bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of appropriate assessment criteria to measure older adults’ driving performance in simulated driving
Authors: Lee Hoe C. , Drake Vaile , Cameron Don
Published: March 2003

This study investigated a laboratory‐based driving simulator and identified assessment criteria for its use as an off‐road screening tool for older adult drivers. The driving performance of 53 volunteer older adults was assessed by the driving simulator and gauged by age‐specific assessment criteria. The assessment criteria used in this study were cognitive functions required in making decisions based on past driving experience and ever‐changing driving conditions. The Cronbach alpha confirmed internal consistency of the scales that comprised the measures of driving performance. Pearson coefficient showed some assessment criteria were significantly correlated with age of participants (−0.59  <
  r
 <  0.49). The multivariate analysis of variance revealed that there was an overall score difference in driving performance between two age groupings: senior drivers and advanced age senior drivers. The younger the age of the participants, the better they performed in driving as defined by the assessment criteria. The findings of this study do not deviate from the literature supporting the evidence that driving ability declines with age. It was established that if appropriate assessment criteria are chosen, driving simulators can differentiate between levels of older adults’ driving skills.
Clinical Supervision and Its Effects on the Quality of Practice of Qualified Practitioners
Authors: Rose Donna M , Boyce Philip M
Published: March 2003

Clinical supervision is a very important component of psychiatric training. For the trainee, formal supervision process presents an opportunity to develop an understanding of psychopathology and the theoretical underpinnings of therapeutic interventions in addition to the acquisition of clinical skills. During this time the supervisor acts as a clinical role model, teacher and examiner, administrator and often the trainee's manager within the mental health service. The supervisor also models for the trainee the personalsocial components of clinical practice, such as professional and ethical standards of conduct and the management of work-related tensions.
Clinical Pathways in Mental Health
Authors: Denton Michelle , Wentworth Sue , Yellowlees Peter , Emmerson Brett
Published: March 2003

‘Caremaps [Clinical pathways] are like microwave ovens: five years from now, members of all disciplines will marvel at how they ever got along without them. Of course there will always be some that refuse to accept innovation or who are technophobic. Most people, however, will readily incorporate useful, practical new products into their daily lives.’ Zander [ 1 ]
Through the Glass Darkly: Towards Options for Training, Examination and Continuing Education
Authors: Adler Robert
Published: March 2003

The Royal Australian and New Zealand College of Psychiatrists is a Fellowship of Psychiatrists working together with and for the general community to achieve the best attainable quality of psychiatric care and mental health [ 1 ].

Since its incorporation as the Australian and New Zealand College of Psychiatrists in 1963 over 2000 psychiatrists have become fellows of the College, most by successfully completing the training and examinations process, either in its present form or in an earlier incarnation. The basic framework for the training and examination of psychiatrists in Australia and New Zealand was set down over 30 years ago. It has been modified substantially over the years as training expanded from a three-year membership to a five-year fellowship program. The current system has served us well, producing psychiatrists who compare favourably with their peers anywhere in the world and who have made significant contributions to knowledge in the field. The current review of training, examination and continuing education is not a criticism of past training and examination. Rather, it is an opportunity to consider whether present practices are the most appropriate to equip future psychiatrists to meet the needs and expectations of the community.
An Agenda for Psychiatric Education in Primary Care
Authors: Hickie Ian B. , Scott Elizabeth M. , Davenport Tracey A.
Published: March 2003

Psychiatric epidemiology now highlights the need to improve markedly the delivery of psychological treatments in primary care. There have, however, been significant deficits in the training of practitioners for this role and a lack of ongoing support from specialist mental health services. This paper describes the educational and training agenda for ‘SPHERE: A National Depression Project’. Primarily, the SPHERE Project provides an opportunity for better organising ongoing education and training initiatives for treating common mental disorders in primary care. By having a broad base of interested practitioners the psychological care delivered within any target community may be rapidly expanded. The ongoing involvement of Divisions of General Practice, access to improved technologies and continuous modification of the Project to meet individual practitioners' needs lie at the heart of the Project.
Formation of a Faculty of Psychotherapy
Authors: Tan Eng-Kong , Lonie Isla , Delaney Elizabeth
Published: March 2003

Our College has always emphasised that the practice of psychiatry is based on a biopsychosocial model. Most of us are aware that, for a variety of reasons, psychiatry, both in our region and internationally, has been emphasising the biological and social aspects.
Psychiatry Registrars' Attitudes to Service Evaluation—Implications for Training
Authors: Hudson-Jessop Pamela , Tobin Margaret
Published: March 2003

Since the introduction of the National Mental Health strategy in 1992, significant service reform has taken place. This has not only included structural reform of mental health services but also a push towards improved service quality, introduction of innovative models of service delivery and a greater demand for accountability and service monitoring [ 1 ]. The Second National Mental Health Plan has as one of its key themes the further development of effective, quality service delivery [ 2 ]. Strategies to achieve this goal include development of standards of care, service evaluation and introduction of outcome measures.
The Role of the Brain in Psychiatry: Implications for the Specialist Practice of Psychiatry
Authors: Koopowitz L. F.
Published: March 2003

As the debate on classification of psychiatric disorders intensifies [ 1 – 7 ], a number of seminal articles, that would once have been the domain of neuropsychiatry, have been appearing in the general psychiatry literature [ 9 – 12 ]. These and other articles focus on the interaction between the human organism (and more specifically the nervous system) and the environment [ 9 – 18 ]. This integrated psychobiological approach will hopefully put an end to the outdated nature versus nurture argument (couched in our more sophisticated terms as genetic versus environmental). It will also hopefully ensure that our understanding of the patient will integrate beyond the more concrete biological and/or psychological and/or social approach, when taking into account the factors which contribute to the clinical presentation of mental illness.
Nurse Practitioners in a Private Psychiatric Practice
Authors: Kaplan Robert , Coombs Tim , Murray Susan
Published: March 2003

Psychiatric practice, like other medical disciplines, constantly needs to evolve to meet changing conditions. Many psychiatrists start their careers in hospital, but a significant number end up in private practice, a trend that will increase in future. While public sector resources are not necessarily decreasing, a range of pressures is leading to demoralisation or dissatisfaction, after which the only option is private practice.
Indigenous People, Psychiatric Training and Cultural Clash
Authors: Green Dominic
Published: March 2003

I am sitting on the pier on Palm Island, north Queensland. I look across a jewelled sea and beautiful blue sky. I see luxurious green foliage and a golden sandy beach. I smell the freshness of the monsoonal rains. Kids of all shapes and sizes splash in the waters around me.
Educational Aims and Objectives for Registrar Training in Rural Psychiatry in Australia and New Zealand
Authors: Burke David , Kelly Brian , Goodwin Ian
Published: March 2003

RANZCP trainees in psychiatry are required to have at least three months experience in a rural area, or with populations who are socially or economically disadvantaged. This requirement was introduced in the College by-laws in 1996 [ 1 ] and applies prospectively to all trainees who commenced training after 1 December 1997. In some training programs relatively few trainees have completed experience in rural areas since this time, for a variety of reasons [ 2 ]. Firstly, the alternative to rural experience (a rotation involving working with economically or socially disadvantaged populations) can be done in many metropolitan areas, thus alleviating the need for temporary relocation to the country. Secondly, the low availability of suitably accredited rural posts may prompt the arrangement of an alternative training experience. Thirdly, the educational value of a rural training experience may not be readily apparent.
Duration of Remisson in Schizophrenia After Electroconvulsive Therapy
Authors: Egorov Vitaliy I. , Kirienko Vladislav M.
Published: March 2003

In the situation of deep economic crisis in most of the countries of the former Soviet Union, with an almost total unavailability of psychotropic agents, electroconvulsive therapy (ECT) has become, in many places, the sole method of treatment of schizophrenia. In this paper the results of ECT in 76 male patients with schizophrenia are presented. The effect of ECT on clinical symptoms and duration of remission in schizophrenia are discussed.
Community Treatment for Heavy Users of Private Mental Health Services: Who Benefits?
Authors: Jessop Nikki , Hassall Jon , Geffen Josh , Yellowlees Peter
Published: March 2003

Much attention has been paid recently to the possibilities offered by the development of integrated services across the public and private sectors. In mental health a variety of models have been proposed and trials implemented. This article describes the advantages of a model of public-private integration that addresses the needs of private heavy service users. The model takes advantage of the increasing expertise within the public sector in managing complex and severe mental health problems in community settings and seeks to address the lack of availability of this type of resource for private sector patients.
Report on 1992 by-Laws Case Histories, Clinical Vivas and Consultancy Viva Examinations
Authors: Handrinos Dennis
Published: March 2003

An analysis was undertaken to provide information to the trainees, supervisors, the committees for training, examinations and the wider College Fellowship on some statistical aspects of the College examinations. An analysis like this contributes to the quality assurance activities of Committee of Examinations. When linked with training outcome data, the necessary next step, some useful information regarding determinants of success may arise. This report is timely as the College is in the midst of a process to review all aspects of training and examination.
The Monash Gender Dysphoria Clinic: Opportunities and challenges
Authors: Damodaran Saji S. , Kennedy Trudy
Published: March 2003

Objective: The paper describes the origin, and establishment of a gender dysphoria clinic at Monash Medical Centre, Melbourne. It aims at describing the various components of the service, especially the triadic notions of assessment, real life experience and surgery for gender identity disorders.

Conclusion: This is a unique service offered by a public psychiatric service, and the viability of the service depends upon new resources and renewed interest from psychiatrists. Besides clinical services, the clinic offers enormous research, teaching and training opportunities.
Surviving Disability
Authors: New Harry N
Published: March 2003

A snapshot view of my experiences since developing Multiple Sclerosis and how I have survived the ravages of this condition, so that I remain to this day in active psychiatric practice.
Summary of Psychiatric Training in the UK
Authors: Stratford Joe
Published: March 2003

The purpose of this article is to summarise the nature of psychiatric training in the UK from entry as a trainee to exit where one is eligible for consultant posts. It may also serve to inform how trainees in psychiatry outside of the UK may gain experience of working here.
New Roles for Old: The Role of The Psychiatrist in The Interdisciplinary Team
Authors: Rosen Alan
Published: March 2003

Objectives: The contributions of the psychiatrist to the interdisciplinary team are described, along with the opportunities for, and barriers to, effective teamwork.

Conclusions: Australasian health and medical training systems still provide perverse incentives deterring psychiatrists from becoming full members of interdisciplinary teams. Sources of potential role conflict should be resolved, and advantages of teamwork support, division of labour, cross-fertilisation and hybrid vigour should be realised. Truly essential and desirable roles for psychiatrists in interdisciplinary teams could be developed and strengthened by further training.
The Financial and Service Provision Implications of a New Eating Disorders Service in a Paediatric Hospital
Authors: McDermott Brett , Gullick Karen , Forbes David
Published: March 2003

Objective: To report the burden of care and financial cost of a new Eating Disorders service within a paediatric teaching hospital.

Method: A 39-month period before and after the inception of a child and adolescent Eating Disorders service was studied. Medical records were analysed to compare the burden of care, including number of admissions and bed-days, during the comparison period. The financial implications of the new service were also investigated.

Results: The number of individuals referred, assessed and offered treatment was significantly greater following the inception of the ED Team. The number of admissions and total bed-days utilised significantly increased. The burden of care was shifted to the medical ward. The overall service cost increased by 108% from baseline. However, the cost per-admission and per-inpatient decreased by 40% and 48% respectively.

Conclusions: There are compelling psychological and medical arguments why children and adolescents with Eating Disorders warrant a coordinated team approach. The inception of such a team is likely to create significant financial economies. However, the overall hospital burden of care will significantly rise.
Mentally Abnormal Homicide in Western Australia
Authors: Kraya Niazi , Pillai Krishna
Published: March 2003

Objective: To review persons charged or convicted with homicide referred to the Western Australian Forensic Psychiatric Service.

Method: Review of case note of referrals over a five-year period.

Results: Data from 42 cases were collected. Offenders and victims belonged to a variety of ethnic backgrounds. There were four cases of multiple homicide. The majority of perpetrators and victims were males. A significant number had a pre-existing major psychiatric disorder, about half of who were under psychiatric care at the time of the offence. Half of the patients were diagnosed with schizophrenia or delusional disorder. A gun was used in one fifth of the cases.

Conclusions: The survey highlights the importance of risk management and assertive community follow-up in those with psychosis.
Using Email with Your Patients
Authors: Hatcher Simon
Published: March 2003

Objective: To describe the potential benefits and pitfalls in relation to the use of email with patients, with a view to fostering discussion about the impact of the technology on our discipline.

Conclusions: Email is useful for supplementing information provided in face-to-face sessions and for monitoring progress. ‘Cyberclinics’ present many possibilities to augment traditional patient management. Problems include not all patients having access to the technology and issues relating to confidentiality. The therapeutic relationship is inevitably altered through its use.
Early Childhood Nurse-Delivered Cognitive Behavioural Counselling for Post-Natal Depression
Authors: Prendergast Joanna , Austin Marie-Paule
Published: March 2003

Objective: The aims were (1) to establish whether Early Childhood Nurses (ECNs) can be trained in a modified Cognitive Behavioural Therapy (CBT) for Post-natal Depression (PND), and (2) to compare the outcome of women treated with this therapy with ‘ideal standard care’ using non-specific counselling by ECNs with no additional training.

Method: Five ECNs were trained in CBT and supervised weekly. Women were screened post-natally using the Edinburgh PND Scale (EPDS) and diagnostically assessed by a research registrar. Women with DSM-IV major or minor depression (n=37) were then randomized into either ‘ideal standard care’ (n=20) or CBT (n=17) for six weekly sessions. Two stages of follow-up were undertaken: research registrar interview immediately post-treatment and a postal follow-up at six months.

Results: The training package was evaluated both by ECN completed questionnaires and analysis of taped therapy sessions. These evaluations indicated that ECNs could deliver modified CBT. There was a very high rate of recovery at initial follow-up with 70-80% recovered (EPDS < 10) in both groups. Six month follow-up showed a trend towards CBT being more effective in the longer term.

Conclusions: ECNs can effectively provide a modified CBT intervention in the treatment of PND. For the majority of this sample with mild-moderate depression, perceived support from their ECN (forming an integral part of both the baseline assessment interview and control condition) appeared to be as effective as modified CBT.
Psychiatry in Western Australia since Federation: An Eloquent Testimony
Authors: Skerritt Paul , Ellis Arch , Prendergast Frank , Harrold Colin , Blackmore Harry , Derham Bill
Published: March 2003

Objective: To review aspects of the history of psychiatry in Western Australia since Federation.

Method: Summary of a meeting of the WA Branch RANZCP with contributions from selected senior psychiatrists and one surgeon.

Conclusion: As the population of Western Australia has moved from about 150,000 to nearly 2,000,000 in the twentieth century, psychiatry has reflected world trends and sometimes has led them.
Social Policy and Humanity: The Use of Language as a Social Defence Against Anxiety
Authors: Little John , Blackman Peter , Rouhan Janice
Published: March 2003

Objective: People who work as social policy makers and as managers use a language that is different from people whose work is direct clinical care. The aim of this paper is to describe and explore this phenomenon in an attempt to understand that difference, why it may have developed and what we may learn from it.

Conclusion: This paper has at its heart the notion that the words we use (or don't use) are part of a system in which we attempt to contain our anxieties when faced with seemingly impossible health care issues. It suggests that by doing so we may unwittingly distance ourselves from people with whom we are working and in some way alter our capacity to heal divisions between and within conceptual and clinical frameworks. “The polarising of financial imperatives on the one hand and clinical concerns on the other, is entirely dysfunctional in terms of ensuring optimal health outcome and maximum effectiveness and efficiency of use of the health dollar. The task is to bring the two disciplines of clinical care and financial management into accord. This, I believe, is the challenge of today's hospital management”. Stoelwinder 1997 1
Smoking and Schizophrenia: The Development of Collaborative Management Guidelines
Authors: Meadows Graham , Strasser Kathryn , Moeller-Saxone Kristen , Hocking Barbara , Stanton John , Kee Pat
Published: March 2003

Objective: Smoking is generally on the decline, but more people with disorders such as schizophrenia smoke than is the rule for the general population. Collectively, health professionals in primary or specialist care settings probably do not do as much as they could to help these people cut down or give up, and the issues involved are more complex than they might at first appear. Assisting change in smoking patterns optimally will require collaboration between staff providing smoking-specific interventions such as group-based programs, and medical practitioners who can appropriately support transitions in smoking behaviour. Doctors providing this support should be aware of considerations specific to this group of patients including some relevant pharmacological interactions. This paper describes a project, which involved collaboration between provision of a group-based intervention and medical care including care within a GP shared-care program. A set of guidelines developed for doctors' use within this study has been adapted for wider use.

Conclusions: Our experience with these guidelines, which are summarised in this paper, suggests they should be helpful for a range of clinicians working with people with schizophrenia who also smoke. The RACGP and the RANZCP have endorsed the guidelines, which are available from an internet website.
Managing Services that Manage People with a Coexisting Mental Health and Substance use Disorders
Authors: Welch Mark , Mooney Julie
Published: March 2003

Objective: The Mental Health and Alcohol and Drug Services (MHADS) initiated the present study as a cross-service investigation into current practice and future developments in the provision of services to clients with dual disorders.

Method: A two-part study was conducted over a six-month period to determine: 1) The fidelity to the principles of care outlined in The Service Delivery Guidelines for The Management of People with a Coexisting Mental Health and Substance Use Disorder (2000) (The Service Delivery Guidelines), and 2) The barriers to following the guidelines.

Results: A number of barriers to the full implementation of the guidelines were uncovered, principally in the areas of system issues, training and education, clinical issues, and policies and procedures.

Conclusions: Comorbidity of mental health and substance use disorders is receiving more attention in health services as awareness of the prevalence of these problems increases and the poor outcomes from current service delivery models are more widely acknowledged. However, it is apparent that there is almost as much ‘comorbidity’ in the services that provide the care as in the population itself.
Advanced Training in Adult Psychiatry
Authors: Hughes David , Burke David , Hickie Ian , Wilson Andrrewn , Tobin margaret
Published: March 2003

Objectives: To discuss the current and future challenges facing Adult Psychiatry, explore innovative Advanced Training in Adult Psychiatry as a solution to some of these challenges, and promote discussion among interested parties as a precursor to developing a bi-national program of Advanced Training in Adult Psychiatry.

Conclusions: Adult Psychiatry is an exciting and rewarding subspecialty with a sound and substantial academic and research base.
Mercenaries or Martyrs? How to Fight the Battle in the Provinces
Authors: Hosford Ian
Published: March 2003

Objectives: To highlight the issues in maintaining adequate numbers of psychiatrists in “provincial” areas of New Zealand and look at alternative approaches to resolve the shortage of psychiatrists in these areas.

Conclusions: The current strategy in addressing this issue is not working. An alternative approach would be to offer different incentives to psychiatrists to settle in provincial areas. These incentives could be monetary or the opportunity to obtain full registration to work as a specialist in New Zealand. The College needs to drive any changes in strategy.
The Development of Consensus Guidelines for the Treatment of Young People with First Episode Psychosis
Authors: Moss Beverley , O'Connor Nick
Published: March 2003

Objective: The aim is to describe the process adopted in Northern Sydney, Sydney, Australia for developing consensus guidelines for the treatment of young people with first episode psychosis.

Method: The process included academic detailing with psychiatrists working in Northern Sydney adolescent and adult mental health services, two clinician forums, and a survey. While the guidelines were based on the Australian Clinical Guidelines for Early Psychosis and published studies, the expertise of clinicians in Northern Sydney was also sought.

Results: The consensus guidelines have been endorsed for use in Northern Sydney. The guidelines cover the issues of assessment and treatment of psychosis in young people, investigations, use of parenteral medication, diagnosis, and information for clients.

Conclusions: The authors make several observations about the process of guideline development. Academic detailing proved to be a more effective way than questionnaires for obtaining information from clinicians. The process of developing the guidelines seemed to be, in some ways, more important than the final product.
Thirty Years On: Psychiatric Services in the United Arab Emirates
Authors: Kraya Niazi
Published: March 2003

Objective: To outline some aspects of the psychiatric services in the United Arab Emirates (UAE).

Conclusions: In its short existence, UAE has made significant strides in all aspects and spheres of life, including the delivery of mental health services. Following brief overview of the country's history and geography, the article considers psychiatric services in UAE, workforce issues, academic psychiatry, and moves to developing a national mental health program.
A Discussion with D.M. Armstrong about the Nexus between Philosophy and Psychiatry
Authors: Bas James Le , Armstrong David , King Robert , Blomfield Jocelyn Dunphy , Phillips Neil
Published: March 2003

Objective: To explore practical issues in the Mind-Body Problem through a discussion with philosopher D.M. Armstrong.

Conclusions: Debate about the Mind-Body Problem stretches from the Ancient Greeks to the present time. Thanks to philosophers such as Armstrong and Smart, Australia has played a pivotal role in modern developments. Dialogues involving clinicians and philosophers hold the promise of opening up new fields of intersection.
Primary Care-Led Mental Health Service Reform: An Outline of the Better Outcomes in Mental Health Care Initiative
Authors: Hickie Ian , Groom Grace
Published: March 2003

Objective: To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001-2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content.

Conclusions: The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non-pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non-medical mental health specialists and psychiatrists to meet population-based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system-related outcomes.
Practising Psychiatry in New Zealand's Rural Areas: Incentives, Problems and Solutions
Authors: Lau Trevor , Kumar Shailesh , Thomas David
Published: March 2003

Objectives: To identify challenges faced by psychiatrists working in New Zealand's non-metropolitan areas and identify strategies that New Zealand psychiatrists use to overcome some of these challenges.

Method: Ten psychiatrists attending the RANZCP New Zealand Branch conference in 2000 participated in a focus group. They identified positive and negative aspects of working in New Zealand's non-metropolitan areas and possible solutions to problems.

Results: Ten main themes were identified. These focussed on professional challenges of practising psychiatry in rural areas. Social and economic factors did not rank highly. The solutions generated included expanding the local psychiatric workforce, modifying workload or work pattern of existing psychiatrists, utilising differing models of service delivery, and enhancing professional development.

Conclusions: This is the first study that has reported on challenges of, and some solutions to, practising psychiatry in New Zealand's non-metropolitan areas. Difficulties identified and solutions generated were similar to those found in rural areas of other developed countries. It is important that a widely-accepted nomenclature (“rural”, “provincial”, “urban” psychiatry) be developed. More research is suggested into the characteristics of New Zealand's specialist psychiatry workforce and into the efficacy of any solutions implemented.
Hypotonic duodenograms of postbulbar duodenal lesions: Pictorial essay
Authors: Sumi Yukiharu , Ozaki Yutaka , Shindoh Noboru , Kyogoku Shinsuke , Katayama Hitoshi
Published: March 2003

General features are described and examples are provided of the radiological manifestations of postbulbar duodenal lesions, particularly the findings on hypotonic duodenograms. Hypotonic duodenography does not always reveal the characteristic findings of postbulbar duodenal lesions, but it helps to evaluate luminal stenosis and diagnose disease entities even in lesions that show non‐specific findings. Radiologists should be familiar with the radiological findings of postbulbar duodenal lesions and know which kinds of lesions can affect the postbulbar duodenum. This is important in making a differential diagnosis and in preventing delays in diagnosis.
Effect of hip prostheses on radiotherapy dose
Authors: Carolan Martin , Dao Phuong , Fox Chris , Metcalfe Peter
Published: March 2003

A small but growing proportion of patients requiring radiotherapy for prostate cancer have one or two hip prostheses which may shadow the target and affect the dose distribution. Approximately 10 such patients are treated at the Illawarra Cancer Care Centre per year. Hence a study was undertaken to examine the accuracy of various treatment methods that involve some of the treatment fields travelling through the prosthesis. A fixed‐field measurement showed a dose reduction of 52% in the shadow of the prosthesis. A Monte Carlo simulation confirmed an increase in dose on the distal surface of the prosthesis of 35%. Of more clinical relevance, however, is the dose distribution due to the overall combined field treatment. Using a power law correction benchmarked against thermoluminescent dosimeters and Gafchromic film, three different beam set‐ups for patient treatment were planned and the dose variation analysed. A four‐field brick technique gave a dose variation across the target volume of ± 15% whereas a dual arc technique gave a dose variation of only ± 5%. A four‐field oblique technique gave a dose variation of only ± 2% across the target volume but the oblique field technique included extra dose to the rectum.
Eligibility audits for the randomized neuropathic bone pain trial (TROG 96.05)
Authors: Roos Daniel E , Davis Sidney R , O’Brien Peter C , Hoskin Peter J , Spry Nigel A , Burmeister Bryan H , Turner Sandra L , Bernshaw David M
Published: March 2003

In February 1996 the Trans‐Tasman Radiation Oncology Group (TROG) initiated a two‐arm, multicentre, prospective randomized trial on radiotherapy for neuropathic pain due to bone metastases (TROG 96.05). This trial compares the response to a single 8‐Gy fraction with 20 Gy in five fractions. The accrual target is 270 patients. In order to evaluate compliance with eligibility criteria after approximately 1 year of accrual, an independent audit of the first 42 randomized patients was commissioned. This found that only one of these patients did not have genuine neuropathic pain, but that this patient and seven others (19%) had infringements of other eligibility/exclusion criteria for the trial. Accordingly it was decided to continue the full audit up to 90 patients. This detected no further patients without genuine neuropathic pain, and found only one other eligibility infringement (1/48; 2%). It is concluded that this quality assurance (QA) measure undertaken early in the trial led to significantly improved clinician awareness of, and compliance with, eligibility/exclusion criteria. It also enabled an accurate comparison of outcome data for all randomized versus all eligible patients at the time of the preplanned first interim analysis at 90 patients. In view of the excellent compliance demonstrated in the second audit, a one‐in‐five sampling is proposed for future audits from centres that have already accrued at least five consecutive eligible patients. This is consistent with TROG QA guidelines now operational.
Modified computed tomography peritoneography: Clinical utility in continuous ambulatory peritoneal dialysis patients
Authors: Hawkins Stewart P , Homer Jocelyn A , Murray Brendan B , Voss David M , Merwe Walter M van der
Published: March 2003

The purpose of the present paper is to review the indications, results, clinical correlation and implications for management of a modified CT peritoneography (CTP) technique in the evaluation of continuous ambulatory peritoneal dialysis (CAPD) patients. Forty CTP in 33 patients were reviewed by two observers blinded to clinical history or outcome. The CTP technique included 100 mL non‐ionic intraperitoneal contrast, 1 h of ambulation and prone positioning during the CT. No precontrast or delayed examinations were performed. A CAPD‐related complication was diagnosed in 33 of 40 (82%) CTP . Twenty‐nine CTP were performed for evaluation of suspected dialysate leaks. In this group there were 18 leaks, a total of seven umbilical hernias (five as isolated findings) and five normal studies. Nine of 18 (50%) leaks resolved with conservative management and six of nine patients (67%) of the remainder continued CAPD after appropriate surgery. Seven patients were evaluated for scrotal swelling (one bilateral), and there were five communicating hydroceles (all with inguinal fat herniation and all surgically confirmed) and three non‐communicating hydroceles (none of which progressed). Umbilical hernias were present in nine of 33 patients (27%). No false positive or false negative studies were identified. The CTP technique described provides accurate diagnostic information in the management of common CAPD‐related complications, particularly dialysate leak, genital swelling, abdominal wall hernias and peritoneal adhesions. Computed tomography peritoneography directs appropriate conservative or surgical management.
Haemangiopericytoma of the trigeminal nerve
Authors: Tan Irene , Soo Mark YS , Ng Thomas
Published: March 2003

A 41‐year‐old man presented with a 4‐year history of progressive right‐sided diplopia on lateral gaze and right nasolabial paraesthesia. A CT revealed minor bone erosion of Meckel’s cave and of the right petrous apex by a uniformly enhancing lesion at the base of the skull. Magnetic resonance imaging on three occasions over 2 years showed tumour, measuring 4 cm in diameter, with features suggestive of a trigeminal neuroma. At surgery the lesion had the macroscopic appearance of a giant schwannoma. Histopathological findings were that of a meningeal haemangiopericytoma (HPC) of the trigeminal nerve. Intracranial HPC are rare and aggressive tumours of the central nervous system. They usually arise from the falx, tentorium and dural sinuses. The present case is unique as it originates from a cranial nerve.
Giant fibroadenoma of the breast in an Arab population
Authors: Hanna RM , Ashebu SD
Published: March 2003

In a retrospective study of giant breast masses over a period of 20 years (1980–2000), we encountered 18 patients with fibroadenomas. Most of them were adolescents and young adults. The bimodal age incidence seen in Caucasians was not observed. The masses ranged from 6 to 15 cm in size and in the youngest patient, they were bilateral. All 18 patients were examined by mammography and 10 of them by ultrasonography (US) as well. The right breast was involved in 12 patients and the left in six. The diagnosis was confirmed pathologically in all patients, by excision biopsy in 17 patients and by fine needle aspiration cytology and excision biopsy in one patient. The radiological findings were the same as those previously described. All patients were treated by simple enuculation. There was only one recurrence over a follow‐up period from 2 months to 3 years.
Dural sinus thrombosis presenting as unilateral lobar haematomas with mass effect: An easily misdiagnosed cause of cerebral haemorrhage
Authors: Singh T , Chakera T
Published: March 2003

Dural sinus thrombosis has protean clinical and radiological manifestations ranging from minimal effacement of sulci with no symptoms to severe haemorrhagic infarcts associated with focal deficits, coma and even death. An uncommon form of presentation is characterized by unilateral lobar haemorrhage associated with extensive oedema and parenchymal distortion. In an acute presentation, this might resemble haemorrhage into a tumour. In delayed presentations, the haematoma, being iso‐ or hypodense and showing peripheral ring‐like enhancement, can mimic aggressive tumours or infective processes. As this is an uncommon condition, misdiagnosis is common with the potential for mismanagement and adverse outcomes. We present five such consecutive cases that were initially misdiagnosed as other entities. Each of these cases on closer inspection show features observed on CT and MRI that should have suggested a diagnosis of dural venous sinus thrombosis. One of these cases progressed to not only extensively involve the superficial sinuses but also the deep veins, with a significant adverse outcome. The imaging features of this interesting variant of dural sinus thrombosis are reviewed. The haemodynamic basis for haemorrhage and anatomical basis for the lateralization of the lesions are discussed.
MRI of muscular hamartoma of the breast
Authors: Wong KW , Ho WC , Wong TT
Published: March 2003

Muscular hamartoma is a well‐demarcated tumour composed of smooth muscle and adipose tissue. We report the MRI findings of a patient with benign breast neoplasm. To the best of our knowledge, its appearance has not been previously reported.
Aneurysms of the inferior vena cava
Authors: Sheth Rahul , Hanchate Vijay , Rathod Krantikumar , Ahmed Iftikhar , Deshmukh Hemant , Chaubal Nitin
Published: March 2003

Two cases of saccular aneurysms of the infrarenal inferior vena cava (IVC) associated with retrohepatic IVC obstruction are described. Ultrasonographic, computerized tomographic and inferior venacavography findings in these cases are presented.
CHRONIC STUDIES ON THE INTERACTION BETWEEN NITRIC OXIDE AND ENDOTHELIN IN CARDIOVASCULAR AND RENAL FUNCTION
Authors: Pollock David M
Published: March 2003

1. Chronic inhibition of nitric oxide synthase (NOS) results in a persistent hypertension, while chronic blockade of endothelin ETA receptors has little effect on arterial pressure. These findings indicate that nitric oxide (NO) plays a more significant role than ET‐1 in the long‐term maintenance of arterial pressure.

2. Although endothelin (ET) appears to contribute to the hypertension in the early stages of NOS inhibition, blockade of either ETA or both ETA and ETB receptors has only a minor effect on the hypertension beyond the initial 2 weeks of NOS inhibition.

3. Endothelin may play a role in vascular lesion development associated with NOS inhibition, at least within the kidney, which may be related to angiotensin II activity.

4. The processes involved in the hypertension associated with chronic NOS inhibition appear to be dynamic and may include an evolution of ET‐1 action. Variability in results from different laboratories may be related to genetic factors and choice of pharmacological agents.
ESTIMATION OF ARTERIAL MECHANICS IN CLINICAL PRACTICE AND AS A RESEARCH TECHNIQUE
Authors: Cameron James
Published: March 2003

1. Large conduit artery pathophysiology is associated with considerable morbidity with even normal ageing, irrespective of concurrent influences, associated with impaired arterial function.

2. Recent technical advances have enabled high‐resolution non‐invasive assessment of pulsatile arterial properties, but this has been largely confined to more muscular superficial arteries. There has been less study of arterial regions prone to disease that would, theoretically at least, benefit from pharmacological or other intervention to improve function.

3. Based on studies in animal models and, in particular, human arterial segments, specific pharmacological agents have been proposed as improving arterial behaviour. If this is to become a therapeutic target, it behoves increased effort to understand and measure meaningful indices of arterial function and to find ways of assessing response and outcome.

4. A number of different approaches to assessment and quantification of arterial mechanics are available in the literature. The present review compares and discusses some of these different techniques and looks at differences between arterial segments and evidence that appropriate intervention may beneficially modify arterial behaviour.

5. For clinical or research usefulness, assessment of arterial mechanics must provide more information than currently derived from simple numerical measurement of brachial blood pressure. This is particularly true because epidemiological risk evidence is based on brachial rather than central blood pressure recordings. There has been an explosion of work in this field in recent years and the present review does not pretend to reference all relevant material; rather, it tries to provide a broad coverage of the topic and hopes to support the need for continued endeavours in the field of arterial mechanics.
EFFECTS OF MILD AEROBIC EXERCISE AND A MILD HYPOCALORIC DIET ON PLASMA LEPTIN IN SEDENTARY WOMEN
Authors: Okazaki Tetsuya , Himeno Etsuro , Nanri Hiroki , Ogata Hajime , Ikeda Masaharu
Published: March 2003

1. The present study was conducted to investigate whether mild aerobic exercise and a mild hypocaloric diet, instead of severe restrictions on caloric intake, would affect weight reduction and plasma leptin concentrations.

2. Forty‐one middle‐aged sedentary women (15 obese and 26 non‐obese) participated in a 12 week lifestyle‐modification programme to reduce cardiovascular risk factors. Bodyweight, body composition, plasma leptin concentrations, serum lipid profiles, fasting plasma glucose and fasting plasma insulin were measured before and after the 12 week intervention. The intervention consisted of aerobic exercise, corresponding to approximately 50% of maximal oxygen consumption, and personal diet counselling.

3. Bodyweight decreased by (mean±SD) 3.9±3.4 kg in the obese group (P < 0.05) and by 1.7±1.8 kg in the non‐obese group (P < 0.05). The plasma leptin concentration decreased significantly from 14.7±5.3 to 8.9±3.6 ng/mL in the obese group (P < 0.001) and from 7.6±3.9 to 5.6±2.2 ng/mL in the non‐obese group (P < 0.01).

4. Overall, for all subjects, both pre‐ and postintervention, the plasma leptin concentration was significantly correlated with body mass index (BMI; pre‐intervention: r = 0.73, P < 0.0001; postintervention: r = 0.67, P < 0.0001), fat mass (FM; pre‐ intervention: r = 0.74, P < 0.0001; postintervention: r = 0.63, P < 0.0001) and fasting plasma insulin (pre‐intervention: r = 0.66, P < 0.001; postintervention: r = 0.45, P < 0.01). The change in plasma leptin concentration was significantly correlated with the respective changes in BMI (r = 0.64, P < 0.0001), FM (r = 0.48, P < 0.01) and fasting plasma insulin (r = 0.58, P < 0.0001). Interestingly, the ratio of plasma leptin concentration to BMI or FM diminished significantly after intervention. In addition, we found that the plasma leptin concentration decreased in participants whose FM did not decrease. These results suggest that the production of leptin per unit FM decreased after intervention.

5. Mild aerobic exercise and a mild hypocaloric intake decreased body mass and the plasma leptin level in Japanese middle‐aged sedentary women. This decrease in plasma leptin levels was likely to be associated with weight reduction plus some unknown factor(s).
LEFT VENTRICULAR MASS AND MICROALBUMINURIA: RELATION TO AMBULATORY BLOOD PRESSURE
Authors: Gatzka Christoph D , Reid Chris M , Lux Alan , Dart Anthony M , Jennings Garry L
Published: March 2003

1. Both microalbuminuria and left ventricular hypertrophy may reflect target organ damage in essential hypertension. Both are related to the prevailing level of blood pressure and both are associated with an increase in morbidity and mortality.

2. The database of the Hypertension Diagnostic Service, a multicentre secondary referral clinic for patients with essential hypertension, was analysed in order to clarify the level of association between microalbuminuria and left ventricular hypertrophy, which might explain the observed increase in morbidity and mortality in patients with microalbuminuria. Microalbuminuria was measured semiquantitatively by urine dip‐stix. After the exclusion of patients with potential secondary hypertension, renal disease and diabetes mellitus, patients with complete data for microalbuminuria, left ventricular mass (LVM) and 24 h blood pressure monitoring were selected.

3. Data were complete for 704 patients (47% male, age 51±12 years) and 42% tested positive for microalbuminuria. Microalbuminuria was positively related to 24 h systolic blood pressure and weight and was negatively related to age. Left ventricular mass was higher in patients with microalbuminuria (men, 265±69 g; women, 207±61 g) than in those without (men, 250±64 g, P < 0.05; women, 185±50 g, P < 0.001). After correction for the effects of gender, body mass index and 24 h systolic blood pressure, the presence of microalbuminuria was associated with an increase in LVM of 10 g (P < 0.05, 95% confidence interval, 2–19 g).

4. Microalbuminuria as measured by urine dip‐stix is associated with an increase in LVM in patients with essential hypertension, independent of other known determinants.