bluuebunny/crossref_metadata_2025 huggingface dataset:
Opinions of healthcare professionals regarding the maternity experiences of indigenous women in an acute care setting
Authors: Watson Jennifer , Hodson Katrina , Johnson Rhona , Kemp Kath , May Jessica
Published: March 2003

Abstract:  This is the report of stage three of a three stage project. The aims of the overall project were to seek advice from expert Indigenous women on how to gather information from birthing Indigenous women while in hospital. Information was gathered from Indigenous women who gave birth in hospital or were admitted after the birth of their baby. The opinions of healthcare professionals on the care of these women were investigated. This paper describes the opinions and concerns of healthcare professionals regarding identified cultural, social and economical issues for Indigenous women at a large acute care hospital in the Northern Territory, Australia. The opinions of healthcare professionals are vital if the needs and concerns of Indigenous women are to be considered within the hospital setting.

Stages one and two of this project have been presented previously. Stage three, reported here, describes a survey of 18 non‐Indigenous and one Indigenous healthcare professionals regarding their opinions of the maternity experiences of Indigenous women admitted to an acute care setting. The consultative process for designing the questionnaire and reflections on issues raised by Indigenous women during their interviews in the previous two stages is presented. The methodology of the survey, demographics and perceptions of healthcare professionals who participated in the project are examined and the similarities and differences between the issues raised by the healthcare professionals and the Indigenous women in stage two of the project are discussed. Suggestions made by the healthcare professionals regarding improving quality of care for Indigenous women when admitted to an acute healthcare setting are presented.
Ipsilateral rotational autokeratoplasty for the management of corneal opacities
Authors: Verma Nitin , Melengas Simon , Garap Jambi Arringa
Published: March 2003

Purpose/Background: Penetrating keratoplasty is the logical solution for the management of corneal opacities. In situations such as in Papua New Guinea, where donor corneal tissue is scarce and corneal opacities are plenty, an alternative procedure for the management of corneal opacities in the form of ipsilateral rotational autokeratoplasty was considered.

Methods: In the present prospective study, ipsilateral rotational autokeratoplasty was performed in 17 eyes over a 2 year period in a general hospital. The patient’s cornea was trephined eccentrically and the corneal opacity was dialed out of the visual axis and was replaced by clear peripheral cornea.

Results: Most opacities were leucomata (76.4%). The average size of the opacity was 5.1 mm and the corneal button size was 7 mm. A final visual acuity of 6/18 or better was obtained in 64.7% of cases (at 12 months). No significant postoperative complications were encountered. No complex formula was needed to calculate the size of the button and, by simply adding 3 mm to the pupillary diameter in standard illumination, one could make an estimation of the graft diameter.

Conclusions: Rotational autokeratoplasty has a definite role in places where donor corneal tissue is scarce, in patients in whom long‐term steroids are a risk or in situations where follow up of patients is difficult. Rejection is a theoretical impossibility, but late endothelial failure could occur, requiring regrafting. Rotational autokeratoplasty should be seriously considered as an alternative to conventional penetrating keratoplasty.
Clinicopathological report: Mucinous carcinoma of the eyelid*
Authors: Lee Graham A , Cominos Diane , Sullivan Timothy J
Published: March 2003

Background: Mucinous carcinoma of the skin is a rare tumour that may involve the peri‐ocular region.

Methods/Results: A case report is presented of a 73‐year‐old woman with a right upper lid tumour, initially diagnosed as a basal cell carcinoma. Excisional biopsy of the residual tumour revealed mucinous carcinoma. Re‐examination of the original pathology proved to be mucinous carcinoma, originating in the eyelid skin. Further treatment involved wide local resection and reconstruction. Systemic investigations were undertaken to exclude the possibility of metastatic mucinous carcinoma.

Conclusion: This case is presented to alert ophthalmologists to the occurrence of this rare tumour in the peri‐ocular region, to highlight the importance of surgical excision with wide margins and the need for systemic investigation to exclude a primary malignancy in other sites, in particular the gastrointestinal system and breast.
Pursuit of the Perfect Mother: An Unusual Case of Stalking
Authors: Samuels Anthony H. , Allnutt Stephen , Tan Eng-Kong
Published: March 2003

Objective: To highlight issues of adoption and twinship in an unusual case of stalking.

Clinical picture: An ususual case of same gender, serial stalking which began at an early age in a young woman who was one of a set of twins adopted at birth.

Treatment: Insight orientated psychotherapy.

Outcome: Beneficial outcome in context of clear boundaries, therapist selection and emphasis upon legal consequences of behaviour.

Conclusions: Early disruptions to attachments including adoption and twinship may have relevance in some patterns of adult stalking behaviour.
How Long does it Take for Antidepressant Therapies to Act?
Authors: Parker Gordon , Roy Kay , Menkes David B. , Snowdon John , Boyce Philip , Grounds David , Hughson Bernard , Stringer Catherine
Published: March 2003

Objective: To review the proposition that antidepressants have a delayed onset of action by employing measurement and analytic strategies that overcome problems confounding interpretation of many efficacy studies.

Method: A subset of patients was recruited to the longitudinal component of the Australasian database study, was assessed at baseline, and then completed measures of depression and anxiety when treatment commenced, and every 3 days over the next 4 weeks. The trajectories of defined 4-week outcome responders and non-responders were compared.

Results: Both groups showed a similar decrease in depression (and anxiety) over the first 3 days. A clear trend break then occurred, with little further improvement in the non-responders, as against distinct and progressive improvement in the responders. Ongoing early improvement (across days 3–6) was a strong predictor of responder status.

Conclusions: The small sample size limits firm interpretation, although distinct interpretive advantages to the study design are evident. Findings are compatible with a number of recent studies arguing against any extensive delayed onset of action for the antidepressant drugs, but argue for caution in interpreting immediate improvement as predicting likely responder status, and more for examining early and sustained improvement as such a marker.
Magnetic Resonance Spectroscopy and Schizophrenia: What have we Learnt?
Authors: Vance Alasdair L.A. , Velakoulis Dennis , Maruff Paul , Wood Stephen J. , Desmond Patricia , Pantelis Christos
Published: March 2003

Objective: Magnetic resonance spectroscopy (MRS) has been increasingly used to investigate the in vivo biochemistry of particular regions of the brain in patients with schizophrenia. We review the literature and discuss the theoretical constructs that form the presumed impetus for these studies in light of the current methodological limitations. Future directions are noted.

Method: The available published literature in English formed the basis for this review.

Results: The results of 31P-MRS have been interpreted as reflecting a relative increase in cell membrane degradation in prefrontal cortical regions at certain phases of schizophrenia. 1H-MRS studies, though less consistent, provide evidence suggestive of a decrease in neuronal cell mass in the hippocampal region, which supports the findings of volumetric studies. Both groups of MRS studies support a neuro-developmental hypothesis of brain dysfunction in schizophrenia. However, current methodological problems limit the reliable interpretation of MRS data. A clear understanding of the methodology and its reliable interpretation is yet to emerge.

Conclusions: MRS remains a research instrument that is yet to be fully utilised in schizophrenia research. A few replicated findings are emerging, although the interpretation of these spectroscopic findings needs to be validated.
FAMILIAL FATAL AND NEAR‐FATAL THIRD VENTRICLE COLLOID CYSTS
Authors: Stoodley Marcus A. , Nguyen Thai P. , Robbins Peter
Published: March 2003

Background: Despite having a presumed congenital origin, familial cases of colloid cysts have been reported only rarely. The first case of a brother and sister with colloid cysts is reported here, and the relevant literature is reviewed.

Methods: A 25‐year‐old man presented with a 24‐h history of headache and vomiting. He rapidly became unconscious and fulfilled the criteria for brain death on arrival at hospital. No surgical intervention was performed.

Results: The patient’s sister presented at the age of 41 with headaches and rapidly became unconscious. The sister had urgent bilateral ventriculostomies, followed by transcallosal removal of a colloid cyst.

Conclusions: These cases support the hypothesis that colloid cysts are congenital lesions and provide some evidence of a possible genetic predisposition to their formation. Sudden death remains a real risk for patients harbouring a colloid cyst.
PREVALENCE OF HELICOBACTER PYLORI INFECTION IN 160 PATIENTS WITH BARRETT’S OESOPHAGUS OR BARRETT’S ADENOCARCINOMA
Authors: Lord Reginald V. N. , Frommer Donald J. , Inder Stephanie , Tran Dinh , Ward Robyn L.
Published: March 2003

Background: The role of Helicobacter pylori infection in the development of Barrett’s oesophagus and its complications is uncertain. The aim of the present study was to determine the importance of H. pylori infection in this disease by comparing the frequency of oesophageal and gastric H. pylori infection in a group of patients with Barrett’s oesophagus or adenocarcinoma, with the frequency of infection in a control group without Barrett’s disease.

Methods: The study group included 160 patients (123 male, 37 female; mean age: 61.2 years) who were classified (according to the highest grade pathological lesion in the oesophagus) as having Barrett’s intestinal metaplasia (IM; 88 patients), Barrett’s oesophagus with low‐grade dysplasia (LGD; 28 patients), high‐grade dysplasia (HGD; five patients), Barrett’s indefinite for dysplasia (n = 4), and Barrett’s adenocarcinoma (33 patients). A total of 91 of these patients had gastric antral specimens available for study. The control group consisted of 214 consecutive, prospectively enrolled symptomatic patients (122 male, 92 female; mean age: 57.2 years) who underwent upper gastrointestinal endoscopy and in whom Barrett’s oesophagus or Barrett’s adenocarcinoma was not found. A modified Warthin–Starry method was used to detect H. pylori infection.

Results: Oesophageal H. pylori infection was found in eight of 160 (5%) patients with Barrett’s oesophagus or Barrett’s adenocarcinoma. Helicobacter pylori organisms in the oesophagus were found only on non‐intestinalized cardiac or oxyntocardiac mucosa. All patients with oesophageal H. pylori infection and an antral biopsy available for study had antral H. pylori infection. Gastric antral H. pylori infection was significantly less prevalent in patients in the Barrett’s study group (15/91, 16.5%) than in the non‐Barrett’s control group (67/214, 31.3%; Fisher’s exact test, P = 0.01). Patients from the control group with an endoscopic diagnosis of duodenal ulcer, gastric ulcer, gastritis, or duodenitis had a significantly higher prevalence of infection compared with the Barrett’s group, but there was no difference in the infection prevalence in patients in the Barrett’s group and patients with reflux oesophagitis, hiatal hernia, no endoscopic abnormality, or any other diagnosis.

Conclusions: Oesophageal H. pylori infection is uncommon in patients with Barrett’s IM, dysplasia, or adenocarcinoma, and may be restricted to non‐intestinalized columnar epithelium. Gastric H. pylori infection may have a protective effect for the development of Barrett’s oesophagus.
THE VALUE OF CYTOLOGY IN GRANULOMATOUS MASTITIS: A REPORT OF 16 CASES FROM MALAYSIA
Authors: Yip C. H. , Jayaram G. , Swain M.
Published: March 2003

Background: Granulomatous mastitis is a rare condition of the breast that can mimic a carcinoma. There are characteristic histological features, the most important of which is a predominantly lobular inflammatory process. It must be differentiated from known causes of granulomatous inflammation, such as tuberculosis.

Methods: In the present paper, the clinical and pathological features of 16 patients with granulomatous mastitis seen over a 3‐year period in the University Hospital, Kuala Lumpur, are described.

Results: A clinical suspicion of malignancy was present in 10 cases. One of the patients was nulliparous. One had an associated hyperprolactinaemia, while two had systemic lupus erythromatosis. One of the patients was pregnant at the time of presentation. Four patients had localized lumps excised, five were treated conservatively because the lesion was too extensive to resect, and seven patients required drainage procedures for abscess formation.

Conclusion: Awareness of this condition is important because it mimics a carcinoma, and surgery may not be the best treatment for recurrent disease.
HIP FRACTURE RATES IN SOUTH AUSTRALIA: INTO THE NEXT CENTURY
Authors: Chipchase L. S. , Mccaul K. , Hearn T. C.
Published: March 2003

Background: Fractures of the femoral neck already represent a major public health problem in Australia. This situation is set to worsen as the population ages. The present study estimates the number of patients over 50 years of age with femoral neck fractures that is expected to impact on the South Australian healthcare service into the next century.

Methods: Population projections from the Australian Bureau of Statistics 1996 census were combined with age‐ and gender‐specific incidence rates for fractures of the femoral neck for persons over the age of 50 in South Australia. Projections for the expected number of hip fractures in this State were then calculated.

Results: Assuming there are no changes in the age‐ and gender‐specific incidence of fracture rates, the number of fractures in South Australia is estimated to increase by approximately 66% by the year 2021 and 190% by 2051.

Conclusion: Based on the population projections and the assumption that conditions contributing to hip fractures remain constant, the number of fractured neck of femurs will increase in far greater proportion than the overall population in the next century. The results of the present study indicate the serious implications for the South Australian healthcare system if there is no reduction in incidence rates.
REFRACTORY AMIODARONE‐ASSOCIATED THYROTOXICOSIS: AN INDICATION FOR THYROIDECTOMY
Authors: Claxton Scott , Sinha Sankar N. , Donovan Shaun , Greenaway Timothy M. , Hoffman Linda , Loughhead Michael , Burgess John R.
Published: March 2003

Background: Tasmania is an area of endemic iodine deficiency. Amiodarone is a class III anti‐arrhythmic drug that is widely used for the management of ventricular and supraventricular tachydysrhythmias. Individuals from areas of endemic iodine deficiency appear more likely to manifest hyperthyroidism following amiodarone therapy, whereas hypothyroidism is a more frequent complication in iodine‐replete communities.

Methods: Cases series. The clinical and biochemical response to medical and surgical management of five consecutive Tasmanian patients presenting with severe type‐II amiodarone‐associated thyrotoxicosis was reviewed.

Results: Five patients were identified. Combinations of antithyroid therapy including propylthiouracil, lithium carbonate, dexamethasone and cholestyramine were used. Thyroidectomy was required in two cases (40%) due to severe unremitting thyrotoxicosis despite combined drug regimens. Anaesthesia and total thyroidectomy were undertaken without complication despite the presence of severe hyperthyroidism at the time of surgery. In both cases thyroid histopathology demonstrated degenerative and destructive follicular lesions with multinuclear cell infiltrate and focal fibrosis.

Conclusion: Amiodarone‐associated thyrotoxicosis may be severe and refractory to medical therapy. Despite the potential risks of anaesthesia associated with uncontrolled thyrotoxicosis, thyroidectomy should be considered in the setting of life‐threatening thyrotoxicosis.
Large bowel volvulus in childhood
Authors: Samuel M. , Boddy S. A. , Nicholls E. , Capps S.
Published: March 2003

Background: Large bowel volvulus is extremely uncommon in children. The probable pathogenesis, predisposing factors and management of large bowel volvulus in children are debatable.

Methods: Seven consecutive cases of large bowel volvulus occurring over a 6‐year period are reported.

Results: Two patients with caecal volvulus, one with transverse and subsequent sigmoid volvulus, one with transverse colon volvulus and three children with sigmoid volvulus are reported. Four girls and one boy with cerebral palsy, one female with Moya Moya disease and spastic paraplegia and an otherwise healthy boy presented at a mean age of 8.3 years (range: 3–15 years). The common presentation was abdominal distension (n = 6), tenderness (n = 6), constipation (n = 7) and bloody mucoid discharge per rectum (n = 6). Plain abdominal X‐ray and barium enema were diagnostic. Resection with primary ileocolic, colocolic or colorectal anastomosis was performed in all cases. The mean follow‐up was 3.4 years (range: 1–6 years) and there was no mortality.

Conclusions: Large bowel volvulus in children may be due to congenital anomalous or absent ligamentous fixation of the large bowel, and abnormal mesocolon or a common ileocolo‐mesentery. Large bowel obstruction due to volvulus must be considered in the differential diagnosis in a child presenting with constipation associated with bloody mucoid discharge per rectum. Resection of the involved segment and primary anastomosis is the definitive treatment for large bowel volvulus in children.
IMPROVING BASIC SURGICAL SKILLS FOR FINAL YEAR MEDICAL STUDENTS: THE VALUE OF A RURAL WEEKEND
Authors: House Anthony K. , House Jill
Published: March 2003

Background: Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques.

Method: The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety‐five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process.

Results: The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty‐five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant.

Conclusions: The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the class‐room. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.
CORPUS CAVERNOSUM AS AN ALTERNATIVE MEANS OF INTRAVENOUS ACCESS IN THE EMERGENCY SETTING
Authors: Nicol D. , Watt A. , Wood G. , Wall D. , Miller B.
Published: March 2003

Background: The present study was designed to investigate the feasibility of using the corpus cavernosum as an alternative means of intravenous access in the emergency setting.

Methods: The feasibility of achieving the infusion flow rates was first ascertained using direct intracavernous infusion of normal saline. The effect of atropine and adrenaline when given via this route was then studied. Hypovolaemic shock was then induced in dogs who were then actively resuscitated via this route using normal saline, Haemaccel and whole blood.

Results: Infusion flow rates were achieved for normal saline of 32.3, 50.3 and 67.3 mL per min at 100, 200 and 300 mmHg pressure, respectively. The peak effects of atropine and adrenaline via this route were seen at approximately 1 min after injection. Resuscitation using this method was uniformly successful in all dogs via the corpus cavernosum, with all reaching or exceeding their premorbid central venous pressure (CVP), and approaching or reaching their premorbid mean arterial pressure (MAP). In comparison the control dog’s CVP and MAP did not rise during the period of observation after it was bled.

Conclusions: The corpus cavernosum is a practical alternative means of intravenous access in the emergency setting in the dog model.
CLINICAL AND HISTOLOGICAL FACTORS ASSOCIATED WITH SENTINEL NODE IDENTIFICATION IN BREAST CANCER
Authors: Kollias J. , Gill P. G. , Coventry B. J. , Malycha P. , Chatterton B. , Farshid G.
Published: March 2003

Background: Although sentinel lymph node biopsy is likely to be offered as a method of assessing nodal status in primary breast cancer, the inability to identify the sentinel node at the time of surgery will limit the number of patients who may benefit from the procedure. The purpose of the present study was to identify factors that are associated with intraoperative identification of the sentinel node(s).

Methods: Between September 1995 and May 1999, lymphatic mapping using a combination of preoperative lymphoscintigraphy and/or blue dye was performed on 169 consecutive patients with clinically lymph node‐negative primary operable breast cancer. Clinical and histological factors were assessed using univariate and multivariate analysis to determine those that were associated with intraoperative identification of the sentinel node.

Results: The sentinel node was identified at the time of surgery in 142 cases (84%). Of the clinical factors assessed, preoperative identification of the sentinel node on lymphoscintigraphy (P < 0.0001), use of blue dye in combination with isotope (P = 0.001), symptomatic palpable tumours (P < 0.05) and the experience of the surgeon (P = 0.03) were significant in identifying the sentinel node at operation. No histological factor was associated with intraoperative identification of the sentinel node. Using multivariate analysis, positive identification of the sentinel node on lymphoscintigram, the experience of the surgeon and the use of both blue dye and isotope for sentinel node mapping were independent factors associated with intraoperative sentinel node identification. The lymphoscintigram result was the strongest independent factor according to its β value, a measure of the weight of significance.

Conclusion: Patients undergoing sentinel lymph node mapping and biopsy should be warned of the possibility of failure of sentinel node identification at operation. Our results suggest that the best predictor of intraoperative sentinel node identification is the visualization of the sentinel node on preoperative lymphoscintigraphy. The result of the lymhoscintigram may allow for additional preoperative counselling of the patient regarding the success or failure of sentinel node biopsy. Technical factors such as the experience and diligence of the surgeon, as well as the sentinel node mapping technique, are also important in determining the success of the procedure.
The Safety Of Electrolytically Induced Hepatic Necrosis In A Pig Model
Authors: Wemyss‐Holden Simon A. , Hall Pauline De La M. , Robertson Gavin S. M. , Dennison Ashley R. , Vanderzon Paula S. , Maddern Guy J.
Published: March 2003

Background: Electrolysis fulfils the criteria for an ideal treatment of patients with unresectable liver tumours. Previous studies in the rat and pig have shown that controlled necrosis can be safely produced by inserting platinum electrodes into normal liver parenchyma and liver tumours. As with any new treatment it is mandatory to investigate the ‘worst‐case scenario’ of inadvertent intra‐vascular electrode placement in a large animal model before progressing to clinical trials.

Methods: Under ultrasound control in six pigs, electrodes were inserted into, or immediately adjacent to, an hepatic vein. An electrolytic ‘dose’ of 100 C was then administered and the evolution of the lesion was monitored using ultrasound. Venous blood was collected before and during the electrolysis to evaluate potential acid/base disturbances and animals were closely monitored during electrolysis and during their recovery until a full autopsy was performed 4–7 days after treatment.

Results: Gas bubbles were seen to enter the hepatic veins or inferior vena cava during treatment in five of the six animals. There were no major complications as a consequence and all animals recovered and remained in a healthy state until they were killed. At autopsy one animal had complete thrombotic occlusion of the left hepatic vein. Otherwise, findings were normal.

Conclusion: In the clinical setting, due to the use of ultrasound to guide electrode placement into the centre of a tumour, the electrodes should rarely juxtapose an hepatic vein. Nevertheless, in this extreme situation, electrolysis is surprisingly safe with only one major vascular occlusion and no morbidity or mortality.
Management of Intraparotid Facial Nerve Schwannomas
Authors: Chong K. W. , Chung Y. F. A. , Khoo M. L. C. , Lim D. T. H. , Hong G. S. , Soo K. C.
Published: March 2003

Background: The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome.

Methods: Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital.

Results: There were three men and two women with an age range of 29–65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine‐needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect, achieving facial nerve grade II–IV (House–Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II.

Conclusions: Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine‐needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.
Operative Field Contamination by the Sweating Surgeon
Authors: Mills S. J. C. , Holland D. J. , Hardy A. E.
Published: March 2003

Background: There are a number of factors relating to the host, bacteria and wound that are important in the development of wound infection. The effect of the surgeon sweating has not been previously reported.

Methods: Ten surgeons performed a mock total hip joint operation under sterile conditions while not sweating and then repeated the operation while sweating. Settle plates were used to quantify the bacterial counts in the operative field in both phases.

Results: For each subject a mean of 3.3 colony forming units (c.f.u.) were present in the non‐sweating phase and 6.9 c.f.u. were present in the sweating phase (P < 0.05). Organisms grown were normal skin flora.

Conclusion: The sweating surgeon may be more likely to contaminate the surgical field than the non‐sweating surgeon. It is important for orthopaedic surgeons, especially those performing joint replacement surgery, to be aware of this and to take measures to minimize sweating in the operating theatre.
National Breast Surgery Audit
Authors: Malycha P. , Tyson S.
Published: March 2003

Background: Surgical audit is routinely conducted throughout the surgical community in order to examine practice in a peer‐review environment. A national audit for breast cancer surgery has been implemented in Australia and New Zealand. It aims to standardize the way in which surgical activities are recorded. The present paper describes the development and implementation of the audit project.

Methods: An audit kit including instruction manual, data dictionary and choice of two data collection instruments (paper or database) were distributed among participants. Surgeons record their patients prospectively, submit data to central office and provide feedback.

Results: Information on 3000 breast cancer patients has been collected within the first 6 months.

Conclusion: The project has been successfully implemented and is continuing to develop. Many surgeons have incorporated the patient record forms in their routine case management activities. Comments and other submissions have been reviewed and changes incorporated into the second and subsequent releases of the kit.
Information about surgery: What does the public want to know?
Authors: Courtney Mark J.
Published: March 2003

Background: Informed consent has become an important part of medical practice. The aim of the present study was to determine what the public prefers to know before an operation and to establish some order of priority on that information.

Methods: A questionnaire was developed from 12 pieces of information each developed into a statement. There were two sections to the questionnaire. The purpose of the first section was to assess the priority that participants place on each statement of information, and the purpose of the second section was to assess the preference to knowing that statement of information.

Results: According to priority the four most important statements were options for treatment; risks (‘common’); the operator (‘meeting the surgeon’); and surgical technique. The four statements with the highest percentage of ‘prefer to know’ responses were recovery time; options for treatment; legal rights; and the operator (‘meeting the surgeon’).

Conclusions: The present study has identified priorities that the public assign to different aspects of preoperative information. The public has a high degree of desire for this information. The present study gives further insight into what information the public would like surgeons to share with them in preoperative consultations.
The development of undergraduate curricula in surgery: III. Assessment
Authors: Hamdorf Jeffrey M. , Hall John C.
Published: March 2003

The present review is aimed at providing an overview of the assessment process. The mode of assessment has a powerful influence on the learning behaviour of students. It is therefore important to ensure that there is congruity between the objective, the task and the test. In other words: define it, teach it, examine it. It is difficult to evaluate many of the attributes that we desire in a doctor; and examples of this include empathy, ethical behaviour, problem‐solving skills, ability to self‐educate and teamwork. Nevertheless, it is generally agreed that it is better to measure uncertainly the significant than to measure reliably and validly the trivial. Furthermore different methods of assessment suit different educational objectives (fitness for purpose) and this supports the use of multiple assessment techniques.
New method of inguinal hernia repair: A new solution
Authors: Desarda Mohan P.
Published: March 2003

Background: A new technique to strengthen the posterior wall of the inguinal canal in all types of inguinal hernias is described. This method of repair is done without mesh and has been developed because mesh is not easily available in rural or remote parts of many countries.

Methods: After excision of the sac, a strip of the external oblique aponeurosis (EOA) is partially separated from its medial leaf, keeping its continuity intact at either end. This undetached strip of EOA is sutured to the inguinal ligament below and the arch of muscle above, behind the cord, to form a new posterior wall. This strip is put under tension by muscular contraction and works as a shield to prevent recurrence so that the external oblique muscle gives additional strength to the weakened internal oblique and transverse abdominis muscles.

Results: A total of 400 patients have been operated on from 1983 to 1999 and follow up by physical examination was carried out. (Eighty patients have been followed up for more than 10 years.) The postoperative period was comfortable with a hospital stay of 2–3 days and a return to work within 1–2 weeks. Recurrence was seen in only one case and haematocoele in one case.

Conclusion: These results are comparable with operations performed with mesh. This operation is simple to perform, does not require mesh or extensive dissection and has produced excellent results. Therefore it is a good alternative to mesh or other open or laparoscopic repairs.
The death of Henry II of France: A sporting death and post‐mortem
Authors: Martin Graham
Published: March 2003

In 1559 Henry II King of France was wounded in a tournament and died. A broken lance entered his right orbit, destroying his eye and leaving behind many splinters. The skull was not penetrated but infection spread intracranially. Both Ambroise Paré and Vesalius saw him and predicted death. Nine days after wounding, both attended the King’s post‐mortem. The story shows how difficult life was without antisepsis, anaesthesia, antibiotics or investigations. The King’s stubbornness highlights the dangers of continuing to play after concussion.
A community development role for occupational therapists working with children, adolescents and their families: A mental health perspective
Authors: Scaletti Rowena
Published: March 2003

With world‐wide deregulation of mental health services, occupational therapy services are being decentralized with growing importance placed on community based interventions. The present article proposes a model of community development for child and adolescent mental health as one way of encompassing change. The model has five steps (developmental casework, mutual support, coalitions of mutual interest, pro‐active community participation, social movements), each facilitating change for subsequent stages of mental health. In combination with the theories of occupational behaviour, role acquisition, developmental and psychosocial theories and the use of coping resources and theories of community development, the model offers an occupation‐specific approach that empowers clients to take control of events that influence their health and lives.
Values of urban Aboriginal parents: Food before thought
Authors: Nelson Alison , Allison Heather
Published: March 2003

Using qualitative methodology, this study investigated values of urban Aboriginal parents, particularly with respect to parenting and child development. Data were collected from five urban‐dwelling Aboriginal parents aged between 25 and 55 years. Participants were parents of children aged between 18 months and 25 years. All participants were also employed in the fields of education or health where they had frequent involvement with other indigenous parents through welfare support or school or health programs. Each informant participated in either an individual interview or focus group. Supplemental data were also collected from participant observation in a kindergarten setting. Descriptions of Aboriginal parents’ values and parenting styles are reported. The main values included an emphasis on maintaining social relationships and cultural identity with an overriding need for survival and security. Implications for occupational therapy practice and further research with urban Aboriginal families are suggested.
Performance of Australian children on the Miller assessment for preschoolers compared with USA norms
Authors: Hickey Annabel , Froude Elspeth H. , Williams Annette , Hart Tanya , Summers Janet
Published: March 2003

The aim of this study was to compare the performance of Australian children on the Miller assessment for preschoolers (MAP), to that of USA norms. The MAP (with Australian language changes) was administered to a sample of 218 Australian children across the six age groups of the test. Chi‐squared analysis, comparing scores of the Australian sample with the USA norms, detected significant differences between the two groups on all variables except the Verbal Index. Australian children obtained higher scores for Foundations, Non‐verbal and Complex Tasks indices and higher Total Scores, and lower scores on the Coordination Index, in comparison to USA children. The findings indicate that, except for the Verbal Index, MAP scores may not accurately reflect developmental performance of Australian children. An Australian standardization or modification of the test is therefore needed. Until changes are made, caution should be adopted when interpreting MAP scores. Clinicians may also find the Australian language changes helpful in making the test more relevant to Australian children.
Issues Associated with the Implementation of Routine Outcome Measures in Public Mental Health Services
Authors: Rock Danny , Combrinck Johann , Groves Aaron
Published: March 2003

Objective: The purpose of this paper is to examine strategies that may facilitate the successful implementation of service-wide outcome measures in public mental health services.

Conclusions: The available evidence suggests that a top-down approach to the introduction of state-wide routine outcome measurement across all public mental health services is likely to have only limited success. A centrally co-ordinated but locally directed bottom-up approach may be a more successful long-term strategy. Such an approach could make optimum use of a small team of “outcome experts”, while the use of strategies such as the development of local clinical guidelines would increase the co-operation and participation of the wider clinical community. An initial collection of clinical and social demographics could provide important contextual information on service populations and would initiate the administrative and communication networks that would need to be developed for later routine, multi-site data collection.
Radiosurgery at the Royal Adelaide Hospital: The first 41/2years’ clinical experience
Authors: Roos De , Brophy Bp , Zavgorodni Sf , Francis Jw
Published: March 2003

Radiosurgery refers to the treatment of small lesions localized by stereotactic technology using highly focused radiation. This review utilizes prospectively gathered data from the Royal Adelaide Hospital Radiosurgery unit to summarize experience with the first 62 patients (65 lesions) treated between November 1993 and May 1998. This experience included acoustic neuromas (23 patients), arteriovenous malformations (18), brain metastases (12), meningiomas (6), and glomus tumour, subependymoma, dural arteriovenous fistula (1 each). Although follow up is relatively short, the outcome in terms of morbidity and tumour control is thus far comparable with results reported in the literature. Radiosurgery provides a viable alternative to neurosurgery and conventional external beam radiotherapy for several benign and malignant intracranial lesions.
Pulmonary inflammatory pseudotumour in children
Authors: Patankar Tufail , Prasad Srinivasa , Shenoy Asha , Rathod Krantikumar
Published: March 2003

Inflammatory pulmonary pseudotumour is an uncommon, non‐neoplastic, occasionally aggressive spindle cell proliferative process of uncertain nosology. It has distinctive histopathological features and benign clinico‐biological behaviour with multifocal lesions or recurrences in a minority of cases. Recognition of this entity is of paramount importance because it has considerable therapeutic and prognostic implications. The radiological features of two patients with pulmonary pseudotumour that was confirmed on histopathological examination are described.
Hyperimmunoglobulinaemia E syndrome: Pulmonary imaging features
Authors: Jhaveri Kartik S , Sahani Dushyant V , Shetty Prashant G , Shroff Manu M
Published: March 2003

Hyperimmunoglobulinaemia E (hyper‐IgE) syndrome (Job’s syndrome) is a rare disease that presents with recurrent cutaneous and sinopulmonary infections, and which begins in infancy and is associated with extreme hyper‐IgE. The pulmonary imaging features typically consist of recurrent alveolar lung infections, pneumatocoeles and, occasionally, pneumothorax. Various other causes of pneumatocoeles in children can be excluded on the basis of clinical history and other data. Computed tomography may add valuable information for the management of these patients.
Invasive lobular carcinoma: Sonographic features of cancers detected in a BreastScreen Program
Authors: Cawson Jennifer N , Law Eu‐Meng , Kavanagh Anne M
Published: March 2003

Sixty‐two screen‐detected invasive lobular carcinomas (ILC) were studied for sonographic, mammographic, clinical and histological findings. Ultrasound (US) features were compared with 60 invasive duct cancers (IDC). Size and axillary lymph node status in ILC were compared with all other cancers detected. In 41 ILC examined with US, 36 were found as masses (87.8% sensitivity; 95% CI 77.8–97.8%). Some US features of ILC and IDC differed: ILC were 9.94 times more likely to be hyperechoic (odds ratio, OR, 9.94; 95% CI 3.28–31.74) and 77% less likely to be taller than wide (OR 0.23; 95% CI 0.18–0.62). Thirty‐three ILC showed typical malignant features of spiculate margins and acoustic shadowing. invasive lobular carcinomas had a greater mean diameter (20.4 mm; n = 60) than other invasive cancers (14.4 mm; n = 322) (P < 0.001). Ultrasound‐guided needle biopsy was the method of diagnosis in 26 of 41 impalpable ILC (63%). Ultrasound has high sensitivity in characterizing screen‐detected ILC, which may have atypical sonographic features including hyperechogenicity and a wider than tall shape. Ultrasound was an important contributor to diagnosis.
Randomized prospective comparison of non‐contrast enhanced helical computed tomography and intravenous urography in the diagnosis of acute ureteric colic
Authors: Homer Jocelyn A , Davies‐Payne David L , Peddinti Bhavani S
Published: March 2003

Non‐contrast enhanced helical CT has become an accepted technique for evaluating acute ureteric colic. The results of a randomized prospective comparison of the accuracy, cost and radiation dose of CT and intravenous urography (IVU) are presented. All patients presenting to the Emergency Department with symptoms and signs suggestive of ureteric colic over a 16‐month period (n = 242) were randomized to CT or IVU. Follow up was obtained for 228 patients (94%), with 14 patients (6%) lost to follow up. One hundred and twenty‐three patients (54%) underwent CT and 105 (46%) had an IVU. At follow up the sensitivity and specificity of CT were each 100%, while those of IVU were 99% and 100%, respectively. Computed tomography demonstrated seven of 26 (27%) potential alternative diagnoses, whereas IVU suggested one of 23 (4%). Estimates of the average effective dose were calculated for CT (4.95 mSv) and IVU (1.48 mSv, 95% confidence interval (CI) 0.7–2.27). Radiation dose and intravenous contrast material safety are discussed and the relative costs are considered. Computed tomography is as accurate as IVU in the diagnosis of acute ureteric colic. It confers certain major diagnostic benefits, and is a fast, well‐tolerated technique. Its accompanying higher effective radiation dose is recognized.
Measurement of the transverse cerebellar diameter in preterm neonates and its use in assessment of gestational age
Authors: Davies Mark W , Swaminathan Mohan , Betheras F Rex
Published: March 2003

This study aims to confirm the relationship between gestational age (GA) and transverse cerebellar diameter (TCD), to define the prediction of GA by TCD, and assess the reliability of TCD measurements. Infants were included in the study if they had a routine cranial ultrasound scan by day 3, and the TCD was measured. Infants were excluded from the study if the GA was not known, if there was any cranio‐spinal malformation or grade 3 or 4 intraventricular haemorrhage (IVH). The GA assessment was an early pregnancy scan or certain dates. Cranial ultrasound scans were done with a LOGIQ 500 scanner (GE Medical Systems, Waukesha, WI, USA) with a 7 MHz curvilinear sector probe (GE LOGIQ‐C721; GE Medical Systems). The posterior fossa was scanned using the asterion as the acoustic window with the TCD measured in the coronal plane. Intra‐ and interobserver reliability were assessed. A total of 221 infants of known GA had their TCD measured. The linear regression for GA versus TCD is: GAweeks = (0.470 × TCDmillimetres) + 13.162 (r = 0.89, r2 = 0.79, P < 0.001). The 95% confidence interval predicts GA to ± 2.33 weeks for a given TCD. Intra‐ and interobserver intraclass correlation coefficients are 0.98 and 0.99, respectively. Transverse cerebellar diameter correlates closely with GA and predicts GA to ± 2.33 weeks. Measurements of TCD have excellent reproducibility.
Lhermitte–Duclos disease associated with Cowden’s syndrome: Case report and literature review
Authors: Murray Conor , Shipman Peter , Khangure Mark , Chakera Turab , Robbins Peter , McAuliffe William , Davis Stephen
Published: March 2003

Lhermitte–Duclos disease (LDD) is a rare entity that may occur in the setting of Cowden’s syndrome (CS). Accurate preoperative diagnosis can be made on the characteristic CT and MR appearances, thereby obviating the need for biopsy. It is important to be aware of the link between LDD and CS so that appropriate genetic counselling and tumour surveillance can be undertaken.
Diagnosis of choledocholithiasis and bile duct stenosis by magnetic resonance cholangiogram
Authors: Hussein Fawzia MY , Alsumait Basil , Aman Sami , Sinan Tariq , Alkandari Khalid , Hniya M Haroon da , Alsaeed Osama
Published: March 2003

We evaluated the diagnostic accuracy of magnetic resonance cholangiography (MRC) in the diagnosis of bile duct calculi and stenosis. Two‐dimensional fast spin echo (FSE) MR cholangiograms were performed using torso multicoil array as a surface coil and respiratory triggering in 50 patients suspected of having bile duct disease. Coronal and axial images were acquired and reviewed prospectively by two radiologists. Direct cholangiographic correlation (endoscopic retrograde cholangiopancreatography [ERCP], intraoperative cholangiogram, percutaneous transhepatic cholangiogram) and surgery were available for comparison and were reviewed by two radiologists. The sensitivity, specificity and accuracy of MRC in diagnosing bile duct dilatation, choledocholithiasis and stenosis were evaluated. It yielded a sensitivity and a specificity of 100% in diagnosing bile duct dilatation. In the diagnosis of choledocholithiasis, MRC yielded a sensitivity of 95%, a specificity and an accuracy of 96%. Bile duct stenosis was diagnosed with a sensitivity and a specificity of 100%. We concluded that MRC exhibited high accuracy in diagnosing bile duct stenosis and choledocholithiasis.