bluuebunny/crossref_metadata_2025 huggingface dataset:
Features of the development of a welfare system for visually disabled people in Denmark
Authors: Ry Andersen Sigurd
Published: December 2004

Purpose: To describe the development of a formal system of welfare for blind and partially sighted people in Denmark.

Methods: The principal laws in Denmark relating to a formal system of welfare for blind and partially sighted people are noted and commented on. No such collection of laws has been found in the literature. The history of aid to visually disabled people in Denmark is described, as are the Danish classifications of visual impairment.

Development: Formalized welfare for blind and partially sighted people was started in Denmark in 1811, as a private initiative by the Kjæde Order. Later, the Danish state took over responsibility, and in 1858 the Royal Danish Institute for the Blind was established. Since then a series of laws concerning welfare for blind and partially sighted people have been issued in accordance with economic and social development in Denmark. In 1858 the Braille writing system for blind people was introduced. The Danish Association of the Blind was founded in 1911 and has profoundly influenced subsequent legislation. During the last 10 years, several visual centres have been established. Since 1968 prevention of blindness has also played a prominent role in Denmark.

Conclusion: Great steps have been taken towards improving the welfare of blind and partially sighted people. However, being blind is still very difficult. Modern technologies and hectic lifestyles have created new problems for blind people. The obligations of the Danish state towards visually disabled people have, therefore, increased in recent years.
Dry eye syndrome in thyroid‐associated ophthalmo‐ pathy: lacrimal expression of TSH receptor suggests involvement of TSHR‐specific autoantibodies
Authors: Eckstein Anja K. , Finkenrath Andreas , Heiligenhaus Arnd , Renzing‐Köhler Katrin , Esser Joachim , Krüger Carsten , Quadbeck Beate , Steuhl Klaus‐Peter , Gieseler Robert K.
Published: December 2004

Purpose:  We evaluated the relationship between ocular surface damage, elevated lid aperture/impaired Bell's phenomenon and reduced tear production in thyroid‐associated ophthalmopathy (TAO). Suspecting a possible role of autoantibodies specific for TSH receptor (TSHR), we further investigated TSHR expression in the healthy lacrimal gland (LG).

Methods:  A total of 48 patients with active TAO and 26 controls were examined for basal tear secretion, Rose Bengal and fluorescein staining, impression cytology (IPC), break‐up time (BUT), and blinking (lid width, lid closure, ocular surface, upward excursion). Healthy LGs were investigated immunohistochemically for expression of TSHR.

Results:  Thyroid‐associated ophthalmopathy patients showed significant ocular surface damage (Rose Bengal staining score: TAO: 2.0 [0–5] versus controls: 0 [0–0.4]; IPC score: TAO 3.0 [0–8] versus controls: 0 [0–1], and BUT: TAO: 3.0 seconds [0–9 seconds] versus controls: 19.5 seconds [13–35.4 seconds]), and significantly reduced tear secretion (TAO: 10 mm [3–20 mm] versus controls: 17 mm [10–27 mm]). Ocular surface damage correlated significantly with tear secretion (r = − 0.35) but not significantly with mechanical alterations (impaired upgaze [r = − 0.34] and ocular surface increase [r = 0.32]). We firstly demonstrate that lacrimal acinar cells physiologically express TSHR.

Conclusions:  As ocular surface damage in TAO significantly correlates with reduced tear production, LG impairment appears to be a major cause of ocular surface drying. Intriguingly, physiological expression of TSHR by LG suggests that, in thyroid disease, autoantibodies may bind to lacrimal TSHR and, perhaps via aberrant signal transduction, contribute to LG impairment and, hence, dry eye syndrome.
Comparison of colour Doppler imaging and retinal scanning laser fluorescein angiography in healthy volunteers and normal pressure glaucoma patients
Authors: Huber K. , Plange N. , Remky A. , Arend O.
Published: December 2004

Purpose:  To correlate retinal circulatory measurements using scanning laser fluorescein angiography and flow velocities of retrobulbar vessels measured by means of colour Doppler imaging.

Methods:  Fifteen patients with normal pressure glaucoma (NPG) and 15 healthy volunteers underwent colour Doppler imaging and fluorescein angiographic studies. Peak systolic velocities (PSVs), end‐diastolic velocities (EDVs) and resistive indices (RIs) of the ophthalmic artery (OA) and central retinal artery were obtained. In the fluorescein angiograms arteriovenous passage time (AVP) was quantified by means of digital dye dilution curve analysis.

Results:  Arteriovenous passage time was significantly prolonged in NPG patients compared to healthy subjects (p = 0.0026). In the central retinal artery PSV (p = 0.023) and EDV (p < 0.0001) were significantly decreased and RI was increased (p < 0.0001) in patients with NPG. The EDV of the central retinal artery showed a significant correlation with AVP (EDV: r = − 0.53, p = 0.0023). The RI of the central retinal artery correlated significantly to AVP (RI: r = 0.63, p < 0.0001). The AVP did not correlate to EDV or PSV, nor to the RI measured in the ophthalmic artery.

Conclusion:  Arteriovenous passage time, which represents blood flow in a vascular segment of artery, capillary bed and corresponding vein, was found to be correlated to the EDV and the RI of the central retinal artery. The combination of different techniques allows further interpretation of ocular circulatory responses.
Pupil size and night vision disturbances after LASIK for myopia
Authors: Helgesen Andreas , Hjortdal Jesper , Ehlers Niels
Published: December 2004

Purpose:  To examine whether standardized, preoperative evaluation of pupil sizes can predict the risk of night vision visual disturbances after bilateral laser in situ keratomileusis (LASIK) for myopia.

Methods:  A prospective study was carried out involving 46 patients who underwent bilateral LASIK for myopia. Pupil sizes were measured before surgery using an infrared pupillometer under standardized settings. Pre‐ and postoperative refraction and best spectacle‐corrected visual acuity (BSCVA) were registered. At the 3‐month follow‐up visit, the patients completed a questionnaire regarding night vision pre‐ and postoperatively.

Results:  The mean bilateral, spherical equivalent refraction (SE) was − 8.76 D (range 6.32 to − 12.0 D) preoperatively, and − 1.69 D (range 0 to − 4.38 D) postoperatively. The mean bilateral BSCVA was not changed by the operations. We found a significant correlation between large scotopic pupil sizes and the impression of worsened night vision (p < 0.01). A significant correlation between gender (males) and subjectively reduced night vision postoperatively was also found (p < 0.05).

Conclusion:  Large pupil size measured preoperatively is correlated with an increased frequency of subjectively experienced post‐LASIK visual disturbances during scotopic conditions. We recommend preoperative evaluation of pupil size in all patients prior to LASIK surgery.
Successful primary culture and autologous transplantation of corneal limbal epithelial cells from minimal biopsy for unilateral severe ocular surface disease
Authors: Nakamura Takahiro , Inatomi Tsutomu , Sotozono Chie , Koizumi Noriko , Kinoshita Shigeru
Published: December 2004

Background:  Patients with severe unilateral ocular surface disease require reconstruction of the damaged ocular surface. We succeeded in culturing primary corneal limbal epithelial cells taken from minimal biopsy and, once grown, transplanting them on denuded amniotic membrane (AM).

Methods:  Autologous corneal limbal epithelial cells from a 3 mm2 biopsy of the uninjured eye were grown for 3 weeks on a denuded AM carrier. The resultant sheet was then transplanted onto the unilateral severely chemically injured eye.

Results:  Minimal biopsy showed the autologous cultivated corneal epithelial cells to have 4–5 layers of sufficient stratification and to be well differentiated. At 19 months post‐transplantation, the ocular surface epithelium was stable and there were no epithelial defects.

Conclusion:  We document that it is possible to produce sufficiently stratified, well differentiated, autologous cultivated corneal limbal epithelium on AM from a minimal biopsy of the donor eye and to transplant it onto the injured eye.
Ocular refractive changes in patients receiving hyperbaric oxygen administered by oronasal mask or hood
Authors: Evanger Knut , Haugen Olav H. , Irgens Ågot , Aanderud Leif , Thorsen Einar
Published: December 2004

Purpose:  The aim of this study was to quantify ocular refractive changes after a standard hyperbaric oxygen (HBO) treatment protocol and to characterize the time period of recovery.

Patients and Methods:  Hyperbaric oxygen therapy was given for 90 min daily at a pressure of 240 kPa for 21 days. Oxygen was administered to 20 patients using an oronasal mask and to 12 patients using a hood. Follow‐up examinations were carried out 2–4 days after treatment, and thereafter regularly for up to 10 weeks in both groups. Refraction was assessed automatically and by the monocular subjective refraction method. A subgroup of nine of the 20 patients to whom oxygen was administered by an oronasal mask underwent a separate eye examination, which included crystalline lens opacity measurements and LOCS III gradings.

Results:  In the patients given oxygen by mask, there was a significant myopic shift in the mean spherical equivalent, which was largest 2–4 days after treatment. The shift was − 0.55 ± 0.40 D in the right eye and − 0.53 ± 0.42 D in the left eye. In the patients given oxygen by hood, the largest shift was observed after 12–16 days, and was − 1.06 ± 0.52 D in the right eye and − 1.10 ± 0.57 D in the left eye. The refractive changes returned to baseline 6 weeks and 10 weeks after HBO treatment, respectively. No significant changes in crystalline lens transparency were revealed.

Conclusions:  The myopic shift after HBO therapy recovers within 10 weeks and may be more pronounced when patients are given oxygen using a hood compared with using an oronasal mask.
The influence of age, sex, race, refractive error and optic disc parameters on the sensitivity and specificity of scanning laser polarimetry
Authors: Costa Vital P. , Lauande‐Pimentel Roberto , Fonseca Roberto A. , Magacho Leopoldo
Published: December 2004

Purpose:  To evaluate the influence of age, sex, race, refractive error and optic disc topography on the sensitivity and specificity of scanning laser polarimetry (SLP) in the diagnosis of glaucoma.

Methods:  A total of 88 normal individuals and 95 glaucoma patients were included in this study. Glaucoma was defined on the basis of both optic nerve damage and visual field defects. Scanning laser polarimetry, optic disc topography, automated perimetry and refractometry were performed in all subjects. The sensitivity and specificity of SLP were assessed applying a previously calculated cut‐off to a previously described linear discriminant function (LDF).

Results:  The sensitivity and specificity of SLP in the study population were 82% and 83%, respectively. Sensitivity and specificity were not affected by age, sex, race, average disc diameter or disc area. The sensitivity of SLP tended to be higher in myopes (93%) than in emmetropes (80%) and hyperopes (71%) (p = 0.08). Sensitivities were higher in individuals with cup areas > 0.96 mm2 (89%), rim areas ≤ 1.36 mm2 (92%), and cup area/disc area ratios > 0.45 (89%) (p < 0.05). Stepwise logistic regression analysis indicated that the presence of a cup area > 0.96 mm2 and a rim area < 1.36 mm2 significantly increased the sensitivity of the LDF, whereas a cup area/disc area ratio ≤ 0.45 significantly increased the specificity of the LDF.

Conclusion:  The sensitivity and specificity of SLP may be influenced by refractive error and optic disc parameters that are affected by glaucomatous damage (cup area, rim area and cup area/disc area ratio). These parameters must be considered in studies evaluating the sensitivity and specificity of optic nerve/retinal nerve fibre layer imaging technologies.
How prostaglandins have changed the medical approach to glaucoma and its costs: an observational study of 2228 patients treated with glaucoma medications
Authors: De Natale Renato , Draghi Eva , Dorigo Maria Teresa
Published: December 2004

Purpose:  The aim of the present study was to investigate how the medical treatment of glaucoma changed between 1997 and 2002, since the advent of prostaglandin derivatives, with regard to drug prescriptions and pharmaceutical costs.

Methods:  A study was made of medical prescriptions for 2228 patients with glaucoma and/or ocular hypertension, in order to investigate the following: (i) the antiglaucoma drugs most commonly prescribed in 1997 and 2002, and any differences between the drugs prescribed in these 2 years; (ii) the number of drugs used per patient in 1997 and 2002, respectively, and (iii) any increase in the prescribing of antiglaucoma drugs and their relative costs from 1997 to 2002.

Results:  From 1997 to 2002 there was a sharp drop in the prescribing of β‐blockers (79% in 1997 and 55% in 2002). A marked increase in the use of prostaglandin derivatives (0% in 1997 and 18% in 2002) was registered and a marked increase in the prescribing of carbonic anhydrase inhibitors (5% in 1997 and 14% in 2002) was also noted. From 1997 to 2002 there was a trend towards drug addition rather than substitution, so that the number of drugs used per patient increased. The number of patients treated increased enormously (by 98%) from 1997 to 2002. The cost of medical therapy from 1997 to 2002 rose dramatically, with an increase of 148.9% per patient.

Conclusion:  The availability of prostaglandin derivatives has strongly influenced the medical approach to glaucoma. This class of drugs will soon become the type most commonly prescribed for patients with glaucoma and/or ocular hypertension. The increased number of treatments also suggests that the approach of ophthalmologists towards these diseases has changed. Ocular hypertension, as well as glaucoma, is now treated more aggressively. Given the increase in the prescription of prostaglandin derivatives, the pharmaceutical cost of treatment has risen dramatically.
Effects of moderate smoking on the central visual field
Authors: Akarsu Cengiz , Yazici Bülent , Taner Pelin , Ergin Ahmet
Published: December 2004

Purpose:  To investigate whether moderate cigarette smoking has any effects on the central visual field.

Methods:  This study included 30 healthy, moderate cigarette smokers (10–20 cigarettes per day for at least the past 5 years) and 22 healthy non‐smokers. After two training test sessions, all individuals underwent computerized visual field examinations (Humphrey 30–2 Full Threshold Test) with both white‐on‐white (W‐W) perimetry and blue‐on‐yellow (B‐Y) perimetry. One eye of each subject with reliable visual field test results was evaluated. The foveal threshold, mean deviation (MD), pattern standard deviation (PSD), short‐term fluctuation (SF), corrected pattern standard deviation (CPSD), glaucoma hemifield test (GHT) and number of significantly depressed points deviating at p < 5%, p < 2%, p < 1% and p < 0.5% on the pattern deviation probability map of the smokers were compared with those of the non‐smokers.

Results:  When the results of W‐W perimetry were analysed, the smokers were found to have significantly lower foveal thresholds (p = 0.001) and mean retinal sensitivity (p = 0.02), and higher PSD (p = 0.002) and CPSD (p = 0.01) than the non‐smokers. Short‐term fluctuation was similar in both groups (p = 0.55). The number of significantly depressed points deviating at p < 5%, p < 2% and p < 1% on the pattern deviation probability map was similar for both groups (p > 0.05). The number of depressed points deviating at p < 0.5% on the pattern deviation probability map was higher for the smokers than for the non‐smokers (p = 0.03). The results of B‐Y perimetry showed the smokers to have a significantly lower foveal threshold than the non‐smokers (p = 0.03). However, there were no significant differences in the global indices of the two groups (p > 0.05). The number of significantly depressed points deviating at p < 5%, p < 2%, p < 1% and p < 0.5% on the pattern deviation probability map was similar in both groups (p > 0.05). No significant difference in GHT was determined with either perimetry for the smokers compared with the non‐smokers (p > 0.05).

Conclusion:  This study suggests that moderate cigarette smoking is associated with both diffuse and localized reductions in retinal sensitivity with W‐W perimetry. Only reduction in the foveal threshold was observed with B‐Y perimetry, with no hints of diffuse and localized reductions.
The nerve fibre layer symmetry test: computerized evaluation of human retinal nerve fibre layer thickness as measured by optical coherence tomography
Authors: Hougaard Jesper Leth , Heijl Anders , Krogh Erik
Published: December 2004

Purpose:  To present and test a new interpretative concept, the nerve fibre layer symmetry test (NST), for computerized evaluation of retinal nerve fibre layer thickness (RNFLT) as measured by optical coherence tomography (OCT) in glaucoma.

Methods:  The NST concept was constructed and tested in a pilot study. A total of 32 healthy and 40 age‐matched glaucomatous eyes were included and examined by OCT, computerized perimetry, RNFL/disc photography, tonometry and a general ophthalmologic examination.

Results:  The observed NST sensitivity and specificity were high, at 38/40 eyes (95%) and 32/32 eyes (100%), respectively, and 40/40 eyes (100%), and 31/32 eyes (97%), respectively, when correcting the OCT RNFLT measurement for the influence of variability in image signal/quality. The NST sensitivity was 8–10% higher than the single most sensitive traditional OCT RNFLT parameter; this difference was not statistically significant in this small sample.

Conclusion:  The NST showed high specificity and sensitivity for detection of RNFLT attenuation indicating early to severe glaucoma. Although promising, the NST needs to be further developed and validated in larger study samples and in patients with various stages of glaucomatous damage.
A codon 31ser–arg polymorphism of the WAF‐1/CIP‐1/p21/tumour suppressor gene in Chinese primary open‐angle glaucoma
Authors: Tsai Fuu‐Jen , Lin Hui‐Ju , Chen Wen‐Chi , Tsai Chang‐Hai , Tsai Shih‐Wei
Published: December 2004

Purpose:  Glaucomatous neuropathy is a type of cell death by apoptosis. Apoptosis is a genetically controlled form of cell death, and one of its primary regulatory steps is the activation of the tumour suppressor protein p53, of which p21 is an effector protein. The association between p21 codon 31 polymorphism and primary open‐angle glaucoma (POAG) patients was evaluated in this study.

Methods:  The study included 58 POAG patients and a control group of 59 healthy volunteers. Polymerase chain reaction‐based analysis was used to resolve the p21 codon 31 polymorphism.

Results:  The genotype frequencies of p21 codon 31 polymorphism were statistically different (p < 0.05) between the two groups. The Arg allele of the p21 codon 31 polymorphism was more frequently found in POAG patients than in healthy individuals (odds ratio: 2.389, 95% confidence interval: 1.14–5.01).

Conclusion:  This study suggests that an association exists between the Arg allele of the p21 codon 31 polymorphism and POAG in the Chinese population.
Professional competence for private practitioners in occupational therapy
Authors: Courtney Michelle , Farnworth Louise
Published: December 2004

The aim of the present study was to investigate the meaning of professional competence for occupational therapy private practitioners and their experience of the barriers to professional competence. Semi‐structured interviews with 16 key informants from private practice in Victoria elicited diverse opinions and experiences. However, the difficulty of assessing competence, and the lack of standards that identify competent practice for occupational therapy were major themes in the findings. The role of theory in competent practice was evident in discussion but it was not clearly articulated by many participants. Experiences of professional socialisation varied yet participants perceived input from peers as contributing to assuring competence. Major barriers to professional competence were identified as professional isolation, time and finances. The present study highlights the complexity of current attempts to assess professional competence for practising occupational therapists including the implementation of an accreditation program by The Australian Association of Occupational Therapists Inc. (OT AUSTRALIA), the peak body representing occupational therapists.
Utilisation of strategic analysis and planning by occupational therapy services
Authors: Boshoff Kobie
Published: December 2004

Many occupational therapists in practice can testify to the continually changing environments that impact on the delivery of effective services in the modern human service delivery system. It is within this context that occupational therapists are urged to regularly undertake strategic planning to keep track of and deal with these ongoing changes. In the present article, strategic analysis and planning will be discussed as a tool for occupational therapists in practice. The first step in strategic planning is an analysis of the external and internal environments of a particular service. The current article will provide an example of an environmental analysis as first step. This is followed by a discussion of the second step: the consideration of appropriate strategies and models of service delivery. The aim of the present article is to emphasise the importance of critical reflection by practitioners in order to adapt to the environmental changes influencing occupational therapy service delivery.
Role perceptions and clinical reasoning of community health occupational therapists undertaking home visits
Authors: Mitchell Robyn , Unsworth Carolyn A.
Published: December 2004

This paper presents the findings of a survey that aimed to: (i) describe the work of metropolitan Community Health Occupational Therapists (CHOTs) in Victoria; and (ii) to obtain basic information regarding the clinical reasoning CHOTs use during home visit assessments. Based on a literature review and clinical experience, a questionnaire was designed to elicit information about CHOT role perceptions and clinical reasoning. Questionnaires were mailed to all 50 CHOTs in metropolitan Melbourne. Thirty‐six responses were received (a response rate of 72%). Exploratory data analysis procedures were used to summarize the demographic data and closed questions. A series of open‐ended questions and four case scenarios were analysed qualitatively. The findings indicated that the majority of community health occupational therapists were mature in age, widely experienced, and client centred in their diverse practice roles. Generally, they were highly confident of their skills in client‐related tasks and enjoyed the main components of their roles, particularly home visiting. Participant responses to the four case scenarios indicated that they used procedural, interactive and conditional reasoning to identify the most important factors to consider, the action they would take, and whether they would see the client again. In conclusion, while the findings of this survey provide an overview of CHOT work in Victoria, further studies are urgently required to explore the clinical reasoning that supports this aspect of occupational therapy practice.
Professional accreditation of occupational therapy educational programs: A bright or embattled future?
Authors: Cusick Anne , Adamson Lynne
Published: December 2004

As Australia introduces a new system of individual accreditation through the program for individual accreditation of occupational therapists, there is a need to also consider the place and scope of specialised educational program accreditation in the maintenance of professional standards. The present article reviews issues relating to educational program accreditation including: the need for accreditation and its tradition in occupational therapy; types of accreditation and stakeholders involved; accreditation processes; and evidence of effectiveness. It suggests that professional association demands of programs and the accreditation processes used for audit and inspection must be relevant and reasonable in order to be considered credible and necessary by all stakeholders. Standards and professional accreditation processes that do not demonstrate that they are relevant and reasonable will face an embattled future. Those that do provide mechanisms for true quality improvement through relevant, well‐conceived processes should have a bright future in a world seeking benchmarks for quality in professional preparation programs.
Powered wheelchair mobility: An occupational performance evaluation perspective
Authors: Hardy Peta
Published: December 2004

Developments in powered wheelchair technology have opened up a world of opportunities for people with disabilities that affect their mobility. The challenge for occupational therapists is to examine the functional utility of powered mobility relative to individual occupational performance needs. In the absence of a comprehensive evaluation strategy, the present paper examines current practice and proposes the use of the Occupational Performance Model (Australia) as an effective framework for examining powered wheelchair mobility as an enabler of human performance. Discussion of the critical elements affecting mobility performance includes the impact of the environment, life roles, space and time, as well as individual component level performance skills.
Development of the student placement evaluation form: A tool for assessing student fieldwork performance
Authors: Allison Heather , Turpin Merrill J.
Published: December 2004

Evaluation of students undertaking fieldwork education placements is a critical process in the health professions. As training programs and practice evolve, systems for assessing students need to be reviewed and updated constantly. In 1995, staff of the occupational therapy training program at the University of Queensland, Australia decided to develop a new tool for assessing student fieldwork performance. Using an action research methodology, a team developed the Student Placement Evaluation Form, a flexible and comprehensive criterion‐referenced evaluation tool. The present paper examines action research as an appropriate methodology for considering real‐life organisational problems in a systematic and participatory manner. The action research cycles undertaken, including preliminary information gathering, tool development, trial stages and current use of the tool, are detailed in the report. Current and future development of the tool is also described.
A self‐directed fieldwork program to provide alternative occupational health placements for undergraduate occupational therapy students
Authors: James Carole , Prigg Alison
Published: December 2004

Second‐year students of undergraduate occupational therapy at the University of Newcastle, NSW, undertake a fieldwork placement in occupational health. However, sufficient placements are not always available. A new fieldwork program attempts to meet this need. Three groups of students conducted risk assessments throughout the academic year, with generally positive results. Students enjoyed the self‐directed nature of the placement and the opportunity to learn generic and occupational health related skills. Although there were some limitations to the program, we believe that fieldwork placements met the learning needs of second‐year students and offered them an excellent opportunity to gain practical experience related to occupational health practice in prevention.
Meanings of creativity within occupational therapy practice
Authors: Schmid Therese
Published: December 2004

Since the early days of the occupational therapy profession, creativity has been intrinsic to the beliefs and practice of occupational therapists. However, notions of creativity have been rarely explicated in occupational therapy research. The aim of this exploratory research was to study the phenomenon of creativity through the subjective perceptions of three occupational therapy clinicians. This qualitative research used a methodology in the spirit of phenomenology and took a descriptive, critical approach. Five themes of meaning were derived from the data: creativity is part of everyday practice; the use of creativity as a conscious approach; creativity involves risk‐taking; creativity needs a supportive environment; and creativity is the use of expressive arts in therapy. This study illustrated that creativity, as a phenomenon, has a multifaceted structure and appears to manifest in practice in a much richer way than is being revealed by occupational therapy literature.
Occupational narratives and the therapeutic process
Authors: Goldstein Karen , Kielhofner Gary , Paul‐Ward Amy
Published: December 2004

Clients’ occupational narratives reveal the overall meaning of life events, signifying their place in a plot that integrates past, present and future. Occupational narratives have also been demonstrated to predict how clients respond to therapy. A closer examination of the details of occupational narratives and how they unfold in the therapeutic context has the potential to give new insights into the experience of therapy by clients. This paper presents narratives of two clients in a vocational program for persons living with AIDS. Comparing their occupational narratives enables us to shed light on the differences between narratives that account for different client outcomes and the extent to which narratives can be impacted upon through occupational therapy intervention.
A description of how three occupational therapists train children in using the scanning access technique
Authors: Jones Jennifer , Stewart Hugh
Published: December 2004

Scanning is a technique that enables children with severe physical disabilities to access an augmentative and alternative communication device or other assistive technology. The purpose of this study was to identify and describe the methods and rationale used by occupational therapists experienced in training scanning when teaching a child to scan. The research was conducted in two phases: (i) a survey phase in which a questionnaire was distributed; and (ii) a consultation phase involving semistructured interviews. Results of the survey revealed that although the population of scanning users is relatively small, scanning remains an important access technique. Thematic analysis of the interviews yielded four themes: (i) ‘The process of training scanning is progressive and parallel’; (ii) ‘Clients must be considered on an individual basis’; (iii) ‘Training scanning is inextricably linked to functional goals’; and (iv) ‘The importance of training the child and primary carers using a collaborative approach’. A unique insight into the major phases of training scanning has been provided. However, it appears that therapists are not advancing clients beyond linear and row–column techniques or increasing the number of switches for increased speed of output. Recommendations for the provision of basic training are given. Occupational therapists would benefit from further investigation of the issues surrounding scanning for ensuring successful client outcomes.
Venous thromboembolism prophylaxis for surgical patients in an Asian hospital
Authors: Tan Li Hoon , Tan Shwu Chuin
Published: December 2004

Background:  Venous thromboembolism (VTE) is increasingly recognized as a significant postoperative complication in Asian hospitals. Recommendations have been published for VTE prophylaxis. We conducted a prospective survey of the risk profile and measures used for VTE prophylaxis in elective surgical patients in our hospital.

Methods:  All patients who underwent elective general or orthopaedic surgery over a 4‐week period were included. Information collected included demographic data, presence of risk factors, type and duration of surgery, perioperative use of VTE prophylaxis and any diagnosis of deep vein thrombosis or pulmonary embolism during the current admission as well as in any readmissions in the 6 weeks after discharge. The patients were classified based on their age, risk factors and type of surgery into low, moderate, high or highest risk and the prophylactic measures they received compared with published recommendations.

Results:  Two hundred and twenty‐six patients underwent 227 elective surgeries over the 4‐week period. There were 7 low, 16 moderate, 45 high and 55 highest risk patients. One hundred and three patients could not be classified. Postoperative prophylactic measures were omitted in 93.8%, 81.8% and 31.5% of patients in moderate, high and highest risk groups, respectively. One patient developed clinical deep vein thrombosis preoperatively and one postoperatively. There were no cases of pulmonary embolism.

Conclusions:  VTE prophylaxis is underutilized in our survey. Further studies are required to identify the reasons for omission and to develop hospital specific protocols to increase appropriate use of prophylaxis.
Developing Australia's first statewide trauma registry: what are the lessons?
Authors: Cameron Peter A. , Finch Caroline F. , Gabbe Belinda J. , Collins Lisa J. , Smith Karen L. , McNeil John J.
Published: December 2004

Trauma registries, like disease registries, provide an important analysis tool to assess the management of patient care. Trauma registries are well established and relatively common in the USA and have been used to change legislation, promote trauma prevention and to evaluate trauma system effectiveness. In Australia, the first truly statewide trauma registry was established in Victoria in 2001 with an estimated capture of 1700 major trauma cases annually. The Victorian State Trauma Registry, managed by the Victorian State Trauma Outcomes Registry and Monitoring (VSTORM) group, was established in response to a ministerial review of trauma and emergency services undertaken in 1997 to advise the Victorian Government on a best practice model of trauma service provision that was responsive to the particular needs of critically ill trauma patients. This taskforce recommended the establishment of a new system of care for major trauma patients in Victoria and a statewide trauma registry to monitor this new system. The development of the Victorian state trauma registry has shown that there are certain issues that must be resolved for successful implementation of any system‐wide registry. This paper describes the issues faced by VSTORM in developing, implementing and maintaining a statewide trauma registry.
Horner's syndrome in association with thyroid and parathyroid disease
Authors: Harding Jane L. , Sywak Mark S. , Sidhu Stan , Delbridge Leigh W.
Published: December 2004

Background:  Injury to the cervical sympathetic chain and its consequence, Horner's syndrome, as a result of thyroid pathology or surgical intervention is an uncommon complication. The purpose of the present study was to examine the experience of one endocrine surgical unit with pre and postoperative Horner's syndrome.

Methods:  This is a retrospective case series. The study group comprised all patients undergoing thyroid and parathyroid surgery at Royal North Shore Hospital from January 2000 to October 2003 who were identified as having either pre or postoperative Horner's syndrome. Patient demographics, operation performed, underlying pathology and outcomes were evaluated.

Results:  There were nine cases of Horner's syndrome recorded from a total of 2208 thyroid and parathyroid operations undertaken: three with preoperative Horner’s, an incidence of 0.14%, six with postoperative Horner’s, an incidence of 0.27%. Patients ranged in age from 22 to 87 years. Two of the three preoperative cases were related to benign pathology, the remaining case having anaplastic carcinoma. Five of the six postoperative cases were related to thyroid malignancy with lymph node dissection; one case was associated with benign parathyroid pathology.

Conclusions:  Cervical sympathetic chain injury is a rare complication of surgery for thyroid and parathyroid conditions. The presence of preoperative Horner's does not necessarily indicate an underlying malignancy.
Antireflux anastomosis following oesophagectomy
Authors: Aly A. , Jamieson G. G. , Pyragius M. , Devitt P. G.
Published: December 2004

Background:  Reflux of duodeno‐gastric fluid is a significant problem after oesophagectomy with gastric conduit reconstruction. It can impact considerably upon the patient's quality of life and can induce oesophagitis and Barrett's metaplasia in the remnant oesophagus.

Aim:  The aim of the present study was to describe the use of a modified fundoplication in controlling reflux after oesophagectomy.

Methods:  Patients undergoing subtotal oesophagectomy at the Royal Adelaide Hospital were identified. Clinical and operative details were obtained from hospital records. All patients had an end oesophagus to side stomach anastomosis. Two cohorts were identified – one with a standard anastomosis only and the other in whom a modified fundoplication had been added. A structured phone interview was used to assess reflux in the two groups with a minimum of 6 months follow up. The interviewer was blinded to the operative details.

Results:  The operative technique is described. A total of 44 patients were assessed, 33 having the fundoplication type anastomosis and 11 the standard anastomosis. Operative morbidity was not different between the groups. Symptoms of reflux were better controlled in patients with the fundoplication anastomosis than in patients with a standard anastomosis. Of those with a fundoplication, 14 of 33 patients (42%) were asymptomatic with respect to reflux compared to only one of 11 patients (9%) in the standard anastomosis group. Only four of the 33 patients (12%) with a fundoplication anastomosis had symptoms of severe reflux while seven of the 11 patients (63%) with a standard anastomosis had severe reflux symptoms.

Conclusions:  This initial evaluation of a modified fundoplication as an antireflux manoeuvre after oesophagectomy suggests that the technique is effective in controlling post‐oesophagectomy reflux in the majority of patients. It is simple to perform and may have benefits in improving quality of life and preventing oesophagitis and metaplastic changes in the remnant oesophagus. A more detailed prospective study of the technique is warranted.
Dorsal lumbotomy incision in paediatric pyeloplasty
Authors: Bajpai Minu , Kumar Arbinder , Tripathi Madhavi , Bal Chandrashekhar S.
Published: December 2004

Background:  The purpose of the present study was to comprehensively assess the results of surgical management of pelvi‐ureteric junction (PUJ) obstruction using lumbotomy as the surgical approach.

Methods:  Records of 36 consecutive patients with unilateral PUJ obstruction who underwent pyeloplasty in the last 5 years were reviewed retrospectively. The investigations included renal function tests, ultrasound and serial renal diuretic scans. A micturating cystourethrogram was also done whenever indicated. A dismembered pyeloplasty via lumbotomy was the only surgical approach considered. Thirteen patients had a right pyeloplasty while 23 had a left pyeloplasty. Mean age at diagnosis was 57 months in 31 patients while five were antenatally diagnosed (range 1 month−12 years). Age at surgery ranged from 1 month to 12 years with a mean of 59.9 months. Nine children underwent surgery in infancy. Six patients had a preoperative percutaneous nephrostomy (PCN) placement, five for poorly functioning kidneys (less than 10% split renal function) and one for oliguria. Records were reviewed for age at diagnosis, age at surgery, duration of surgery, preoperative and postoperative split renal function.

Results:  The follow‐up period in the present study ranged from 9 months to 68 months with a mean of 44.9 months. Mean duration of surgery was 78 min of the group as a whole but in PCN patients it was significantly more (100 min vs 71.3 min). Fourteen patients had an improvement in split renal function noticed at 3 and 6 months postoperatively, 17 patients had no change while one patient had a deterioration of split renal function. Four patients had a solitary functioning kidney and in all of these glomerular filtration rate improved postoperatively. Hospital stay was on the average 7.45 days with a range of 6−10 days. However, when a double‐J (D‐J) stent was used across the anastomosis and the uretero‐vesical junction (transrenal D‐J stenting), the mean stay was reduced to 3 days. All patients returned to full oral feeds by postoperative day 1. No incidences of wound related problems were encountered.

Conclusions:  Pyeloplasty results in predictably good outcome in paediatric PUJ obstruction whenever indicated. The lumbotomy approach avoids muscle cutting, thereby minimizing complications related to wound and assisting with faster recovery. Keeping a double‐J (D‐J) stent across the anastomosis and the uretero‐vesical junction (transrenal D‐J stenting) reduces hospital stay.
Novel in‐line multielectrode radiofrequency ablation considerably reduces blood loss during liver resection in an animal model
Authors: Gananadha Sivakumar , Morris David L.
Published: December 2004

Introduction:  Liver resection is widely used in the treatment of primary and secondary liver tumours. One of several important factors associated with mortality both in cirrhotic and non‐cirrhotic patients after liver resection is operative blood loss. We evaluated the use of a prototype radiofrequency ablation probe to treat the transection plane prior to liver resection in the sheep model.

Methods:  In‐line radiofrequency ablation (RFA) was performed on the liver using a prototype device consisting of 11 electrodes mounted on a 8‐cm base. The RITA 1500 generator was used for power delivery. Ultrasonic aspirator (UA) and clamp resection were performed on the liver of sheep with and without in‐line RFA. The blood loss was measured by weighing swabs.

Results:  A total of 26 liver resections were performed. The mean (SD) blood loss with UA resection was 0.032 g (0.011) versus 0.005 (0.005) g without and with prior in‐line RFA, respectively (P = 0.001). The mean (SD) blood loss with clamp resection was 0.087 (0.10) g versus 0.01 (0.008) without and with in‐line RFA, respectively (P = 0.155).

Conclusion:  In‐line RFA makes liver resection easier with minimal blood loss and may make cirrhotic liver resection easier with minimal blood loss. This is likely to improve the operative safety of liver resection.
Case of duodenal haematoma treated with ultrasound guided drainage
Authors: Lloyd Geraint M. , Sutton Christopher D. , Marshall Leslie J. , Jameson John S.
Published: December 2004

Duodenal haematoma usually occurs secondary to blunt abdominal trauma1, although more recently it has been recognized as a complication of endoscopic duodenal biopsy2. The two established management strategies are to treat conservatively until resolution of the haematoma occurs or to surgically evacuate the haematoma. We present a case of duodenal haematoma that was successfully treated by ultrasound guided drainage when no improvement occurred with conservative treatment.
Surgical management of thoracic outlet syndrome: a 10‐year experience
Authors: Samarasam Inian , Sadhu David , Agarwal Sunil , Nayak Sukria
Published: December 2004

Background:  Thoracic Outlet Syndrome (TOS) refers to compression of the neurovascular structures in the region between the scalene muscles and the first rib, or by anatomical abnormalities such as cervical rib, fibrous bands and other variations in the scalene musculature.

Methods:  Our experience with 63 consecutive operations for TOS, over a period of 10 years, has been reviewed. Preoperative symptoms and signs, investigations, surgery done, complications and the outcome of surgery are analysed.

Results:  A total of 60 patients underwent 63 operations for decompression of TOS. All the 63 first ribs, were excised by the transaxillary approach. In seven patients (16%), a combined transaxillary and supraclavicular approach was used. There was no operative mortality in this series. The operative complications included pneumothorax in four patients (6.3%), which was treated by insertion of chest drain, and lower brachial plexus neuropraxia in two patients (3%), which improved with conservative management. The mean duration of postoperative hospital stay was 3.6 days. At 12 months following surgery, 56 patients (93%) had complete or partial relief of symptoms and only four patients (6.6%) had no relief of symptoms.

Conclusion:  The results of the present study confirm that transaxillary excision of the first rib is a surgical procedure associated with very low morbidity and excellent relief of symptoms. It can therefore be offered as an early option for patients with thoracic outlet syndrome. It may be combined with the supraclavicular approach if exposure of the subclavian artery is required for vascular reconstruction.
Patient preference for bra or binder after breast surgery
Authors: Laura Sharon , Clark David , Harvey Fiona
Published: December 2004

Background:  No data are currently available to assess the relative merits of breast binder or bra following breast surgery.

Methods:  A randomized controlled study was undertaken to compare a breast binder with a bra postoperatively for patients undergoing lumpectomies, partial mastectomies and total mastectomies.

Results:  Fifty‐eight patients were included in the study. Six different parameters were compared and the bra was found better on all criteria; a small group of patients who initially used a binder and then, for a second procedure, used a bra, found the bra more comfortable.

Conclusion:  Postoperative discomfort can be decreased by using a well‐fitting bra rather than a breast binder.
Methicillin‐resistant Staphylococcus aureus and beyond: what's new in the world of the ‘golden staph’?
Authors: Marshall Caroline , Kossmann Thomas , Wesselingh Steve , Spelman Denis
Published: December 2004

Methicillin‐resistant Staphylococcus aureus (MRSA) continues to plague our hospitals. With the appearance of isolates that are resistant to vancomycin, now, more than ever, we must direct our efforts to controlling its development and spread. New antimicrobials have become available for treatment, but may only be a short‐term answer. Our efforts towards control must be directed towards infection control measures such as improved hand hygiene with user‐friendly products, such as alcohol‐based hand disinfectants. Intranasal mupirocin may have a place in prevention of surgical site infection, although this role has not yet been clearly defined. Other areas where MRSA control may be effected include prudent controlled use of antibiotics, including surgical prophylaxis.