bluuebunny/crossref_metadata_2025 huggingface dataset:
Cannabis Use is Not Associated With the Development of Psychosis in an ‘Ultra’ High-Risk Group
Authors: Phillips Lisa J , Curry Christina , Yung Alison R , Pan Yuen Hok , Adlard Steven , Mcgorry Patrick D
Published: March 2003

Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis.

Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake.

Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder.

Conclusion: The results of this study suggest that cannabis use may not play an integral role in the development of psychosis in a high-risk group. While this study does not support a role for cannabis in the development of first-episode psychosis, we cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study (the low level of cannabis use in the current sample, the lack of monitoring of cannabis use after intake) suggest that it may be premature to dismiss cannabis use as a risk factor for the development of psychosis and further research is urged in this area.
A Five Year Follow-Up Study of the Use of Clozapine in Community Practice
Authors: Drew Leslie R.H. , Griffiths Kathleen M. , Hodgson Donna M.
Published: March 2003

Objective: To present information about the value of clozapine in treatment-resistant schizophrenia. Data is reported on the use of clozapine in an entire cohort of (42) patients in a community, the Australian Capital Territory. It extends a 3-year study of clinical and financial outcomes to 5 years.

Method: Experiences during the 2 years before clozapine was prescribed and those of the 5 years following prescription were compared by a records review, including hospital and hostel bed use and estimated treatment costs. Changes in dose levels, living circumstances and employment status were assessed, and treating psychiatrists reported on side-effects and their impression of clinical change since clozapine was prescribed.

Results: Ten subjects were excluded. The remaining cohort (32 subjects) demonstrated continuing clinical improvement and cost savings during follow-up. Those (22) remaining on clozapine after the five year period showed continuing clinical improvement, reduced hospital admissions and hospital bed usage and significantly large cost savings, and were moderately to markedly improved after 3 years. Only one patient (of 22) showed a slight deterioration in the next two years while 14 showed further improvement. After 5 years, the clinical status of four of the 10 subjects who discontinued clozapine was unchanged or deteriorated compared with their preclozapine status. There were no suicides.

Conclusion: The findings of continuing clinical improvement and decreased costs after longterm (5 years) use of clozapine supports the selective use of clozapine in community practice.
Neuropsychological Functioning in Children With DSM-IV Combined Type Attention Deficit Hyperactivity Disorder
Authors: Tripp Gail , Ryan Junita , Peace Kathryn
Published: March 2003

Objective: To compare the global cognitive functioning and frontal lobe functioning of children with and without DSM-IV combined type Attention Deficit Hyperactivity Disorder (ADHD).

Method: Participants were 6 to 10 year old, clinic-referred children diagnosed with combined type ADHD, who were medication naïve; and an age (± 3 months) and sex matched group of children without behaviour problems. The performance of the two groups were compared on measures of intellectual functioning and tests designed to assess the functions of the frontal lobes (verbal and-non-verbal fluency, reasoning, problem solving, spatial working memory, attention).

Results: The children with ADHD obtained significantly lower Wechsler Intelligence Scale for Children-third edition IQ scores than controls and performed more poorly across the range of frontal lobe tests. Group differences on these tests were attenuated when IQ scores were included in the analyses as a covariate.

Conclusions: Children with combined type ADHD have mild to moderate global cognitive impairment together with some impairment of functions subserved by the frontal lobes. Longitudinal studies are required to determine if the deficit in global cognitive functioning is a primary deficit or secondary to the deficit in frontal lobe functioning. The importance of neuropsychological assessment and follow-up for children with ADHD is stressed. Study limitations relate to the generalizability of the findings and the absence of a psychiatric control group.
Is it Time to Introduce Repetitive Transcranial Magnetic Stimulation into Standard Clinical Practice for the Treatment of Depressive Disorders?
Authors: Fitzgerald Paul
Published: March 2003

Objective: To examine issues relating to the potential introduction of repetitive transcranial magnetic stimulation (rTMS) into clinical practice as a treatment for depression.

Method: A review of the outcomes literature accompanied by an analysis of issues relating to the potential advantages and pitfalls of the introduction of rTMS as a treatment strategy.

Results: Evidence is progressively accumulating that rTMS has antidepressant properties that are clinically relevant. These effects are biologically plausible and supported by basic research. Patients with therapy-resistant depression have few treatment alternatives and experience significant suffering, thus justifying the early introduction of a new treatment such as rTMS for this patient group. However, this must be balanced by a need to foster considerable further research and not to raise expectations unreasonably.

Conclusions: It is timely for rTMS to be made more available to patients with treatment-resistant mood disorders. This need not be limited to clinical research trials but should only occur in medical settings where continual evaluation and research is conducted.
IS THE PORT SITE REALLY AT RISK? BIOLOGY, MECHANISMS AND PREVENTION: A CRITICAL VIEW
Authors: Allardyce Randall A.
Published: March 2003

Early case reports of port site tumour implants led to debate regarding the appropriateness of laparoscopic techniques for abdominal malignancies. Review of clinical, animal and cell culture studies addresses the relationships between tumour staging and shed cell behaviour that contributes to the peri‐operative spread of tumours. In addition, a porcine model was used to test tumour cell distribution after laparoscopic and open colonic resections. Clinical evidence indicate that wound recurrence rates are 0.60 and 0.85% for open and laparoscopic colon cancer operations, respectively. Tumour staging and operative techniques are the most important factors determining wound implantation. Port site and open wounds are at equal risk of tumour implantation.
TRAUMA IN THE ELDERLY: A NEW EPIDEMIC?
Authors: Young Lorinda , Ahmad Hairul
Published: March 2003

Australia’s population is ageing. Statistics predict that by the year 2021, 17.8% of our population will be over the age of 65 years.1 These statistics are reflected in most Western nations. The elderly represent an increasing proportion of emergency department patients. They are generally more acute on presentation, they get admitted more frequently, and account for an increasing proportion of admissions to intensive care units.2 The elderly trauma patient will increasingly consume more resources than patients from any other age group. There are significant differences in physiology and response to trauma between the elderly patient and the young. Airway compromises, a decrease in lung compliance, a change in cardiovascular haemostasis and the prevalence of pre‐existing disease all contribute to increase morbidity and mortality in a patient with an already limited physiological reserve. Many studies demonstrate an increased mortality in hospitalized elderly trauma patients. For those who die from traumatic insult, death is mainly due to multi‐ organ system failure.3 The long‐term functional outcome of the elderly trauma patient has been investigated by a number of authors. One study showed that only 8% of survivors returned to independent living 1 year post‐polytrauma.4 Another more encouraging study showed that 89% of survivors of blunt multiple trauma after 38 months were independent and living at home.5 Ethical issues have been raised regarding the appropriateness of care for the severely injured elderly patient given today’s ever‐shrinking hospital finances and bed shortages. Today’s environment is very challenging as frequently, the clinician is forced to make an economic decision on who will take the last critical care bed, which is a far from optimal situation.
APPLICATION OF PROGNOSTIC SCORING SYSTEMS IN DIFFERENTIATED THYROID CARCINOMA
Authors: Chaplin JOHN M. , O’Brien CHRISTOPHER J. , Mcneil EDWARD B. , Haghighi Kourosh
Published: March 2003

Background: Total thyroidectomy is widely practised in Australasia for papillary and follicular thyroid carcinoma. Data from large overseas series have demonstrated that patients with these cancers may be separated into risk groups based on clinicopathological prognostic factors. Furthermore, evidence suggests that low‐risk patients may be safely treated with less than total thyroidectomy. The aim of the present paper was to determine what proportion of our patients with papillary and follicular thyroid cancer were in the low‐risk group in order to select candidates for less aggressive treatment.

Methods: A prospectively documented series of 175 previously untreated patients with papillary and follicular thyroid carcinoma, treated principally by total thyroidectomy over a 10‐year period, was divided into risk groups using the Mayo Clinic, Lahey Clinic and Memorial Hospital prognostic scoring systems. Complication rates for 103 patients treated by total thyroidectomy were also studied and reported.

Results: Women outnumbered men by 2.3:1. There were 128 papillary carcinomas (73%) and 47 follicular cancers (27%). These tumours were < 4 cm in diameter in 81% of patients, and 41% of patients were 40 years of age or younger. Low‐risk patients accounted for 75, 81 and 45% of the study group, respectively, when the three prognostic scoring systems were applied to our patient population. The rates for recurrent laryngeal nerve palsy and permanent hypoparathyroidism for patients having total thyroidectomy were 1 and 1.9%, respectively. In the low‐risk group there were no permanent complications.

Conclusion: Most patients treated at Royal Prince Alfred Hospital during the past 10 years were low‐risk patients who may have been eligible for less aggressive surgical treatment.
KELOIDS AND HYPERTROPHIC SCARS: RESULTS WITH INTRA‐OPERATIVE AND SERIAL POSTOPERATIVE CORTICOSTEROID INJECTION THERAPY
Authors: Chowdri Nisar Ahmad , Mattoo Mohammad Masarat Ajaz , Darzi Mohammad Ashraf
Published: March 2003

Background: The management of keloids and hypertrophic scars continues to be controversial. Experience of treating 58 such lesions, 58.62% of which were recurrent, is presented.

Methods: Each lesion was subjected to surgical excision with intra‐operative local injection of triamcinolone acetonide, followed by repeat injection of the same drug at weekly intervals for 2–5 weeks depending on the symptomatic relief, and then monthly injections for 4–6 months.

Results: Complete symptomatic relief was achieved in all patients within 5 weeks of surgery. Objective response in terms of no recurrence was noted in 91.9% of patients with keloids, and 95.24% of patients with hypertrophic scars at a mean follow‐up of 30.5 months. Local or systemic complications were insignificant.

Conclusion: Because of promising results, further use and evaluation of this method of treatment is recommended for large, recurrent and complicated keloids and hypertrophic scars.
PHENOXYBENZAMINE IN THE MANAGEMENT OF NEUROPATHIC BLADDER FOLLOWING SPINAL CORD INJURY
Authors: Al‐Ali M. , Salman G. , Rasheed A. , Al‐Ani G. , Al‐Rubaiy S. , Alwan A. , Al‐Shaikli A.
Published: March 2003

Background: The present study aims to show the clinical and urodynamic effects of phenoxybenzamine on the neuropathic bladder of spinal cord‐injured patients who failed to be free of catheter by attaining satisfactory voiding function, despite initial bladder training.

Methods: Forty‐six spinal cord‐injured patients were subjected to pharmacological manipulation with phenoxybenzamine. It was used as an adjunct in the management of neuropathic bladder dysfunction that caused failure of the bladder to empty, by tapping or crede to achieve satisfactory residual urine volume of < 100 mL. Phenoxybenzamine was started with a dose of 10 mg daily, increased by 10 mg every 3 days to a dose of 30 mg daily; this was maintained from 3 weeks to 6 months (mean: 39 days). The pre‐treatment residual urine volume ranged between 100 and 1050 mL (mean: 360 mL). Follow‐up periods ranged between 12 and 36 months (mean: 16 months).

Results: Five patients (11%) were excluded due to either inadequate treatment or inadequate follow‐up. Nineteen patients (41%) with reflex (upper motor neurone) bladders showed improvement of bladder evacuation. There was a reduction of the maximum urethral closure pressure, which ranged between 10 and 32 cm of water (mean: 22 cm). Twenty‐two patients (48%) did not respond, requiring other measures to be taken which included transurethral surgery (n = 19). Nine of the failures involved areflex (lower motor neurone) bladders, and seven failures involved reflex bladders with an extremely tight outlet and urethral closure pressure of > 50 cm of water. Six failures involved reflex bladders that were lacking strong enough detrusor contractions to attain a balanced bladder responsive to abdominal tapping; response was achieved by administration of a parasympatheticomimetic drug. Neuropathic bladders with uninhibited detrusor contractions responded well to phenoxybenzamine.

Conclusions: Phenoxybenzamine proved useful in reducing bladder outlet resistance after spinal cord injury, provided that detrusor bladder contractions were present. It is useful in controlling detrusor–sphincter dyssynergia and autonomic hyperreflexia. It was not useful in areflex bladders, perhaps due to the development of spasticity of the striated muscle component of the external sphincter. The presence of bladder neck (internal sphincter) dysfunction may modify or abolish its effect.
PROSPECTIVE RANDOMIZED CONTROL STUDY ON THE EFFECT OF BRANCHED‐CHAIN AMINO ACIDS IN PATIENTS WITH LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA
Authors: Meng W. C. S. , Leung K. L. , Ho R. L. K. , Leung T. W. T. , Lau W. Y.
Published: March 2003

Background: Aminoleban EN contains branched‐chain amino acids (BCAA) and is known to be beneficial for the protein‐energy malnutrition in cirrhotic patients. Patients suffering from hepatocellular carcinoma often have background cirrhosis, and the present study investigates the effect of Aminoleban EN on these patients after hepatic resection for the primary disease.

Methods: A prospective randomized controlled clinical trial, to which 50 patients were recruited, was carried out. The study group received Aminoleban EN in addition to normal diet for 12 weeks and the control group received an isonitrogenous and isocaloric diet only.

Results: After exclusions, there were 21 patients in the study group and 23 patients in the control. The study group had a shorter hospital stay, and had a significantly higher haemoglobin level, higher sodium level, higher albumin level and lower bilirubin during the postoperative course. There was no significant difference in terms of neuropsychiatric symptoms or Karnofsky performance score. There was no difference in gastrointestinal symptoms or other signs. No adverse reaction was associated with the administration of Aminoleban, and there was no significant difference in terms of morbidity and mortality between the two groups of patients.

Conclusion: Aminoleban EN is safe to administer and does not have significant adverse effects. It contributes to a shorter hospital stay and quicker improvement of liver function in the early postoperative period. These beneficial results require only a 12‐week period of administration of BCAA after operation.
A POPULATION‐BASED STUDY OF THE INCIDENCE, MORTALITY AND OUTCOMES IN PATIENTS FOLLOWING SURGERY FOR COLORECTAL CANCER IN WESTERN AUSTRALIA
Authors: Semmens James B. , Platell Cameron , Threlfall Timothy J. , Holman C. D’Arcy J.
Published: March 2003

Background: The literature contains many reports on the management of colorectal cancer from single institutions or groups of specialist surgeons. But there are few data on community‐wide patterns of treatment or the outcomes of colorectal surgery. The aim of the present study was to use a population‐based linked database to assess the trends in colorectal cancer incidence and mortality in Western Australia (WA) in the period 1982–95, and to evaluate the outcomes following surgical care.

Methods: A population‐based linked database was used to relate the cancer registry, hospitalization and mortality records of all patients with a diagnosis of colorectal cancer in WA during 1982–95. Data on surgical treatment and postoperative morbidity and mortality in this group of patients were available only in 1988–95. Patient records were selected using the international classification for diagnosis and procedure codes pertaining to colorectal cancer and surgery. Incidence and mortality trends in colon and rectal cancers were estimated by Poisson regression of age‐standardized rates, and relative survival analysis was used to compare patient survival with the general population.

Results: During the 14‐year period, 9673 patients presented with a diagnosis of colorectal cancer. The sex distribution of patients with colon cancer was evenly divided, but rectal cancer was more common in men (ratio 1:4). The mean age at diagnosis was 67.8 years (SD: 12.7). During the study period there was a significant increase in the standardized incidence rate of rectal cancer in men, and in the mortality rates from colon cancer in women. The overall crude 5‐year survival was 57%. Large bowel resections were performed on 71% of patients with an in‐hospital postoperative mortality of 4.2%.

Conclusion: Colorectal cancer is a continuing major cause of morbidity and mortality in WA. The present study demonstrated increases in the incidence rate of rectal cancer in men and in the mortality rate from colon cancer in women in the period 1982–95.
INFLAMMATORY CONDITIONS OF THE COMMON BILE DUCT
Authors: Tranter S. E. , Maddern G. J. , Berry D. P.
Published: March 2003

Background: Inflammatory conditions of the biliary tree are infrequently reported with the exception of sclerosing cholangitis. These conditions, especially when affecting the common bile duct (CBD), can be mistaken for tumours; their existence should be considered in the differential diagnosis of biliary lesions and, in particular, biliary strictures. Few descriptions of inflammatory conditions exist in the published literature.

Methods: A comprehensive search was undertaken of the last 20 years of published literature.

Results: Potential aetiological factors include infection, infestation, traumatic bile duct injury, foreign body or gallstone reaction and the host inflammatory response.

Conclusions: These conditions typically mimic malignant tumours of the CBD but knowledge of the aforementioned processes might alter the surgical approach to biliary strictures (especially after previous cholecystectomy), with greater emphasis on surgical exploration.
AUSTRALASIAN SURVEY OF SPLIT SKIN GRAFT DONOR SITE DRESSINGS
Authors: Lyall Patrick W. , Sinclair Stewart W.
Published: March 2003

Background: There is an ever increasing array of products available for wound dressings. The aim of the present study was to establish which dressings should be used as standard controls for future studies; what factors are regarded as most important in assessing a dressing; what the level of satisfaction is with the available products; what the strengths and weaknesses of the commonly used dressings are; and what dressings would be preferred if cost were no issue.

Methods: A postal survey was sent to every plastic and reconstructive surgeon registered in Australasia (n = 217). A total of 53% responded.

Results: The most commonly used dressing type overall is the calcium alginates, despite the fact that they were not the highest performing dressings. This is also the most commonly used in Australia. In contrast scarlet red is still used most commonly in New Zealand. The level of satisfaction with the most commonly used dressing varied very little. The factor regarded most important was patient comfort level. A profile of the commonly used dressing was constructed. Calcium alginates and or scarlet red should be used as the control for new product comparisons.

Conclusions: Most of the respondents were satisfied with their preferred dressing and were not interested in trying alternative dressings.
GALLSTONES AND COMMON BILE DUCT CALCULI IN INFANCY AND CHILDHOOD
Authors: Kumar Rajendra , Nguyen Kelly , Shun Albert
Published: March 2003

Background: Gallstones and common bile duct calculi have been increasingly diagnosed in recent years in infants and children. The present study aims to review the spectrum of this disorder in the last two decades.

Methods: During the period 1979–96 a total of 102 consecutive infants and children were diagnosed in Royal Alexandra Hospital for Children with gallstones or common bile duct calculi. A detailed retrospective analysis and follow‐up of these children form the basis of the present report.

Results: The median age at presentation was 10 years. Recurrent right upper quadrant pain was the most common clinical presentation. The male‐to‐female ratio was 3:2 and this male predominance was noted in all the age groups. Aetiologically three identifiable groupings were noted: idiopathic disease (n = 66), haematological diseases (n = 23) and specific non‐haematological disease (n = 13). The incidence of idiopathic and haematological stones had increased two‐fold in the second half of the study. The majority of children (86%) underwent surgical correction. Choledocholithiasis (CDL) was noted in 18 children (18%). Jaundice was commonly associated with abdominal pain in this group. A higher incidence of common bile duct calculi was noted in females and children less than 5 years of age (P < 0.01). Common bile duct calculi were accurately diagnosed by pre‐operative imaging in all 18 children. Surgical correction was required in all except two.

Conclusions: The present study suggests an increasing incidence of gallstones in children. Cholelithiasis in children occurs commonly in boys, is idiopathic in aetiology and presents with a vague right upper quadrant pain. Choledocholithiasis is not uncommon in children, occurs more commonly in girls aged < 5 years and presents with jaundice or abnormal liver function tests.
MANAGEMENT OF GUNSHOT WOUNDS AT A SYDNEY TEACHING HOSPITAL
Authors: Chambers Anthony J. , Lord Reginald S. A.
Published: March 2003

Background: Injuries caused by firearms account for only a small percentage of trauma admissions and deaths in Australia but are frequently the subject of media and public attention. The present study examines the epidemiology and management of firearm injuries presenting to St Vincent’s Hospital, which is located at the edge of the central business district of Sydney.

Methods: The medical records of all patients presenting to St Vincent’s with a gunshot wound (GSW) from January 1988 to December 1998 were analysed. Additional details were acquired from New South Wales State Coroner’s Court reports and media archives, especially major newspapers.

Results: Seventy‐four patients presented to St Vincent’s Hospital with 103 GSW. The age (mean ± SD) was 31 ± 11 years. Sixty‐seven patients (91%) were male. Alcohol was identified as a factor in 24 cases (32%) while other drugs were indicated in four cases (5%). Ten patients (14%) had intentionally self‐inflicted wounds, seven (9%) had accidental wounds and 57 (77%) had wounds that were caused by crime‐related violence. Sixty patients (81%) underwent operation for their injury. Thirty complications were seen in 18 patients (24%). Eleven patients (15%) died. The length of hospital stay (mean ± SEM) was 18 ± 9 days.

Conclusions: The incidence of trauma due to firearms has not increased at St Vincent’s hospital in the period 1988–98. Most GSW were inflicted in the setting of criminal violence, with a high proportion due to handguns. Patients were mostly young men, and alcohol or other drugs were frequently involved. Outcomes are comparable to other centres managing large volumes of penetrating trauma.
SQUAMOUS CELL CARCINOMA OF THE LIP: A RETROSPECTIVE REVIEW OF THE PETER M ACCALLUM CANCER INSTITUTE EXPERIENCE 1979–88
Authors: Mccombe D. , Macgill K. , Ainslie J. , Beresford J. , Matthews J.
Published: March 2003

Background: Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective.

Methods: A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause‐specific mortality, and the incidence of metachronous lesions.

Results: Recurrence‐free survival at 10 years was estimated to be 92.5%, and cause‐specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period.

Conclusions: Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.
Thoracoscopic Sympathectomy: A One‐port Technique
Authors: Weight S. C. , Raitt D. , Barrie W. W.
Published: March 2003

Background: The present paper describes the development of a one‐port technique for thoracoscopic sympathectomy.

Methods: A 7‐mm thorascope with a working channel for diathermy was used.

Conclusion: A highly cosmetic, simple, safe, day‐case procedure is achievable.
RESULTS OF LAPAROSCOPIC FUNDOPLICATION WHERE ATYPICAL SYMPTOMS COEXIST WITH OESOPHAGEAL REFLUX
Authors: Chen R. Y. M. , Thomas R. J. S.
Published: March 2003

Background: Laparoscopic Nissen fundoplication (LNF) has been increasingly performed for gastro‐oesophageal reflux disease. The outcomes of LNF for patients with concurrent symptoms other than heartburn are unclear. The purpose of the present paper was to review the outcomes of LNF performed by one surgeon over 4 years and compare the outcomes of patients with reflux symptoms with those of patients having reflux symptoms plus atypical symptoms.

Methods: The records of a consecutive series of 90 patients were reviewed. Preoperative symptoms were defined as typical (heartburn and reflux) or atypical (other symptoms, e.g. cough, atypical chest pain, choking). At the time of follow up an independent observer interviewed patients, and collected data on current symptoms and patient satisfaction. A questionnaire of current symptoms and patient satisfaction was completed. A satisfaction score from 1 to 10 was given by patients, with 1 being very unsatisfied and 10 being very satisfied.

Results: Of the 90 patients, 97% had typical symptoms and 56% had concurrent atypical symptoms. Eighty‐three of 90 patients were contacted; typical reflux symptoms improved in 95% of patients whereas atypical symptoms improved in only 54%. Overall, the mean satisfaction score was 8.7. Patients with atypical symptoms had a lower satisfaction score of 8.0 versus a satisfaction score of 9.0 for patients with only typical symptoms (P < 0.05). Patients with a satisfaction score < 8.0 had a higher rate of atypical symptoms (75%) than patients with a satisfaction score ≥ 8 (50%).

Conclusion: Laparoscopic Nissen fundoplication controlled typical reflux symptoms very well but atypical symptoms were improved in only approximately 50%. A lower satisfaction score was associated with preoperative atypical symptoms.
Preoperative depression and mortality in coronary artery bypass surgery: Preliminary findings
Authors: Baker Robert A. , Andrew Marie J. , Schrader Geoffrey , Knight John L.
Published: March 2003

Background: There is convincing evidence to suggest that depression significantly increases the risk of mortality following myocardial infarction. There are few data concerning depression as a risk factor for mortality following cardiac surgery. The aim of the present observational study was to determine if preoperative depressive symptoms resulted in an increased risk of late mortality following cardiac surgery.

Methods: Preoperative assessments of depressive symptoms were performed on 158 patients undergoing coronary artery bypass surgery. Elevated preoperative depression symptoms were defined as a depression anxiety stress scale score of ≥ 10.

Results: Twenty‐four of the 158 patients (15.2%) were classified as having elevated preoperative depressive symptoms. Patients were followed for a median of 25 months (range: 4–38 months). Three of the 24 patients (12.5%) with preoperative depressive symptoms died within the follow‐up period, compared with three of the 134 (2.2%) non‐depressed patients (odds ratio: 6.24; 95% CI: 1.18–32.98; P = 0.046). There were no other group differences on variables including population demographics, medical risk factors, surgical parameters, and indices of postoperative morbidity.

Conclusions: Elevated depressive symptoms before coronary bypass surgery may be a significant predictor of late death. Prospective studies evaluating the prevalence of depressive symptoms in cardiac surgical patients and their effect on long‐term outcome must be undertaken.
Use of a computer‐controlled bipolar diathermy system in radical prostatectomies and other open urological surgery
Authors: Sengupta Shomik , Webb David R.
Published: March 2003

Background: Ligasure® is a computer‐controlled bipolar diathermy system, designed to optimally seal vessels ≤ 7 mm in diameter. The aim of the present study was to evaluate its application to open urological surgery.

Methods: The Ligasure® device was used in 32 consecutive open surgical cases, including 25 radical prostatectomies, five radical nephrectomies, one partial nephrectomy and one nephro‐ureterectomy. All procedures were performed using standard surgical techniques, with the exception that the Ligasure® device was used for haemostasis. This included pelvic lymphatics and prostatic, adrenal, gonadal and aberrant obturator vessels, as well as vessels associated with the ureter, vasa, seminal vesicles, peri‐renal fat, peritoneum and peri‐adrenal tissues. Vessels > 7 mm in diameter, such as the renal artery, were ligated. In no patients were haemostatic clips used.

Results: In all procedures, vessels and other structures < 7 mm were successfully sealed using the Ligasure® device. For some structures, such as the prostatic pedicles and the seminal vesicles, the Ligasure® device was much easier to apply than haemostatic clips. Use of the Ligasure® device reduced the operating time (mean: 113 min vs 135.5 min; P < 0.001) and blood loss (mean: 529 mL vs 642 mL; P < 0.02) for radical prostatectomies. No intraoperative or postoperative blood transfusions were required. There were no postoperative haemorrhages, lymph leakage or lymphocoeles. Median inpatient hospital stay was 7 days (range: 6–9 days) and no patients required readmission.

Conclusion: The Ligasure® device was safe and easy to use in major urological procedures.
Reflections on doing, being and becoming*
Authors: Wilcock Ann Allart
Published: March 2003

Occupation, and its relationship with health and well‐being, is very complex. It can be described in many different ways by the profession within which it is so central that it provides its name. A simple way to talk about occupation that appears to appeal to a wide range of people is as a synthesis of doing, being and becoming. In the present paper I reflect on how a dynamic balance between doing and being is central to healthy living and wellness, and how becoming whatever a person, or a community, is best fitted to become is dependent on both. Doing is often used as a synonym for occupation within our profession and is so important that it is impossible to envisage the world of humans without it. Being encapsulates such notions as nature and essence, about being true to ourselves, to our individual capacities and in all that we do. Becoming adds to the idea of being a sense of future and holds the notions of transformation and self actualization. It is a concept that sits well with enabling occupation and with ideas about human development, growth and potential. Occupational therapists are in the business of helping people to transform their lives through enabling them to do and to be and through the process of becoming. In combination doing, being and becoming are integral to occupational therapy philosophy, process and outcomes, and some attention is given as to how we may best utilize these in self growth, professional practice, student teaching and learning, or towards social and global change for healthier lifestyles.
Practitioner‐researchers in occupational therapy
Authors: Cusick Anne
Published: March 2003

Few occupational therapy clinicians are research productive even though their involvement in research is encouraged. The role of ‘research‐practitioner’ is put forward as a means by which practitioners can be research productive. There is, however, an absence of studies exploring experience of the minority of practitioners who do produce research. This study used a qualitative approach to do this in occupational therapy. Purposive sampling was conducted of all research productive clinicians in acute‐care hospitals in one Australian city. Of the 20 possible researchers, 15 participated in in‐depth interviews which explored their experience of research. Results were analysed using the constant comparative method and six conceptual categories were developed to describe their experience. The key findings were that clinicians who did research perceived themselves to be different from other clinicians in terms of attributes; and they described special ways of getting research done, and ways of reflecting on outcomes of their research involvement. The study provides an empirical foundation to further consider the practitioner‐researcher role in practice professions such as occupational therapy.
Becoming an evidence‐based practitioner through professional development
Authors: Cusick Anne , McCluskey Annie
Published: March 2003

Occupational therapy practitioners need to incorporate evidence‐based practice into their professional role to remain competent, relevant and clinically effective. However, therapists may feel uncomfortable with the emphasis on evidence, may not know how to use it in practice and may not know where to start to develop the necessary skills. This paper explores these issues and proposes six strategies for continuing professional development which individual therapists can consider using or promoting to become evidence‐based practitioners. These strategies are: (i) changing individual practitioner behaviours; (ii) changing consumer behaviours and expectations; (iii) using evidence about how best to get evidence into practice; (iv) developing institutional requirements for evidence‐based practice; (v) supporting professional association initiatives; and (vi) using or developing local clinical guidelines. Each of these strategies is described in detail.
Quality activities: Utilising evidence and informing clinical research
Authors: Mickan Sharon , Rodger Sylvia
Published: March 2003

This paper defines and contextualises quality activities and clinical research within occupational therapy. Their characteristics are explained using a clinical example and cyclical models. It is argued that quality activities are a means by which clinicians can utilise existing research evidence and inform further clinical research. To familiarise clinicians with the quality activity process, a framework to assist them to engage in and analyse quality activities is presented. Quality activities and clinical research are compared to clarify their similarities and differences. It is proposed that quality activities are an important strategy for clinicians to be informed consumers and contributors to clinical research while maintaining high quality client care.
Gender differences in the perceptions of psychosocial experiences reported by persons with disabilities
Authors: Crisp Ross
Published: March 2003

The objective of this study was to describe the subjective experience of living with disability. Intensive semistructured interviews were conducted with 35 participants who had a disability. Data were collected and analysed with grounded theory methods, and resulted in typological and thematic analyses. Four groups were identified according to their overall sense of well‐being, and these groups were referred to as Battlers, Strugglers, Contenders and Optimisers. The Battlers and Strugglers reported the greatest psychosocial difficulties. The Contenders indicated that they were progressing towards achieving their vocational and social goals, and the Optimisers reported satisfaction in social and vocational activities and a high sense of well‐being. Dominant gender stereotypes were evident in most of the participants’ self‐reports and influenced their perceptions concerning issues related to employment status and social interaction. Issues related to 13 persons with non‐English speaking backgrounds were also reported.
Interpersonal Therapy: An Introduction for Clinicians
Authors: Robertson Michael
Published: March 2003

Interpersonal Psychotherapy (IPT) (Klerman and Weissmann [ 1 ]) is currently enjoying increasing popularity in North American and European psychiatry. The modality is a brief and highly structured manualbased psychotherapy that addresses interpersonal issues to the exclusion of all other foci of clinical attention. This approach has allowed ready modification of the original treatment manual for depression to a variety of illnesses[ 2 ]. Rather than paraphrasing the original IPT manual, this article aims to serve as an introduction of IPT for the general clinician in the hope of encouraging its utilisation as another treatment modality in the everincreasing number of options for brief psychotherapy.
Corporatised, Scientistic and Authoritarian: A 2020 Vision of a Psychiatric Oligarch
Authors: Harari Edwin
Published: March 2003

It is the start of the academic year 2020. The Techno Mac Casino University Inc. which last year successfully bid for the government tender to run medical education in Australia announced today that psychiatry has been deleted as a medical specialty. As part of the restructuring and rationalisation of psychiatry its domains of thought and clinical practice are to be divided between TechnoMac's School of Neuro-pharmacology in Geneva and its California Academy of Evidence-based Counselling, each of which offers a (part-time) diploma course on the Internet to any subscriber who owns more than ten thousand shares in TechnoMac or its subsidiary healthinsurance or pharmaceutical companies.
Neuroscience and the Problems of Success
Authors: Spencer D. J.
Published: March 2003

New knowledge may be beneficial to our understanding of illness and help us in devising new and more effective treatments. Conversely, the same new knowledge can simultaneously introduce conceptual confusion and an urgent need to re-examine some of our categorical boundaries. Some of medicine's biggest challenges (for example) are due to a successful contribution to the increase in life expectancy which enables us to enjoy the pleasures of life long after retirement. Unfortunately these pleasures are counterbalanced by the increased demands on the National Health Service due to the high incidence of medical problems associated with ageing. The challenges of success are particularly true in psychiatry and forensic psychiatry where recent advances in neuroscience cause us to re-examine many interfaces and basic concepts of illness and many of the related ethical issues.
Considering the Changing Environment of Indigenous Child Development
Authors: Hunter Ernest
Published: March 2003

This poem, by a resident of Palm Island in northern Queensland, raises many issues—alcohol and drug use, unemployment, hopelessness, emotional pressure and pain and fights within the family. Between the lines there is much more, allusions, perhaps, to childhood sexual abuse. There is also mention of a mental health professional, a psychiatrist, seeking the solution inside that tormented individual's mind. But, as the author emphasises, ‘No one knows what's in another's mind’, not even the psychiatrist. Perhaps because — ‘they just won't listen’. At the end of the poem the rope appears as the inevitable end of the road.
Charlatans and ‘Gold Standards’: Traversing the Minefield of Psychiatric Psychotherapy Training
Authors: Morstyn Ron
Published: March 2003

BRIDGES TO WHERE?

An innocuous enough looking sentence in A15.6 Explanatory Notes, Medicare Benefits Schedule — ‘that the RANZCP has undertaken to establish an appropriate mechanism to enable use of Item 319 by suitably trained psychiatrists’ — appears to have led to a flurry of activity. Although psychotherapy is not specifically mentioned in Item 319, the assumption appears to have been made that we are facing the possible future regulation of intensive psychotherapy and psychoanalysis by accreditation of ‘suitably trained psychiatrists’. This is a little surprising given that to be eligible for Item 319 a patient must not only be so severely ill that they score a GAF of less than or equal to 50 at the commencement of treatment but they must retain this severely impaired score throughout the treatment to retain eligibility for 319 benefits. Surely, this must exclude many if not most, for example, patients who are candidates for a psychoanalysis, who would be unlikely, on account of the continuing severity of their illness, to either tolerate or benefit from significant regression.
Integrating Public and Private Psychiatric Practice: From National Agenda to Personal Experience
Authors: Paton Michael , Tobin Margaret , Hudson-Jessop Pamela
Published: March 2003

The National Mental Health Policy in April 1992 [ 1 ] highlighted the need to reform mental health care delivery. The policy suggested that mental health care be restricted to those with a ‘serious mental illness’ and that half of the people with serious mental illnesses were untreated whilst many with less serious illnesses were over-serviced. A key challenge for service reform from the outset was the need to allocate appropriate resources in a manner that reflected the point of care [ 2 ]. Several authors suggested that whilst the policy made recommendations regarding the process of reform, little mention was made of the resources required to accomplish such reform and that there was a significant shortfall of manpower [ 3 , 4 ].
The Return of Imperialism
Authors: De Saxe Ian
Published: March 2003

On the surface, an innocent enough piece of gossip journalism about one of the world's richest men. However, at the end of the 20th century, it appears we are returning to a situation where Empires are dominating the world. Now it is the multinational companies and their owners that have replaced the Kings and Emperors of the last century. The owners and their families have become the new ‘Royal’ families, and we are mesmerised and entertained with reports of their various romantic and other shenanigans, usually by newspapers or TV stations owned by their competitor moguls.
Much Briefer Assessments of Children and Adolescents
Authors: Allison Stephen , Roeger Leigh , Dadds Vikki , Wood Andrew , Martin Graham
Published: March 2003

Childhood emotional and behavioural problems are widespread [ 1 ] and each year thousands of families seek assistance from Child and Adolescent Mental Health Services (CAMHS) around Australia. The overwhelming demand means that families often have to wait months for their first appointment [ 2 , 3 ]. As a result, troubled children can be denied timely help and family patterns of dysfunction can become entrenched. In South Australia, consumers and referrers have advocated change towards a more streamlined intake system. This prompted the South Australian CAMHS Program Committee to introduce Initial Consultations to triage new referrals.
Patterns of Posttraumatic Stress Over 12 Months Following Rural Road Accidents
Authors: Jeavons Sue , Greenwood Kenneth M.
Published: March 2003

Objectives: To study patterns of posttraumatic stress in a group of rural road accident victims for 12 months post accident, identifying posttraumatic stress or ‘subsyndromal’ posttraumatic stress on each measurement occasion and documenting changes in diagnostic status over time.

Method-Design: A prospective longitudinal study of road accident victims over 12 months.

Sample: Seventy-two people who consented to the study from a group of consecutive attendees to hospital following road accidents. Three, six and twelve month follow-ups were completed by 61, 62 and 57 people, respectively.

Chief Outcome Measures: Posttraumatic stress as diagnosed using the Posttraumatic Stress Disorder Interview.

Results: Initially after the accident 23.6% of participants had posttraumatic stress, 11.5% at 3 months, 9.7% at 6 months and 7.0% at 12 months. There was overall decline in symptoms with time but with some individuals being symptomatic later despite being asymptomatic earlier.

Conclusion: A meaningful proportion of Australian rural road accident victims had symptoms of posttraumatic stress on each measurement occasion. This would justify follow-up by hospitals or provision of information to alert patients to possible psychological sequelae of accidents.