bluuebunny/crossref_metadata_2025 huggingface dataset:
Media use as a reason for meal skipping and fast eating in secondary school children
Authors: Van den Bulck J. , Eggermont S.
Published: March 2006

Objective  This study examined self‐reported meal skipping and eating faster than usual with the goal of watching television or playing computer games.

Method  Respondents reported their media use and indicated how often they skipped a meal to watch a favourite television programme or to play a computer game, and how often they ate faster than usual in order to watch television or play a computer game.

Subjects  Respondents were 2546 adolescents of 13 (first year of secondary school) and 16 years (fourth year of secondary school) of age.

Results  About one respondent in 10 skipped at least one meal every week for either television viewing or computer game playing. Weekly meal skipping for television viewing occurs more regularly in boys and first‐year students, but particularly in teenagers who view 5 h or more daily (15% of the sample). The category of teenagers who play computer games four times a week or more (25.3% of the sample) is at increased risk of meal skipping; those who play more than four times a week are 10 times more likely weekly to skip a meal. A quarter of the adolescents eat faster at least once a week to be able to watch television or play a computer game. Regardless of gender and school year, teenagers’ risk of eating faster progressively increases with their use of the media. Those who watch 4 h or more daily are about seven times more likely to skip a meal for television and those who play computer games at least four times a week are nine times more likely weekly to skip a meal.

Conclusions  Unhealthy eating habits can be a side effect of heavy or excessive media use. Teenagers’ use of television or game computers during nonworking or out‐of‐school hours partly displaces the amount of time that needs to be spent at meals. Practitioners and educators may try to encourage or restore a pattern of healthful meal consumption habits by reducing the amount of media use, and by supporting parental rule‐making regarding children's eating habits and media use.
The importance of maltose in transitory starch breakdown
Authors: LU YAN , SHARKEY THOMAS D.
Published: March 2006

Starch content of leaves responds to environmental stresses in various ways. Understanding these environmental effects on starch metabolism has been difficult in the past because the pathways of transitory starch synthesis and degradation are not completely known. Over the past two years there has been a significant increase in our understanding of transitory starch breakdown. The discovery of a maltose transporter (MEX1) and the studies of a cytosolic disproportionating enzyme (D‐enzyme, DPE2) confirmed that maltose is the predominant form of carbon exported from chloroplasts at night. Maltose increases in leaves when starch breakdown is induced during the day under photorespiratory conditions. Maltose metabolism is regulated by a circadian clock, day length and temperature. The expression of maltose‐metabolizing genes shows a pronounced circadian rhythm indicating maltose metabolism is clock regulated. Indeed, the maltose level oscillates under continuous light. The transcript of a β‐amylase gene (BAM3) peaks during the day in long days and peaks at night in short days. This could provide a mechanism for adjusting starch breakdown rates to day length. Under cold‐stress conditions, maltose increases and BAM3 expression is induced. We hypothesize that maltose metabolism is a bridge between transitory starch breakdown and the plants’ adaptation to changes in environmental conditions.
Carotenoid accumulation and function in seeds and non‐green tissues
Authors: HOWITT CRISPIN A. , POGSON BARRY J.
Published: March 2006

Carotenoids are plant pigments that function as antioxidants, hormone precursors, colourants and essential components of the photosynthetic apparatus. Carotenoids accumulate in nearly all types of plastids, not just the chloroplast, and are thus found in most plant organs and tissues, albeit at trace levels in some tissues. In this review we summarise the current knowledge of the carotenoid content of non‐green plastids and discuss what is known about the regulation of their biosynthesis in roots, fruits, flowers, tubers and seeds. The emphasis is on food crops as carotenoids are essential components of human diets, primarily as some are precursors of vitamin A. The low carotenoid content of many staple foods, such as cereals, can exacerbate dietary deficiencies. The World Health Organisation has estimated that more than 100 million children are vitamin A‐deficient and up to 500,000 of these children become blind each year. Many of these children die within 12 months of going blind. Thus, understanding the regulation of carotenoid accumulation in food crops, especially tubers and cereals, should facilitate improvements to nutritional value with potentially significant health benefits.
Can improvement in photosynthesis increase crop yields?
Authors: LONG STEPHEN P. , ZHU XIN‐GUANG , NAIDU SHAWNA L. , ORT DONALD R.
Published: March 2006

The yield potential (Yp) of a grain crop is the seed mass per unit ground area obtained under optimum growing conditions without weeds, pests and diseases. It is determined by the product of the available light energy and by the genetically determined properties: efficiency of light capture (ɛi), the efficiency of conversion of the intercepted light into biomass (ɛc) and the proportion of biomass partitioned into grain (η). Plant breeding bringsηandɛiclose to their theoretical maxima, leavingɛc, primarily determined by photosynthesis, as the only remaining major prospect for improvingYp. Leaf photosynthetic rate, however, is poorly correlated with yield when different genotypes of a crop species are compared. This led to the viewpoint that improvement of leaf photosynthesis has little value for improvingYp. By contrast, the many recent experiments that compare the growth of a genotype in current and future projected elevated [CO2] environments show that increase in leaf photosynthesis is closely associated with similar increases in yield. Are there opportunities to achieve similar increases by genetic manipulation? Six potential routes of increasingɛcby improving photosynthetic efficiency were explored, ranging from altered canopy architecture to improved regeneration of the acceptor molecule for CO2. Collectively, these changes could improveɛcand, therefore,Ypbyc. 50%. Because some changes could be achieved by transgenic technology, the time of the development of commercial cultivars could be considerably less than by conventional breeding and potentially, within 10–15 years.
Microscopy and outpatient malaria case management among older children and adults in Kenya
Authors: Zurovac D. , Midia B. , Ochola S. A. , English M. , Snow R. W.
Published: March 2006

Objective  To evaluate the accuracy of routine malaria microscopy, and appropriate use and interpretation of malaria slides under operational conditions in Kenya.

Methods  Cross‐sectional survey, using a range of quality of care assessment tools, at government facilities with malaria microscopy in two Kenyan districts of different intensity of malaria transmission. All patients older than 5 years presenting to outpatient departments were enrolled. Two expert microscopists assessed the accuracy of the routine malaria slide results.

Results  We analysed 359 consultations performed by 31 clinicians at 17 facilities. Clinical assessment was suboptimal. Blood slide microscopy was performed for 72.7% of patients, who represented 78.5% of febrile patients and 51.3% of afebrile patients. About 95.5% of patients with a positive malaria microscopy result and 79.3% of patients with a negative result received antimalarial treatment. Sulphadoxine–pyremethamine monotherapy was more commonly prescribed for patients with a negative test result (60.7%) than for patients with a positive result (32.4%). Conversely, amodiaquine or quinine were prescribed for only 14.7% of patients with a negative malaria microscopy result compared to 57.7% of patients with a positive result. The prevalence of confirmed malaria was low in both high (10.0%) and low‐(16.3%) transmission settings. Combining data from both settings, the sensitivity of routine microscopy was 68.6%; its specificity, 61.5%; its positive predictive value, 21.6% and its negative predictive value, 92.7%.

Conclusions  The potential benefits of microscopy are currently not realised because of the poor quality of routine testing and irrational clinical practices. Ambiguous clinical guidelines permitting treatment of older children and adults with a negative blood slide also undermine rational use of antimalarial drugs.
Unseen Kala‐azar deaths in south Sudan (1999–2002)
Authors: Collin Simon M. , Coleman Paul G. , Ritmeijer Koert , Davidson Robert N.
Published: March 2006

Objective  To estimate the number of deaths due to primary or relapse kala‐azar (KA), which occurred unseen within the catchment area of Médecins Sans Frontières (MSF) clinics in southern Sudan.

Method  Review of clinical records of consecutive KA patients presenting between October 1998 and May 2002 in treatment centres at Wudier (Eastern Upper Nile), Lankien (Bieh State), Magang (Sobat Province) and Nimne and Thonyor (Western Upper Nile). To estimate the proportion of patients who either presented for treatment or died undetected, we compared the time‐to‐presentation of KA patients against the rate at which KA patients died before treatment becomes effective.

Results  We estimated that the 2891 KA patients who presented at MSF clinics in south Sudan during the period October 1998 to May 2002 represented 55% (2891/5300; 95% CI 29%–77%) of the total number of cases of KA in that area and that 91% (2409/2649; 95% CI 78%–97%) of deaths from KA were undetected.

Conclusion  The huge proportion of undetected KA mortality is deeply troubling and unlikely to improve under prevailing political conditions.
Facial Bones of Long‐Legged Buzzard (Buteo rufinus)
Authors: Orhan İ. Ö. , Kabak M.
Published: March 2006

The department of National Parks and Protection of Wild Nature sent five (two males, three females) adult long‐legged buzzards for investigation of their deaths to Ankara University Veterinary Faculty. Facial bones of buzzards were evaluated. Distinguishing facial features such as strong os premaxillare, cavum nasale filled with spider webbing‐like structures, prominent os prefrontalis and processes, H‐shaped paraglossum were determined. In this study, we investigated the anatomic properties of facial bones in long‐legged buzzard. We also aimed to identify the data using these bones in order to separate different bird species.
Genetic analysis of Ankamali pigs of India using microsatellite markers and their comparison with other domesticated Indian pig types
Authors: Behl R. , Sheoran N. , Behl J. , Vijh R.K.
Published: March 2006

Ankamali pigs, the domesticated native pigs of Kerala province of India were genetically characterized using 23 FAO recommended microsatellite markers and were compared with other native Indian pig types and Large White pigs. Twenty‐six blood samples were collected from genetically unrelated animals from their breeding tract and DNA was isolated by standard procedure of phenol/chloroform. The genomic DNA was amplified by polymerase chain reaction (PCR) at these 23 microsatellite loci, which were also used earlier to characterize Desi (North Indian) and Gahuri (North‐East Indian) pigs, the other two native domesticated pig types of India. The PCR products were resolved by denaturing urea‐polyacrylamide gel electrophoresis and alleles were visualized after silver nitrate staining. The data were analysed for allele size range, number of alleles, allelic frequencies, heterozygosity and polymorphism information content for each locus. The allele size range varied between 92–108 bp at locus S0026 and 280–296 bp at locus IGF‐1. The total number of alleles varied between five (S0178 and S0386) and 11 (S0355). The mean observed and expected heterozygosities were found to be 0.74 ± 0.09 and 0.83 ± 0.03 respectively. In the neighbour‐joining dendrogram based on DA genetic distances developed after 1000 bootstraps, the Ankamali pigs did not show genetic closeness either with other native Indian pig types or exotic Large White pigs with high bootstrap values indicating genetic distinctness of Ankamali pigs.
In vivo prediction of internal fat weight in Scottish Blackface lambs, using computer tomography
Authors: Lambe N.R. , Conington J. , McLean K.A. , Navajas E.A. , Fisher A.V. , Bünger L. ,   Sustainable Livestock Systems Group, SAC
Published: March 2006

From a calibration trial involving computer tomography (CT) scanning and dissection of 45 lambs, a prediction equation was derived to estimate total internal fat weight in Scottish Blackface lambs from measurements taken on cross‐sectional CT images. Using data from two cross‐sectional images (at the hip and loin) internal fat can be predicted with relatively high accuracy (adjusted R2 = 62.2%, r = 0.79). The derived equation was then used to predict internal fat weights in a further 427 Scottish Blackface lambs from a separate trial. Phenotypic correlations were calculated between predicted internal fat weight and weights of total carcass fat, muscle and bone, predicted using previously derived equations. When considering absolute tissue weights, adjusted for fixed effects, internal fat showed the strongest positive correlation with carcass fat (0.58), followed by muscle (0.36), and then by bone (0.32). When tissue weights were adjusted for fixed effects and total carcass weight (so considering tissue weights relative to size), internal fat showed a lower correlation with carcass fat weight (0.36) and negative correlations with muscle (−0.35) and bone (−0.19). These results provide the basis for more complex studies of relationships (phenotypic and genetic) between internal fat in hill lambs and economically important traits, such as carcass composition and survival of lambs, and tissue levels in different depots in hill ewes.
Cytogenetic mapping of 11 functional genes to chicken chromosomes by fluorescence in situ hybridization
Authors: Yuan J. , Zhao Y. , Zhang L. , Li N.
Published: March 2006

With chicken bacterial artificial chromosome (BAC) DNA as probes, 11 non‐assigned functional genes were localized to chicken chromosomes 1 or 2 by fluorescence in situ hybridization (FISH). The 11 genes and their chromosomal positions are as follows: ALVEB5, 1p26‐24; ACO2, 1p16‐14; HSP108, 1p14‐13; CD4, 1q11; HSD3B; 1q11; SOD1, 1q14‐21; LAMP1, 1q24‐31; P2Y5, 1q35‐36; EN2, 2p31‐24; NPY, 2p14‐13 and CA2, 2q31‐32. Metaphase chromosome spreads used for hybridization were prepared from embryonic chicken fibroblast cultures. The gene position was identified according to the international standardized G‐banded karyotype of chicken by measuring the relative fractional length from the telomere of the p‐arm to the hybridization signal (FLpter). The 11 genes mapped newly will enrich the cytogenetic map and serve as additional anchor markers for integrating the cytogenetic map with the genetic map of chicken.
Effect of subsidy regimes on economic values of functional traits in beef cattle breeding
Authors: Wolfová M. , Přibyl J. , Wolf J. , Zahrádková R.
Published: March 2006

We investigated the impact of five monetary subsidy regimes on economic values of traits in a cow–calf pasture production system with surplus calves fed for slaughter. The following regimes were analysed: (1) maximum prices for slaughter animals actually received in the Czech Republic during 2004, with no subsidies of any kind; (2) prices as in (1), with subsidies awarded per hectare of permanent grassland and per calf born; (3) prices as in (1), with subsidies awarded per hectare of agricultural land, per hectare of pasture and meadow, per beef cow in a forage system and per livestock unit; (4) prices as in (1), with subsidies awarded per hectare of agricultural land; (5) no subsidies, but prices received for slaughter animals that covered production costs and resulted in 1% profitability. The modelled farm showed negative profit under real price conditions with no subsidies (regime 1), which led to an underestimation of economic values for functional traits. The same results were obtained in regimes in which subsidies did not depend on the number of animals (3) or on meat production from the enterprise (4). Economic values of production traits (growth and carcass traits) did not vary among subsidy regimes. To determine optimum economic values for functional traits in beef cattle, we advocate using the method applied in subsidy regime 5, no subsidies but prices for slaughter animals that cover production cost and a small profit.
Liver X receptor alpha and beta genes have the potential role on loin lean and fat content in pigs
Authors: Yu M. , Geiger B. , Deeb N. , Rothschild M.F.
Published: March 2006

Liver X receptor alpha (LXRA) and beta (LXRB) are members of the nuclear receptor subfamily and are important regulators of genes involved in lipid, fatty acid and glucose metabolism in liver, and adipose tissue as well as in skeletal muscle. To investigate whether the two LXR genes play a role in influencing lean and fat growth in pigs, we discovered and examined two polymorphisms in LXRA (LXRA Bsl in exon 2, and LXRA HpyCH4 III in intron 8) and one polymorphism in LXRB (LXRB Aci I in exon 5) for genetic linkage and association analyses. Linkage analyses using a three‐generation resource family of a cross between the Berkshire and Yorkshire (BY) pig breeds assigned LXRA to SSC2 and LXRB to SSC6. Association analyses were carried out among those polymorphisms and traits evaluated in the BY F2 family and four pig commercial populations. These analyses indicated that the LXRA HpyCH4 III polymorphism was significantly associated with loin eye area and total lipid in individuals from the BY family. Significant associations were also found between Bsl I polymorphism in LXRA and boneless loin (%), as well as marbling score in one commercial line. The LXRB Aci I polymorphism was significantly associated with lean meat and fat content in the BY family and a number of the commercial lines examined. Our current findings suggested that LXRA and LXRB might have potential effects, especially for loin lean and fat content.
First Record of Fusarium Wilt of Tobacco in Greece Imported as Seedborne Inoculum
Authors: Tjamos S. E. , Markakis E. A. , Antoniou P. , Paplomatas E. J.
Published: March 2006

Leaf yellowing and brown discoloration was observed in tobacco plants cv. Burley TN97 in tobacco fields of central Greece in 2002. Fusarium oxysporum f. sp. nicotianae was isolated from symptomatic plants and Koch's postulates were fulfilled. The pathogenicity of the isolated fungus was examined on five tobacco cultivars (Burley TN97, BurleyB21, VirginiaBE9, Virginia Niki and Anatolika KE26/2). The pathogen was present in tobacco seed batches imported in 2000 and 2001, which indicates that the infected seed is most probably the primary source of the disease in Greece. As Fusarium oxysporum f. sp. vasinfectum can also cause vascular wilt in tobacco, the hypothesis that the isolated F. oxysporum strain belongs to f. sp. vasinfectum was excluded by a pathogenicity test to cotton cv. Acala SJ‐2. This is the first report of F. oxysporum f. sp. nicotianae in Greece and the second in the European Union, although the seedborne nature of the pathogen has not been previously reported in Europe.
Needlestick and sharps injuries among nurses in a tropical Australian hospital
Authors: Smith Derek R , Smyth Wendy , Leggat Peter A , Wang Rui‐Sheng
Published: March 2006

Although needlestick and sharps injuries (NSI) represent a major hazard in nursing practice, most studies rely on officially reported data and none have yet been undertaken in tropical environments. Therefore, we conducted a cross‐sectional NSI survey targeting all nurses within a tropical Australian hospital, regardless of whether they had experienced an NSI or not. Our overall response rate was 76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months. The most common causative device was a normal syringe needle, followed by insulin syringe needles, i.v. needles or kits and blood collection needles. Half of the nurses’ NSI events occurred beside the patient's bed: drawing up medication was the most common reason. Nurses working in the maternity/neonatal wards were only 0.3 times as likely to have experienced an NSI as their counterparts in the medical or surgical wards. Overall, our study has shown that NSI events represent an important workplace issue for tropical Australian nurses. Their actual rate might also be higher than official reports suggest.
Why are elderly individuals at risk of nutritional deficiency?
Authors: Brownie Sonya
Published: March 2006

The older population is the single largest demographic group at disproportionate risk of inadequate diet and malnutrition. Ageing is associated with a decline in a number of physiological functions that can impact nutritional status, including reduced lean body mass and a resultant decrease in basal metabolic rate, decreased gastric secretion of digestive juices and changes in the oral cavity, sensory function deficits, changes in fluid and electrolyte regulation and chronic illness. Medication, hospitalization and other social determinants also can contribute to nutritional inadequacy. The nutritional status of older people is an important determinant of quality of life, morbidity and mortality. This review critically examines the factors that contribute to the development of poor nutritional status in older people and considers the consequences of malnutrition.
Educational and health service needs of Australian general practitioners in managing hepatitis C
Authors: Gupta Leena , Shah Sangeeta , Ward Jeanette E
Published: March 2006

Background:  There has been interest in recent years in the role of primary care practitioners in managing hepatitis C, but there has been minimal research to identify educational and health service needs. A national survey of Australian general practitioners (GPs) was therefore conducted to assess their needs and identify areas for service development.

Methods:  A self‐administered questionnaire was developed that included questions to assess caseload, confidence in patient management, educational needs and approaches to management and prevention. Questionnaires were sent to a random sample of Australian GPs. Returned questionnaires were coded, frequencies tabulated and significant associations identified.

Results:  A 70% response rate was achieved from 658 eligible GPs. A total of 76% of respondents had managed one patient in the previous year with hepatitis C. While 69% reported feeling more confident about their management of hepatitis C than 5 years previously, 55% identified a high level of need for hospital‐based clinics. Financial benefits for case conferences and chronic case management were not considered useful by most GPs. Topics identified for further skills development included therapeutics and diagnostic testing. Only 39% were highly likely to discuss psychosocial issues as part of initial patient management and 37% reported finding it difficult to play a central role in the medical and psychosocial care of patients with hepatitis C.

Conclusion:  These results have significant implications for policy and service development, as well as identifying areas where GPs need support. The findings invite further discussion between health authorities about the source and magnitude of funding for hospital‐based services and further consideration of how to provide services to address patients’ psychosocial needs.
Influence of urease activity in the intestinal tract on the results of 13C‐urea breath test
Authors: Urita Yoshihisa , Hike Kazuo , Torii Naotaka , Kikuchi Yoshinori , Kanda Eiko , Kurakata Hidenori , Sasajima Masahiko , Miki Kazumasa
Published: March 2006

Background and Aim:  A late rise in 13CO2 excretion in the 13C‐urea breath test (UBT) should be found when the substrate passes rapidly through the stomach and makes contact with the colonic bacteria. The aim of this study was to evaluate the influence of intestinal urease activity on the results of the UBT.

Method:  A total of 143 subjects who were diagnosed as Helicobacter pylori negative by serology, histology and rapid urease test were recruited. At the end of endoscopy, the tip of the endoscope was placed to the second part of the duodenum and 20 mL of water containing 100 mg of 13C‐urea was sprayed into the duodenum. Breath samples were taken at baseline and at 5, 10, 20, 30 and 60 min after administration.

Results:  Of 143 subjects, breath Δ13CO2 values higher than 2.5‰ were detected in six (4.2%), four (2.8%) and five (3.5%) subjects at 20, 30 and 60 min, respectively. There was no subject with high Δ13CO2 values at 5 and 10 min. Only one subject had an immediate rise at 60 min.

Conclusion:  Variability derived from urease activity in the intestinal tract appears to be minimal up to 60 min after ingestion of the test urea.
Impact of infant health problems on postnatal depression: Pilot study to evaluate a health visiting system
Authors: UEDA MOTOKO , YAMASHITA HIROSHI , YOSHIDA KEIKO
Published: March 2006

Abstract  This pilot study aimed to elucidate whether or not mothers who receive neonatal home visits tend to suffer from depressive disorders during the first postpartum year and to examine what kinds of factors were related to the postnatal depression observed in these mothers. The subjects consisted of 70 Japanese mothers who received neonatal home visits and completed the 1‐year study. At their first visit, the health visitors asked about their personal backgrounds and early postpartum mood, and depression was assessed by a Japanese translation of the Edinburgh Postnatal Depression Scale (EPDS). At 12 months postpartum, a diagnostic interview using the Structured Clinical Interview for DSM‐IV (SCID) was performed to confirm the maternal diagnosis by a psychiatrist. An assessment of infant development using the Denver Developmental Screening Test (DDST) was administered to each infant by a psychologist. Nineteen mothers (27%) were categorized as having had a new onset of depression (12 major depressive disorders and seven depressive disorders not otherwise specified). In comparison to the non‐depressed mothers, infant‐related health problems that required either outpatient treatment or hospitalization were significantly related to postnatal depression. Pediatric diseases in infants did not always precede their mother's depression. The extra burden of caring for a sick infant tends to increase the risk of developing postpartum depression. As a result, neonatal home visits by health visitors may therefore be a potentially crucial opportunity to provide emotional support, particularly for mothers with the extra burden of having to care for sick infants.
REVIEW OF PATIENTS WITH PERITONEAL MALIGNANCY TREATED WITH PERITONECTOMY AND HEATED INTRAPERITONEAL CHEMOTHERAPY
Authors: Hadi Reema , Saunders Vanessa , Utkina Olga , Clingan Philip , Kam Peter , Links Matthew , Morris David L.
Published: March 2006

Background:  Peritoneal dissemination of malignancy is usually considered incurable. The purpose of the present study was to evaluate the efficacy of intraperitoneal chemohyperthermia and cytoreductive surgery.

Methods:  The present article is a retrospective review of prospectively recorded data in 60 patients who underwent 71 peritonectomy procedures between January 1996 and May 2004. Hospital records, a database and department notes were studied. Conditions treated were pseudomyxoma peritoneii (PMP) and appendiceal cancer (23), mesothelioma (7), colorectal cancer (CRC, 15), ovarian cancer (6) and other forms of malignancy (9). Following cytoreductive surgery, early postoperative intraperitoneal chemotherapy (EPIC) was given in 47 procedures, five with added i.v. mitomycin C. In 34 procedures, heated intraperitoneal chemotherapy (HIPEC) was administered. A policy change was made from intravenous to intraperitoneal mitomycin C chemotherapy in December 2001. Peritoneal cancer index (PCI) was calculated for all procedures.

Results:  Of the procedures, 23 had PCI ≤ 10, 37 had PCI of 11–20, and 11 had PCI > 20. The median operation time was 9 h. Blood units transfused and length of hospital stay have declined. Mortality was 4/60 patients (6.7%), caused by pancytopenia and sepsis. Morbidity occurred in 28/71 procedures. The 3‐year survival rate for the HIPEC group was 71% compared with 28% for the no HIPEC group. In the complete excision group, the 3‐year survival rate was 52% compared with 13% for the incomplete excision group. The 3‐year survival rate for PMP and appendiceal cancer was 74%. The 2‐year survival rate for ovarian cancer was 67%, mesothelioma 57%, and CRC 50%, respectively.

Conclusions:  Morbidity is significantly associated with duration of surgery and units of blood transfused. Our findings are consistent with the international experience in patients treated with combined peritonectomy and HIPEC.
MANAGEMENT OF MUSCLE‐INVASIVE BLADDER CANCER IN VICTORIA, 1990–1995
Authors: Millar Jeremy L. , Frydenberg Mark , Toner Guy , Syme Rodney , Thursfield Vicky , Giles Graham G. ,   Urology Study Committee of the Victorian Co‐operative Oncology Group
Published: March 2006

Background:  The management and outcomes of muscle‐invasive bladder cancer are described in this article.

Methods:  A retrospective survey of medical practitioners involved in the management of bladder cancer was conducted. The survey obtained at least 5 years of follow‐up data on all patients. The sample was taken from the public and private health sectors in Victoria. All were cases of muscle‐invasive bladder cancer diagnosed between 1990 and 1995. The main outcome measures included reported management by staging, treatment and survival.

Results:  Completed questionnaires were returned for 743 (89.6%) of 829 cases. Of these, 523 (70.4%) were men, and the mean age was 72.7 years. More than 75% of the cases (560) presented with macroscopic haematuria. The majority (696, 94%) had transitional cell carcinoma. A variety of treatments were given in various sequences, with 231 cases (31.1%) having initial surveillance. Eventually, 303 cases (40.8%) proceeded to ‘definitive’ management with either radiotherapy (132, 17.8%) or cystectomy (171, 23.0%). In addition, chemotherapy was given to 254 patients (34.2%) at some time. Most patients (613, 82.5%) have subsequently died; 402 (54%) died from bladder cancer. Crude 5‐year survival was 13.0%, and disease‐specific survival was 27.7%. Multivariate analysis identified the following predictors of greater disease‐specific survival: grade 1 or 2 histopathology (P = 0.0003), T2 primary (P < 0.0001), N0 disease (P = 0.04), M0 disease (P < 0.0001), radiation dose in BED10 >70 Gy and cystectomy (P < 0.0001).

Conclusion:  Muscle‐invasive bladder cancer in Victoria typically occurs in elderly patients, and a notable proportion of these patients do not proceed onto ‘definitive’ treatment. Disease stage, cystectomy and the use of high doses of radiation are associated with better outcomes. Chemotherapy was given to approximately one‐third of patients at some point in their disease management. Our data are similar to population‐based data from North America, and provide a baseline against which potential changes in management of bladder cancer can be compared.
THE SURGICAL TRAINEE LOG WE NEED: MINIMUM OF WORK, MAXIMUM OF OUTPUT
Authors: Merry Chris , Goodall‐Wilson Darrin , Guest Glenn , Papas Chris , Selvidge Jannie , Watters David A. K.
Published: March 2006

Background:  The objective of this study was to design a trainee logbook suitable for both surgical training and surgical audit. The fields of the logbook should conform to both the current requirements for surgical trainee logbooks and the minimum and recommended datasets for surgical audit. The database should be able to share information with other databases including hospital information systems. The current logbook requirements do not include much outcome data. Therefore, keeping the logbook does not train the young surgeon to collect all the information necessary for surgical audit, particularly the recently promoted minimum (12 fields) and recommended (22 fields) datasets.

Methods:  An electronic logbook was developed as part of the hospital's clinical information system (CORDis). Patient identifier information was available in the system and did not need to be re‐entered (e.g. name, number, date of birth and sex). The trainee only input the necessary fields for his/her logbook and was able to derive information already available from CORDis on complications, outcome and final diagnosis of the patient.

Results:  Thirteen of 16 trainees used the program over a period of 2.5 years, and more than 4600 operative procedures were recorded. Information on outcome and complications was included in the logbook, regardless of who in the team entered the data. This also facilitated surgical audit presentations. Logbook reports for the Advanced Training Board were produced with the click of a mouse rather than by spending a whole weekend counting items in the operation register at the end of a 6‐month rotation. This system could be used at different hospitals or the data can be exported to another database including databases on a hand‐held device.

Conclusion:  The logbook contains all the data for reporting to the Specialty Training Board and Surgical Audit. Duplication of data entry was reduced, and presentation of unit/trainee surgical audits was facilitated. The data can be exchanged with other common databases when the trainee rotates out of Geelong.
AIRWAY FIRE DURING TRACHEOTOMY
Authors: Tykocinski Michael , Thomson Peter , Hooper Robin
Published: March 2006

We report a case of airway fire during surgical tracheotomy using diathermy for the incision into the trachea. A literature review of airway fire during tracheotomy was carried out, and the management of airway fire is discussed. Recommendations are made to prevent this adverse outcome.
Increasing underrepresentation of elderly patients with advanced colorectal or non‐small‐cell lung cancer in chemotherapy trials
Authors: Jennens R. R. , Giles G. G. , Fox R. M.
Published: March 2006

Background: Elderly patients are underrepresented in chemotherapy trials for advanced colorectal cancer (CRC) and non‐small‐cell lung cancer (NSCLC). However, the change in underrepresentation over time has not been documented.

Aims: This study aimed to quantify (i) the change in the median age of patients enrolled in clinical trials for metastatic CRC and NSCLC between 1982–1991 and 1992–2001 compared with the general colorectal and lung cancer population, and (ii) the proportion of trials with an upper age limit for eligibility.

Methods: A retrospective review of data from the Victorian Cancer Registry and all large published randomized chemotherapy trials for advanced CRC and NSCLC between 1982 and 2001 was conducted.

Results: The median age of patients with CRC enrolled in clinical trials remained constant between the two decades (62.0 and 62.2 years), whereas the median age of the CRC population increased from 68.4 to 70.2 years, increasing the median age difference from 6.4 to 8.0 years. The median age of patients with lung cancer in clinical trials increased from 59.8 to 61.8 years, whereas the median age of the lung cancer population increased from 67.4 to 70.4 years, widening the age difference from 7.6 to 8.6 years. More trials set an upper age limit for eligibility in the first decade than in the second decade for both CRC (51 vs 29%, P = 0.04) and NSCLC (68 vs 41%, P = 0.03).

Conclusion: International clinical trials for CRC and NSCLC are becoming increasingly unsuitable for application to Australian patients because of the increasing age discrepancy, despite fewer trials restricting eligibility by age.
Effect of an education programme on the utilization of a medical emergency team in a teaching hospital
Authors: Jones D. , Bates S. , Warrillow S. , Goldsmith D. , Kattula A. , Way M. , Gutteridge G. , Buckmaster J. , Bellomo R.
Published: March 2006

Background: Medical Emergency Teams (MET) have been developed to identify, review and manage acutely unwell ward patients. Previous studies have suggested that there may be obstacles to the utilization and activation of the MET.

Aims: To determine the effect of a detailed education programme on the rate of utilization of the MET system 3.5 years after its introduction in a University teaching hospital.

Methods: Prospective interventional study involving a detailed programme of education, feedback and decision support for nursing and medical staff given before, during and after implementation of a MET system. We measured the number of MET calls per month for both medical and surgical patients for 109 250 consecutive admissions to the acute care campus of Austin Health from August 2000 to June 2004.

Results: Overall activation of the MET increased from 25 calls per month to a peak of 79 calls per month over the study period (average increase of one MET call/month). After standardization for monthly admissions, the increase in MET utilization for surgical patients (increase by 1.13 MET/1000 admissions/month) was 4.9‐fold greater than for medical patients (increase by 0.23 MET/1000 admissions/month; P < 0.0001). At the peak level of activity (April 2004), the MET was called to review 8.4% of surgical and 2.7% of medical admissions (P < 0.0001).

Conclusions: There was a progressive increase in the utilization of the MET service in the 3.5 years after implementation, with the rate of uptake 4.9 times greater for surgical than for medical patients. Sustained uptake of the MET system is possible, but increased utilization may take several years to develop. Short‐term studies testing the efficacy of the MET system are likely to significantly underestimate its effect on reducing adverse events. Intensive care unit resource adjustments will become necessary to meet increased demand.
Neuropathic pain: are we out of the woods yet?
Authors: Cavenagh J. , Good P. , Ravenscroft P.
Published: March 2006

Patients suffering from neuropathic pain continue to pose challenges in clinical practice. This descriptive review discusses the continuing debate on the definition and concerns about increasing incidence of neuropathic pain. The clinical features of neuropathic pain are outlined, and the current understanding of the possible mechanisms of neuropathic pain is highlighted. Current management strategies are reviewed, and future advances in our understanding of the mechanisms, accurate clinical diagnosis and more effective treatment strategies are eagerly awaited.
The pharmacokinetics of a single rectal dose of paracetamol (40 mg·kg−1) in children with liver disease
Authors: CORMACK C.R.H. , SUDAN S. , ADDISON R. , KEATING J. , SHERWOOD R.A. , ASHLEY E.M.C.
Published: March 2006

Background:  The aim of our study was to measure the serum paracetamol concentrations achieved following a single rectal loading dose of 40 mg·kg−1 in children with chronic liver disease.

Methods:  We recruited 17 children (3–15 years, 10.6–75 kg) undergoing minor surgical procedures under general anesthesia. Paracetamol was administered at the end of surgery and blood samples were taken for analysis at 2, 3, 4, 6 and 8 h postdose.

Results:  The mean Cmax of 11.4 mg·l−1 [coefficient of variation (CV) 66%] was achieved at a Tmax of 2.7 h (CV 42%). The relative bioavailability (F) of the suppository formulation was not estimated, but clearance (Cl/F) estimates 0.73 l·kg−1·h−1 (CV 87%) and time–concentration profiles for these children were similar to the normal pediatric population.

Conclusions:  There are currently no biologic markers available for monitoring possible hepatotoxicity in this cohort of patients with liver disease, but our data suggest that a single‐dose suppository is a satisfactory analgesic alternative.
Chemo‐prevention in superficial bladder cancer using mitomycin C: a survey of the practice patterns of British urologists
Authors: CLARKE NICHOLAS S. , BASU SAURAJYOTI , PRESCOTT STEVEN , PURI RAJIV
Published: March 2006

OBJECTIVE

To assess the use of mitomycin C, by urologists within the UK, as a single‐dose intravesical agent. Current European recommendations are to use one dose after any new tumour resection.

METHODS

We assessed the current patterns of mitomycin C usage amongst British urologists, particularly with reference to one instillation after resecting a new bladder tumour, hypothesizing that British urologists would use mitomycin C in line with current guidelines. A one‐page questionnaire was mailed to 527 consultant urologists in the UK enquiring about their use of mitomycin C in superficial bladder cancer. A second mailing was sent to encourage nonresponders.

RESULTS

Of the 527 consultants, 320 (61%) replied, of which 313 (59%) questionnaires were evaluable. Of these 313 respondents, 299 (95%) used mitomycin C; 244 respondents (82%) advocated the use of one dose of mitomycin C after resecting a new tumour, but only 10 (4%) would use it immediately after tumour resection and 155 (64%) use it within 24 h. Most (98%) respondents favoured the use of a mitomycin C course after resecting multiple tumours or after multiple recurrences. Interestingly, 20 respondents (7%) would use mitomycin C as a first‐line therapy for carcinoma in situ and a further 23 (8%) would use it for G3T1 tumours. A minority (14%) would use it after nephrectomy for upper tract transitional cell carcinoma. Almost all respondents indicated a dose of 40 mg in 40 mL of diluent. Maintenance treatment with mitomycin C was advocated by 44 (15%) of respondents, mainly for recurrent multifocal Ta/T1 tumours. The perception of the side‐effects of mitomycin C was favourable, with 69% of respondents judging mitomycin C to be well tolerated with mild side‐effects.

CONCLUSION

Urologists adopt new ideas rapidly, as shown by the wide acceptance of the UK Medical Research Council study. The prompt use of mitomycin C needs to be reinforced, as efficacy is optimum within 6 h of resection. A few consultants persist in continuing with established practices, which have little evidence base. The publication of such survey results, with guidelines for treatment, should encourage those urologists whose practice is at variance from the norm to reflect on and change their practice.
Risk factors for urinary stone formation in men with spinal cord injury: a 17‐year follow‐up study
Authors: KU JA HYEON , JUNG TAE Y. , LEE JEONG K. , PARK WON H. , SHIM HONG B.
Published: March 2006

OBJECTIVE

To establish hazard ratios for risk of urinary stone formation in men with chronic spinal cord injury.

PATIENTS AND METHODS

In all, 140 men injured before 1987 were eligible for this investigation and were followed yearly from January 1987 and December 2003.

RESULTS

Over the 17 years, 39 patients (28%) and 21 (15%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. In multivariate analysis, bladder stone was more common in patients injured when aged ≥ 24 years than in those injured when aged <24 years (odds ratio 2.5; 95% confidence interval 1.1–5.7; P = 0.03). In another model, patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (4.1, 1.3–12.9; P = 0.016). Renal stone was more common for patients with urethral catheterization than for those voiding spontaneously (5.7, 1.3–24.6, P = 0.021) and for patients with bladder stone than for those without (4.7, 1.5–15.1; P = 0.01).

CONCLUSION

Injury characteristics are important for the development of urinary stone in chronic traumatic spinal cord injury. In addition, the present findings suggest that in men who cannot use intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than urethral catheterization to avoid renal stone formation.
Ileocaecal vs ileal neobladder after radical cystectomy in patients with bladder cancer: a comparative study
Authors: KHAFAGY MEDHAT , SHAHEED FOUAD ABDEL , MONEIM TAREK ABDEL
Published: March 2006

Authors from Egypt present the results of a comparative study of bladder reconstruction after radical cystectomy for bladder cancer. They compared an ileocaecal bladder with a neo‐ileal bladder, and found no difference in continence between them, but found the ileocaecal bladder to be better for renal unit preservation, residual urine and the development of acidosis.

OBJECTIVE

To compare an ileocaecal orthotopic bladder, (which has been the standard procedure in Egypt for >30 years) with the ileal neobladder, as there is no ideal continent orthotopic bladder replacement for patients after cystectomy for bladder cancer.

PATIENTS AND METHODS

Between June 1999 and December 2001, 60 patients with invasive bladder cancer were randomized into two groups. Group A comprised 29 patients who had radical cystectomy and reconstruction with an ileal neobladder (median age 50 years, 27 men and two women) and group B included 31 who had an ileocaecal bladder substitution after radical cystectomy (median age 51 years, 28 men and three women).

RESULTS

The complication rate after surgery in group A was 17%, with two deaths, one from acute myocardial infarction and the other from haematemesis. In group B, the complication rate was 13%, with two deaths, one from a massive pulmonary embolism and the other from liver cell failure. Daytime continence was achieved in 93% of patients in group A and 90% in group B. The mean (sd) postvoid residual urine volume was larger in group A than group B, at 90 (72) vs 12 (20) mL. Acidosis and hyponatraemia were evident in the patients in group A but in none in group B (P < 0.05). The pelvicalyceal systems were preserved in 85% of patients in group A and 93% in group B during the 2‐year follow‐up. The mean (sd) renal cortical thickness was less in group A than in group B, at 1.8 (0.5) and 1.9 (0.2) cm, respectively. Although the cystometric capacity was greater and the basal pressure less in group A than B, these were not reflected in the degree of diurnal and nocturnal continence or back pressure on the renal units.

CONCLUSION

Continence in both pouches was similar but the renal units were preserved better in the ileocaecal than in the ileal neobladder. Residual urine volume was greater in the ileal neobladder, with its potential complications of infection and stone formation, and acidosis was more evident.