially quite dangerous, and most of the care of the psychiatrically ill was provided in overcrowded and underfunded institutions by poorly trained staff, not all of whom were up to the task. In spite of this, there is evidence that in NSW, mainly under the thirty-year influence of Frederick Norton Manning, the care of the psychiatrically ill was passing through a humanitarian phase, characterised by a recognition of the value of the therapeutic milieu, a policy of normalisation, protective legislation and an administrative attitude that reflected a positive concern for the welfare of patients.
Borderline Personality Disorder: Foundation Training for Public Mental Health Clinicians
Authors: Krawitz Roy , Rreal
Published: March 2003

Objective: To describe the development and delivery of a brief training workshop on borderline personality disorder for public mental health clinicians.

Method: During the initial phase the author had contact with key informants, undertook a North American study tour and completed a course in adult teaching. A two-day workshop was developed and delivered to one public mental health service and private workshops were run in three cities. This led to requests to run workshops in other public mental health services. Independent qualitative research of workshop participants provided feedback assisting the evolution of the workshop, as did ongoing participant feedback.

Results: One hundred and three workshops were delivered to 2048 participants in Australia and New Zealand between 1997 and 2000. Participants rated the workshop positively with 99.7% stating they would recommend the workshop to others.

Conclusions: The numerous workshop requests, good attendance and participant endorsement indicated a desire and readiness of general public mental health clinicians for the training being offered. Substantial training has been available for psychotherapists working in this area but little or nothing for general public mental health clinicians. This workshop provides an addition to training options available in the public sector.
“Beyondblue: The National Depression Initiative”
Authors: Hickie Ian
Published: March 2003

Objective: To describe the initial phases of “beyondblue: the national depression initiative”. In doing so, this paper aims to highlight those issues that are likely to be most relevant to clinical, academic and administrative psychiatrists.

Conclusions: beyondblue potentially represents a very significant development in mental health for the Australian community. Its success will depend on its capacity to engage the wider community in the issues that impact on persons suffering from depression and related disorders. There is the potential for psychiatrists to take leading roles in promoting a public health approach, working closely with primary care and allied health colleagues and devising national research projects of international significance.
How to Make an Editor's Life Easier
Authors: Ellard John
Published: March 2003

Objective: To describe the duties of editors and the ways in which authors can make an editor's life easier.

Conclusions: An editor's tasks include knowing his or her reader, making a journal attractive and ensuring articles are accurate and up to date. Authors can assist by having the reader in mind, writing in plain English and keeping articles short. Peer review is an important aspect of medical publishing but has limitations.
Perceived Roles and Functions of Psychiatry Medical Staff in Two Melbourne Services
Authors: Tan Meileen
Published: March 2003

Objectives: To examine (1) perceived roles and functions of psychiatry medical staff in two multidisciplinary teams at two state-funded health services, a community mental health clinic at a general public psychiatry service and an alcohol and drug service, and (2) factors influencing these roles and functions.

Method: Data were obtained from focus groups, key informant interviews, participant observation and document review.

Results: Clinical roles were well conceptualised in both services, with good concordance between medical and non-medical staff. Team and leadership roles, however, were not well conceptualised. Service-related factors influenced clinical and many other roles. Power and professional cultural differences between medical and non-medical staff influenced team and leadership roles.

Conclusions: Addressing lack of role clarity and teaching interpersonal and team leadership skills to psychiatry medical staff are likely to improve multidisciplinary team functioning for psychiatrists in these settings.
CME and the Pharmaceutical Industry: Towards a More Ethical Relationship
Authors: Freidin Julian , Prior Nigel , Sara Grant
Published: March 2003

Objectives: To feedback the strategies put to, and accepted by, General Council as a result of the survey of College Fellows views on the ethics of the relationship between the Pharmaceutical Industry and Continuing Medical Education (CME).

Conclusions: The proposals accepted by General Council recognise that education of registrars and psychiatrists about the complex nature of their relationships with Industry, increasing their awareness of how this may impact on patient care and encouraging greater individual and collective openness are important steps to take in increasing the confidence of the public that we genuinely are their advocates in all matters to do with the Pharmaceutical Industry.