bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of roles and professional development needs of nurse executives working in metropolitan, provincial, rural or remote settings in Queensland
Authors: Courtney Mary , Yacopetti Jane , James Catherine , Walsh Anne , Finlayson Kathleen
Published: March 2003

Abstract:   This research provides a profile of nurse executives’ roles, career opportunities and professional development needs across metropolitan, provincial, rural and remote settings in Queensland. A cross‐sectional survey was posted to all Directors/Assistant Directors of Nursing in the Queensland Public Health Sector (n = 281), with a response rate of 52.3% (n = 147).

Findings indicated that the role of nursing executives has expanded and diversified, with multiple role responsibilities increasing with distance from the metropolitan area. Nurse executives in remote areas were less satisfied with the quality of supervision and mentorship they received, and least likely to participate in career enhancing activities. Metropolitan nursing executives utilised more of the career enhancing opportunities provided by the Queensland Public Health Sector than did provincial, rural or remote nursing executives. Provincial nurse executives were the group most likely to network, attend conferences and participate in informal educational activities. Professional development needs, although generally common to all groups, were more practice specific for those in rural and remote areas. Many nurse executives begin their careers in rural or remote areas where limited opportunities for career development may be detrimental to their future development.
Ruralising medical curricula: the importance of context in problem design
Authors: Hays Richard , Sen Gupta Tarun
Published: March 2003

The establishment of a new medical school in northern Australia, with its focus on preparing graduates to understand the health care needs of the regional population, has raised an interesting issue in problem design for teaching and assessing in an integrated curriculum. This issue is the extent to which the clinical content of a teaching or assessment problem should consider more subtle contextual issues that help to define the different roles played by rural practitioners, rather than what might be regarded as appropriate for ‘generic’ medical education. This brief paper provides example case studies that highlight the challenge facing curriculum designers developing programs for rural clinical schools.
Hanging, Firearm, and Non-Domestic Gas Suicides Among Males: A Comparative Study
Authors: De Leo Diego , De Leo Diego , Evans Russell , Neulinger Kerryn
Published: March 2003

Objective: To identify characteristics that could distinguish males who completed suicide by hanging from males who completed suicide by firearms and non-domestic gas, and to suggest suicide prevention strategies targeted at hanging.

Method: Using the psychological autopsy design, males who used hanging, firearms and non-domestic gas were compared on a range of variables covering social, psychological, and health related factors and aspects of the suicide incident. The sample consisted of 950 males who suicided in Queensland, Australia, between 1994 and 1996.

Results: Compared with males who used firearms and non-domestic gas, males who used hanging were significantly younger, less likely to have left a suicide note, and more likely to have been diagnosed with a psychotic disorder. Compared with males who used firearms, males who used hanging were significantly more likely to have made prior suicide attempts and have had no physical illness. Compared with males who used non-domestic gas, males who used hanging were significantly more likely to have lived with others, have had prior legal trouble, and have suicided at their residence.

Conclusions: The results are discussed in terms of the availability and socio-cultural acceptability of methods. The authors suggest a possible relationship between impulsive traits and method choice. This proposition requires further investigation using alternative methodologies. Some suicide prevention measures targeting hanging suicides are discussed in light of the results.
Treatment-Resistant Depression: When Antidepressant Drug Intolerance May Indicate Food Intolerance
Authors: Parker Gordon , Watkins Tim
Published: March 2003

Objective: To describe a patient with food intolerance probably contributing to depressive symptoms, intolerance to psychotropic medication and treatment resistance.

Method: The case vignette and investigatory procedures are detailed.

Results: The patient's course improved considerably with an elimination diet.

Conclusions: The prevalence of food intolerance as a contributing factor to depressive disorders requires clarification. Clinicians should be aware of the possible syndrome and that it may be worsened by psychotropic medication.
Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder
Authors: Schore Allan N
Published: March 2003

Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder.

Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions.

Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders.

Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.
Characteristics of Parent- and Child-Reported Anxiety in Psychostimulant Medication Naïve, Clinically Referred Children with Attention Deficit Hyperactivity Disorder, Combined Type (ADHD-CT)
Authors: Vance Alasdair , Costin Jan , Barnett Rebecca , Luk Ernest , Maruff Paul , Tonge Bruce
Published: March 2003

Objective: Anxiety is a frequent comorbid condition in referred primary school-age children with attention deficit hyperactivity disorder, combined type (ADHD-CT), yet there has been relatively little systematic research of the nature of this comorbid anxiety. We describe the characteristics of parent-reported child anxiety disorders and child-reported anxiety disorders in primary school-age children with ADHD-CT.

Method: A cross-sectional study of 75 clinically-referred psychostimulant medication naïve children with ADHD-CT examining separately parent and child reports of anxiety, defined categorically and dimensionally. A two-year follow up of 12 children with parent-reported child anxiety and 12 children with child-reported anxiety was also completed.

Results: There was no significant association between the child and parent reports of anxiety. Generalized anxiety disorder (GAD), separation anxiety disorder (SAD), specific phobia (SpPh) and social phobia (SoPh) were the most common anxiety disorder diagnoses reported by parents and children. Two-year follow-up data revealed no decrease in the parent report but a significant decrease in the child report of anxiety disorders.

Conclusions: The dissonance between the parent report of child anxiety and the child report of anxiety, emphasizes the importance of careful and thorough clinical assessment of the child's perspective. The nature of parent-reported child anxiety and children's self-report of anxiety requires further systematic research.
Naltrexone in the Treatment of Heroin Dependence: Relationship with Depression and Risk of Overdose
Authors: Ritter Alison J
Published: March 2003

Objective: This article examines the use of naltrexone in the treatment of heroin dependence. The relationship between naltrexone and depression as well as risk of overdose is examined.

Method: The existing literature is reviewed along with recent interim data from clinical trials underway in Victoria.

Results: Naltrexone is a recent addition to treatment for heroin dependence in Australia. The relationship between depression and naltrexone has been examined in previous literature. Underlying rates of depression in heroin users are high and treatment may resolve or exacerbate depression. Research to date demonstrates that the addition of naltrexone does not necessarily increase depression in patients. The risk of non-fatal heroin overdose is significantly elevated after naltrexone treatment as a result of reduced tolerance. Data from clinical trials underway in Victoria demonstrate a significantly elevated rate of non-fatal overdose in naltrexone patients compared to those in substitution maintenance treatment. The mortality rate subsequent to naltrexone treatment appears to be equivalent to or greater than that for untreated heroin users. Further research is required.

Conclusions: Clinicians need to carefully monitor depression in patients, and warn patients of the risks of reduced tolerance to opiates following naltrexone treatment. Agonist treatments such as methadone, LAAM and buprenorphine carry much less risk of overdose.
TOTAL COLECTOMY FOR CROHN’S DISEASE
Authors: Rieger Nicholas , Collopy Brian , Fink Roy , Mackay John , Woods Rodney , Keck James
Published: March 2003

Background: Total colectomy for Crohn’s disease of the colon may be restorative with ileorectal anastomosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy and whether this was related to disease in the rectum at the time of the original operation.

Methods: A retrospective case note review was undertaken of patients operated upon between 1968 and 1994.

Results: Thirty‐eight patients were identified (mean age 35 years; range 17–65 years). One patient died perioperatively from an anastomotic leak. Median follow‐up for the remaining patients was 7 years (range 1–29 years). Ileorectal anastomosis was performed in 17 patients and total colectomy and ileostomy in 20 patients. Indications for surgery were failure of medical treatment (61%); toxic colitis (18%); abscess (8%); perforation (5%); large bowel obstruction (5%); and colovesical fistula (3%). Subsequent proctectomy (14 patients, 38%) was more likely with subtotal colectomy and ileostomy (nine patients, 45%) than ileorectal anastomosis (five patients, 29%). This was not statistically significant (P = 0.33). Additionally, seven patients had diversion of the rectum making 21 with an ileostomy (57%). Rectal involvement at the time of the original procedure significantly increased the likelihood of permanent ileostomy (P = 0.001). The presence of anal disease did not increase the prospect of ileostomy. One patient died with advanced adenocarcinoma in a defunctioned rectum.

Conclusions: A permanent ileostomy after total colectomy for Crohn’s disease is common and significantly more likely with rectal involvement.
NEW RELEASE OF THE BOONPONG LAPAROSCOPIC CAMERA HOLDER
Authors: Kornsuthisopon Songsak
Published: March 2003

Background: A voice‐activated robotic arm named AESOP (automated endoscopic system for optimal positioning) has enabled the view through the laparoscopic camera to be kept in focus, but is very expensive. There is thus a need for a cheap, manually controlled, laparoscopic camera holder.

Methods: The original prototype utilized the principle of an adjustable desk lamp. This holder proved steady at any required angle. To protect the camera shaft, this was inserted through the wider part of a cut end 10 mm port before fixation in the holder. To improve manoeuvrability, a ‘floating arm’ was adopted between the table clamp and the holder. Subsequent developments included reduction in size of the modified desk lamp and water heating of the inverted protective sheath to minimize lens fogging. Pre‐operatively, the holder is sterilized for 15 min in glutaraldehyde solution, while the floating arm is autoclaved.

Results: The instrument has been used in 42 laparoscopic operations in which a steady, well‐focused view of the operating field has been attained.

Conclusion: The instrument is easily and cheaply constructed. It can be adapted to hold other endoscopic instruments as in anorectal laser surgery, or to hold the laparoscopic camera when this is used to perform microsurgery without a microscope. It is named ‘the Boonpong laparoscopic camera holder’ in memory of a Thai hero under whose Dunlop‐Boonpong Scholarship the author has had the opportunity to gain some Australian surgical experience.
DEREGULATION OF APOPTOSIS IN COLORECTAL CARCINOMA: THEORETICAL AND THERAPEUTIC IMPLICATIONS
Authors: Butler Lisa M. , Hewett Peter J. , Fitridge Robert A. , Cowled Prudence A.
Published: March 2003

Apoptosis, or programmed cell death, maintains the structure of the colonic crypts by providing a balance to the rate of cell proliferation. Colorectal carcinoma arises partly from a disruption in this balance in the favour of uncontrolled growth. Until recently, most research into colon cancer has focused on the molecular regulators of cell‐cycle progression and proliferation, but it is now evident that apoptosis is also defective. A failure of cells to die in response to premalignant damage may allow the progression of the disease and maintain the resistance of cancer cells to cytotoxic therapy. This review outlines the importance of apoptosis in the normal colon and presents recent studies that demonstrate that induction of apoptosis is defective in colonic tumours. When the molecular regulation of apoptosis is better understood, this knowledge may lead to the earlier detection of patients at greater risk of developing colorectal carcinoma, and also to the development of more effective therapies.
DIFFICULT OR INCOMPLETE FLEXIBLE SIGMOIDOSCOPY: IMPLICATIONS FOR A SCREENING PROGRAMME
Authors: Stewart Bruce T. , Keck James O. , Duncan Anne V. , Santamaria Nicholas M. , Allen Philip
Published: March 2003

Background: Pilot studies are currently underway to investigate the use of flexible sigmoidoscopy as a screening tool for colorectal cancer. Estimates of the sensitivity of this investigation in detecting adenomas and carcinomas frequently assume a complete examination to 60 cm in all cases. This study seeks to determine the depth of insertion of flexible sigmoidoscopy in asymptomatic volunteers, and to examine the causes and implications of an incomplete examination.

Methods: A prospective study of flexible sigmoidoscopy in asymptomatic volunteers was conducted. The maximum depth of insertion was measured in all cases, and a database compiled of patient characteristics, discomfort and endoscopic difficulty.

Results: Independent risk factors for reduced depth of insertion were female sex, previous abdominal surgery in females, high expectation of pain in females and poor bowel preparation. The procedure was considered difficult in 33% of cases.

Conclusions: Estimates of the efficacy of flexible sigmoidoscopy as a colorectal cancer screening modality should take into account the relatively high rate of incomplete studies, particularly in women.
DERIVING OPERA FROM OPERATION
Authors: Magee Reginald
Published: March 2003

Male castration has been practised for centuries in many parts of the world. In Italy in the 16th to the 19th centuries it was performed for the purpose of preserving the soprano voice of boys. The castrati performed in the church choirs, but in the field of opera they achieved the popularity and status of the modern day rock singers. An outline of the operative procedure is given with its physiological consequences, and mention is made of some of the singers who achieved fame at that time. Recently an attempt has been made to reproduce the sound of the castrato voice using the facilities of modern electronic technology.
HOW TO PREDICT RETURN TO THE COMMUNITY AFTER FRACTURED PROXIMAL FEMUR IN THE ELDERLY
Authors: Cree Andrew K. , Nade Sydney
Published: March 2003

Background: There are numerous studies about morbidity and mortality, technical complications and in‐hospital factors after proximal femoral fracture surgery in the elderly. Although experienced clinicians are often able to make an accurate prediction, little information is available about the factors that allow early determination of whether a patient may return to the community. The present study aimed to provide that information and, hence, allow better use of health resources.

Methods: At Westmead Hospital a prospective study was conducted of 304 patients with a proximal femoral fracture who were previously residing at home. A number of different factors were analysed using statistical methods to determine their effect on outcome, which was defined simply in terms of whether the patient was able to return to the community or whether they needed institutional care.

Results: Factors that had an adverse influence on return to the community were: a low activities of daily living (ADL) score on admission; increasing age; dementia; the use of regional analgesia; and the occurrence of postoperative complications. Other factors such as gender, fracture type, delay to surgery and length of stay were not significant.

Conclusions: Consideration of the ADL score, age and mental state at the time of admission to hospital is all that is needed to determine return to the community. This is helpful to the patient and their family, and allows an early and appropriate referral pattern to either community services or a nursing home.
THE ANATOMY OF THE EXTRATHORACIC INTERCOSTOBRACHIAL NERVE
Authors: O’Rourke Michael G. E. , Tang Tek S. , Allison Stephen I. , Wood Walter
Published: March 2003

Background: In the past decade surgeons have become increasingly aware of the morbidity caused by the division of the inter‐ costobrachial nerve (ICBN) during axillary dissection. To prevent this problem and also to explain its variable occurrence, a detailed knowledge of the anatomy of the nerve is required.

Methods: Twenty‐eight axillary dissections were performed demonstrating the anatomy of the ICBN.

Results: In all dissections the nerve originated from the second intercostal space, with contributions from the first and third intercostal nerve each on one occasion. The posterior axillary branch was constant but may branch early, simulating a second nerve. The ICBN had a variable relationship to the lateral thoracic vein: anterior, posterior or wrapping around it. In 36% there was a connection to the medial cord of the brachial plexus in the axilla. In the upper arm the nerve lies in the subcutaneous fat; in the majority it supplied at least the proximal half of the arm, and in one‐third it reached the level of the elbow joint. In 18% there was a connection to the medial cutaneous nerve of the arm.

Conclusion: The ICBN and its main branch (the posterior axillary nerve) were constant in all dissections. But its origin, size, connection to the brachial plexus and medial cutaneous nerve of the arm were variable, as was its ultimate destination in the arm.
THE OPERATIVE MANAGEMENT OF SCREEN‐DETECTED BREAST CANCERS
Authors: Crawford M. D. , Biankin A. V. , Rickard M. T. , Coleman M. J. , West R. , Niesche F. W.
Published: March 2003

Background: Mammographic screening for breast cancer not only reduces the overall mortality from breast cancer but allows greater opportunities for breast‐conserving operations. The predicted degree of breast conservation is not being realized, but is increasing in centres that have published their results.

Methods: The operative management of breast cancers diagnosed by BreastScreen Central and Eastern Sydney Screening and Assessment Service were compared between two time periods: January 1988–December 1992 (group 1) and January 1993–December 1995 (group 2). The rate of breast conservation, and other data were compared between the two periods. An attempt was made with multivariate analysis to identify some of the factors that made mastectomy rather than conservation more likely.

Results: There were 723 cancers detected that were suitable for analysis (group 1, n = 273; group 2, n = 450). In group 1 the breast conservation rate was 42.9%; this increased significantly to 60.4% in group 2 (P < 0.001). The data were examined to determine if there was any other factor that had changed over the time periods which might account for the increased rate of breast conservation. The use of pre‐operative diagnostic techniques such as fine needle aspirate cytology and core biopsy increased significantly. Multivariate analysis comparing the differences in patient age, diagnostic technique, tumour type, grade, size, location and lymph node status, both independently and compositely did not account for the increase in breast conservation in group 2.

Conclusion: The increase in breast conservation is due to other factors such as the surgeons’ approach and patient attitude. The use of pre‐operative, minimally invasive tissue sampling techniques is increasing.
AN EVALUATION OF TRAUMA TEAM RESPONSE IN A MAJOR TRAUMA HOSPITAL IN 100 PATIENTS WITH PREDOMINANTLY MINOR INJURIES
Authors: Lu Wen Hao , Kolkman Karel , Seger Maria , Sugrue Michael
Published: March 2003

Background: A prospective study of trauma team response and performance at a major trauma service was undertaken between June and September 1998.

Methods: Following activation of the trauma team, the timing of the trauma team’s arrival, the subsequent early management of the patient, time to monitoring, X‐ray investigation and procedures performed were documented.

Results: The study evaluated 100 activations, 76% male, mean age 32 years and 65% were due to road trauma. The team leader, airway doctor and surgical registrar were present on patient arrival in 96%, 90% and 76% of cases, respectively. The airway, procedure and scribe nurses were present on patient arrival in 77%, 97% and 95% of cases, respectively. The radiographer was present in 69% of cases. Comparison between normal and after‐hour response revealed little difference in medical and radiographer response, but the after‐hour nurse response was significantly worse (P < 0.001). The median time to achieve electrocardiogram monitoring, blood pressure reading, and oxygen saturation tracing was 3 (range: 1–13), 4 (range: 2–20) and 3 (range: 1–21) min, respectively. Intravenous cannulation, phlebotomy and dispatch of bloods occurred at median times of 5 (range: 2–22), 6 (range: 3–23) and 17 (range: 7–40) min. The median times for intubation, chest tube and splintage of fracture were 10 (range: 3–19), 10 (range: 6–14) and 26 (range: 19–55) min, respectively.

Conclusions: The present study identified an excellent multidisciplinary trauma response and provides a template to improve performance in early trauma management.
Appendicitis In The Elderly
Authors: Lee J. F. Y. , Leow C. K. , Lau W. Y.
Published: March 2003

Background: Acute appendicitis in the elderly (i.e. those over 60 years of age) is associated with high morbidity and mortality rates. The present retrospective study reviews 10 years (1986–1996) of experience and outcome in treating acute appendicitis in patients aged 60 or above.

Methods: One hundred and thirty patients with acute appendicitis were identified and their case notes reviewed.

Results: Acute appendicitis was diagnosed at admission in 84 patients (64.6%). The remaining patients were observed for a median duration of 9.4 h prior to diagnosis and treatment. Patients with an underlying perforated acute appendix had a significantly longer period of pain prior to admission (P = 0.029; Mann–Whitney U‐test) but perforation per se was not associated with a significantly higher rate of morbidity and longer length of hospital stay. In contrast, the use of midline or paramedian incisions was associated with a higher wound infection rate (P = 0.003; Pearson chi‐squared test) and a longer hospital stay (P < 0.001; Mann–Whitney U‐test). None of the patients were subsequently found to have an underlying colonic neoplasm. The overall morbidity rate was 28%. The mortality rate was 2.3% and all three patients who died had a severe comorbid medical condition prior to developing acute appendicitis.

Conclusions: Acute appendicitis in the elderly is still associated with significant morbidity. But once acute appendicitis is diagnosed, then expedient surgery, appropriate use of perioperative antibiotics and a right lower quadrant incision can help to minimize the morbidity. Pre‐existing severe comorbid medical condition(s) is a major contributory factor to mortality in these patients.
Pancreatic Cancer and Diabetes: Is there a Relationship? A Case‐controlled Study
Authors: Frye J. N. R. , Inder W. J. , Dobbs B. R. , Frizelle F. A.
Published: March 2003

Background: There is controversy about whether diabetes mellitus is a risk factor for pancreatic cancer or an epiphenomenon of the cancer. The present study aims to determine if long‐term diabetes is a risk factor for pancreatic cancer.

Methods: The study undertook to determine the prevalence of diabetes among three matched (age/gender) patient groups (pancreatic cancer (PaC), colorectal cancer (CRC), and fracture neck of femur (NOF)) at the date of diagnosis of cancer or fracture as well as 1 and 5 years prior to this. A retrospective review of the medical records of the three groups of patients was undertaken. Patients identified with PaC in the period July 1994 to February 1998 were age (± 5 years)‐ and gender‐matched to patients identified in the same time period with NOF and with CRC. The data were then analysed using McNemar’s test for discordant pairs.

Results: Over a 44‐month period 116 patients with PaC were identified of which 24% had diabetes at the time of diagnosis of their malignancy (NOF, 8%; CRC, 9.5%). There was a statistically significant difference (PaC and NOF, P < 0.01; PaC and CRC, P < 0.01). For a duration of diabetes of > 5 years the prevalence of diabetes fell to 7.8% in the PaC group, to 6% in the NOF group and to 6.9% in the CRC group, with no significant difference between the groups.

Conclusion: There is no increase in the prevalence of long‐standing diabetes mellitus in patients with PaC compared to age‐ and gender‐matched controls with NOF and CRC. The relationship of PaC and diabetes may be an epiphenomenon, rather than diabetes being a risk factor for pancreatic malignancy.
Documented prevalence of HIV and Hepatitis C infection in patientswith penetrating trauma
Authors: Chambers Anthony J. , Lord Reginald S. A.
Published: March 2003

Background: Trauma patients infected with human immunodeficiency virus (HIV) or hepatitis C (HCV) pose specific problems to health‐care workers due to the risk of exposure to these agents in blood and other body fluids. Studies of patients with penetrating trauma in the USA have shown a higher prevalence of HIV and HCV infection than the general population. No studies have examined the prevalence of these infections in Australian trauma patients.

Methods: The medical records of all patients presenting to St Vincent’s Hospital, Sydney, from January 1994 to December 1998, with a stab wound to the neck, chest or abdomen, or with a gunshot wound to any anatomical site, were retrospectively reviewed. The number of patients with a history of HIV or HCV infection, or with risk factors for these such as male‐to‐male sexual intercourse and intravenous drug use, were recorded.

Results: The medical records of 148 patients with stab wounds to the neck, chest or abdomen, or with gunshot wounds were examined. Risk factors for HIV or HCV infection were recorded in 31 patients (21%). Two patients (1.3%) had a history of HIV infection and a further eight patients (5.4%) were known to have HCV.

Conclusions: There was a high prevalence of risk factors for HIV and HCV in patients with major penetrating wounds at St Vincent’s Hospital. The prevalence of documented HIV and HCV infection was subsequently greater than that expected in the general population, highlighting the risks to health‐care workers managing these patients.
Coconut palm‐related injuries in the pacific islands
Authors: Mulford J. S. , Oberli H. , Tovosia S.
Published: March 2003

Introduction: Coconut palms are an integral part of life in the Solomon Islands, given the widespread dependence of subsistence agriculture. Injuries related to the coconut palm are thus inevitable. Hospital records from the Central Referral Hospital were reviewed to identify (i) how commonly the coconut palm is implicated in injuries referred to the surgery department; (ii) which patients are being injured; and (iii) the type of injuries sustained.

Methods: The present study reviews all patients referred to the Department of Surgery and Orthopaedics between January 1994 and December 1999 who had a coconut palm‐related injury. This was possible due to the trauma epidemiology form, which records the patient details, cause of injury, fracture details and other injury information.

Results: A total of 3.4% of all injuries presenting to the surgical department was related to the coconut palm. Eighty‐five patients fell from the coconut palm, 16 patients had a coconut fruit fall on them, three patients had a coconut palm fall on them and one patient kicked a coconut palm. The majority of patients who were injured by falling from a coconut palm were young (aged 6–25 years). Eleven of the 16 patients struck by falling fruit were under 25 years of age. The majority of injuries sustained were fractures. Patients falling from coconut palms sustained mainly upper limb fractures (60.1% of all fractures) or spinal fractures (16.3%). Patients injured by falling fruit sustained skull or upper limb fractures. All skull fractures occurred in patients under the age of 10 years.

Conclusion: This is the largest review of coconut palm‐related injuries. It highlights some epidemiological facts that raise considerations for preventative health measures in the Solomon Islands. Parents and young children must be warned of the dangers of playing beneath coconut trees. Boy and girls should be warned of the dangers of collecting fruit. With an increasing amount of schooling becoming available the Solomon Islands is an ideal place to direct an education programme about the dangers of coconut palms as well as many other primary health issues. Because subsistence farming plays a crucial role in the life of most Solomon Islanders, injuries that result in loss of function are crippling both to the patient and the village. Any preventative measure to reduce the rates of injury will be important.
Publication bias in presentations o the Annual Scientific Congress
Authors: Kiroff George K.
Published: March 2003

Background: Free papers presented to the Annual Scientific Congress (ASC) of the Royal Australasian College of Surgeons (RACS) were reviewed for the years 1994, 1995 and 1996. Reports were examined for evidence of publication bias.

Methods: Suitable free papers were identified from the proceedings of the meetings and authors were contacted to obtain information about the research reported and any publications resulting from it.

Results: Responses were obtained from 302 of 576 presentations considered suitable. A total of 55% of responding authors reported publication of their paper. Basic science papers were most likely to be published. There was a significant bias in favour of publication of positive results (98 of 139 positive vs 76 of 159 inconclusive or negative reports; P < 0.01). Retrospective data were as likely to be published as prospective (51% and 57%, respectively). Reports describing studies of high‐level evidence were more likely to be published in journals with a high impact factor.

Conclusion: The ASC is a comprehensive meeting that attracts a wide range of free papers from most sections of the RACS. There appears to be no evidence of bias in selection of papers for inclusion in the meeting but there is bias in the subsequent publication, which favours positive reports.
Management of extravasation injuries
Authors: Kumar Rohit J. , Pegg Stuart P. , Kimble Roy M.
Published: March 2003

Background: Various agents have been implicated in causing tissue necrosis after intravenous infusions have extravasated. These include solutions of calcium, potassium, bicarbonate, hypertonic dextrose, cytotoxic drugs and antibiotics. Views on management of these injuries differ, and range from a non‐operative conservative approach to early debridement and grafting.

Methods: A retrospective review was undertaken of the hospital files of patients with extravasation injuries seen in three Australian hospitals. Nine patients were identified, and their management and long‐term follow up are reported.

Results: Age ranged from 17 days to 60 years. Two patients received their injuries from solutions containing isotonic dextrose/saline. The other seven patients received injuries from a variety of solutions including calcium gluconate (n = 1), parenteral nutrition (n = 1), sodium bicarbonate (n = 1), immunoglobulin (n = 1), gentamicin and penicillin (n = 1), flucloxacillin (n = 1), and the chemotherapeutic agents epirubicin and cyclophosphamide (n = 1). The sites involved included the dorsum of the right foot (n = 3), the dorsum of the left foot (n = 3), the right groin (n = 1), the right hand (n = 1) and the left hand (n = 1). Four patients were managed by delayed debridement and split skin grafting, while five were treated non‐operatively. Prolonged scar management was necessary in seven of the nine patients. Final results were satisfactory in all patients who received skin grafting and in all patients who were managed conservatively.

Conclusions: Management of extravasation injuries should be conservative if possible. Delayed debridement and split skin grafting is required if the area of skin loss is extensive. Scar management remains a problem. Prevention of these injuries with the education of both medical and nursing staff remains the ultimate aim.
Lumbrical muscle with an additional origin in the forearm
Authors: Singh Gurmit , Bay Boon‐Huat , Yip George W. C. , Tay Samuel
Published: March 2003

Background: Although variations in the attachments of the lumbrical muscles have been commonly reported, these have been seen mainly in the Caucasian population. The present study is the first reported case of such an anomaly in a Chinese cadaver in the literature.

Methods: The upper extremities of 26 Chinese (23 male and three female) cadavers were examined.

Results: Dissection of a male 66‐year‐old Chinese cadaver has revealed the rare case of a bipennate first lumbrical muscle with an additional origin extending from the distal part of the forearm. Its first origin arose from the flexor digitorum profundus in the hand distal to the flexor retinaculum. The intrinsic muscles in the hands of all the other cadavers were normal.

Conclusions: An anomalous origin of the lumbrical from muscles in the forearm has the potential to cause compression of the median nerve in the carpal tunnel.
Cusum analysis of trends in operative selection and conversion rates for laparoscopic cholecystectomy
Authors: Bartlett Adam , Parry Bryan
Published: March 2003

Background: Laparoscopic cholecystectomy (LC) requires a high degree of technical ability, spatial resolution and dexterity. Assessing trainees and competent operators is an important aspect of quality assurance in patient care. Most institutions quote mean conversion rate as a method of comparing operators’ performance. The purpose of the present study was to use the technique of cumulative sum (cusum) analysis to determine whether a learning curve phenomenon exists in operators performing LC.

Methods: Data were obtained retrospectively by reviewing the operative records of all patients undergoing elective and acute cholecystectomy for a 30‐month period coinciding with the commencement of LC at North Shore Hospital. Patients’ age and gender, date and type of operative procedure, duration of operation, and name of operator were recorded. Mean and cusum‐transformed data were derived for all operations as well as for four individual operators’ performances.

Results: Over the study period a total of 614 cholecystectomies was performed, with 85% attempted laparoscopically. A total of 9.8% required conversion to the open technique. Time trend analysis with the cusum technique for all surgeons revealed an inverse relationship between selection rate and conversion rate. Analysis of four individual surgeons revealed three different time trend profiles.

Conclusion: There was a direct inverse relationship between conversion rate and selection rate, in that careful selection is associated with a low conversion rate. Comparison of individual surgeons’ performance showed wide variation, with only one surgeon exhibiting the phenomenon of a learning curve. Contrary to other reports, we found that performance on LC was not always related to operative experience. This highlights the need for a more objective method to analyse operator competence than operator experience alone.
Anastomotic leak in colorectal surgery: A single surgeon’s experience
Authors: Isbister William H.
Published: March 2003

Background: Anastomotic leakage following colorectal resection and anastomosis has been proposed as a colorectal surgical indicator. Leak rates after elective surgery vary and tend to be higher as anastomoses become lower. The present study audits leak rates and outcomes of patients undergoing colorectal surgery, under the care of a single surgeon, in two geographically different centres.

Methods: Patients presenting to the University Colorectal Service in Wellington between 1975 and 1990 and patients presenting to the colorectal service at King Faisal Specialist Hospital (KFSH) between 1990 and 1999 were recorded in computerized databases. These databases were searched for patients who developed anastomotic leakage. The records of patients identified were examined in relation to diagnoses, presentation, primary operation, further surgery performed, and final outcome.

Results: Two thousand and 11 patients were entered into the Wellington database and 1348 were entered into the Riyadh database. Twenty‐nine patients with a leaking anastomosis (3.6%) were identified. There were 19 male patients. The postoperative mortality rate in patients who did not leak was 1.7% but in patients who developed a leak after the same operation this rate was 24.1%. Most patients who sustained a leak had an original diagnosis of colorectal cancer. More non‐leaking anastomoses were sutured. Sixteen patients with leaks (55.2%) received perioperative total parenteral nutrition (TPN) (9.2% in the no‐leak group). Leaking anastomoses were associated with more postoperative respiratory problems (55.2%vs 24.0%) and wound infections (65.5%vs 14.8%). Of the 22 living patients, seven had no surgical intervention, 14 had stomata (two stomata were retained) and one patient with a localized leak was drained percutaneously. Five other patients in addition to having a stoma constructed were drained percutaneously. No patient developed an enteric fistula following leakage.

Conclusion: Anastomotic leakage may be minimized by ensuring that patients are as fit as possible prior to surgery, stomata are used liberally, particularly in emergency patients, and a good anastomotic technique is utilized at all times. Despite these precautions some patients will still develop a leak and if timely and appropriate action is taken the majority will survive and have their stomata closed.
Recreational folk dance: A multicultural exercise component in healthy ageing
Authors: Connor Margaret
Published: March 2003

Recreational international folk dance provides a gentle form of exercise for people of all age groups, and may be used by an occupational therapist to provide a different leisure option for older people. The older adult is often stereotypically perceived as being only capable of certain types of leisure activities, such as bowls, bingo and cards. In multicultural Australia, activities need to be more diverse. Recreational folk dance provides an activity that is socially engaging, physically challenging, creative, and culturally and mentally stimulating. Involvement in the activity has general exercise benefits, which contribute to a healthy lifestyle. The participants can be empowered by their increased participation in community life, due to the classes, but also because of the public performance aspect that is offered with this activity. Exposure to folk costumes, customs, and traditions, can increase awareness of other cultures. Recreational folk dance has a beneficial effect on interpersonal and intrapersonal aspects of self. The language of dance crosses many cultures. Gesture and movement can be conveyed without words, thus making folk dance a good ‘non‐language’ based activity to be used in a multicultural population.
Implementing a problem‐based learning curriculum in occupational therapy: A conceptual model
Authors: Salvatori Penny
Published: March 2003

Problem‐based learning in occupational therapy education has enjoyed increasing attention in recent years. Drawing on concepts from general systems theory and organizational theory, this paper presents a conceptual model of an occupational therapy education program as an open and dynamic system that interacts with and is responsive to the external environment. The model is described in the generic context of developing, implementing and evaluating a problem‐based learning curriculum. The Bachelor of Health Sciences (Occupational Therapy) program at McMaster University in Canada is used to provide a practical illustration of the various components of the model. The model is considered to be sufficiently generic and adaptable for use by any occupational therapy program in any sociocultural environment in the world, and will be of particular interest to those who are considering problem‐based learning as an alternative to traditional educational approaches.
The effectiveness of the Hierarchic Dementia Scale in tailoring interventions to reduce problem behaviours in people with Alzheimer’s disease
Authors: Paterson Janis , Hamilton Mary Managh , Grant Helen
Published: March 2003

The aim of this single subject design study was to determine the effectiveness of using results from the Hierarchic Dementia Scale (HDS) to tailor interventions that may reduce behaviour problems in people with Alzheimer’s disease (AD). The participant was diagnosed with AD and exhibited a specific problem behaviour defined as walking repeatedly around the rest home unit in which she resided with no apparent aim. Repeated observational measures of the time spent walking were taken to establish a baseline of the problem behaviour. Once the baseline was established, the HDS was administered and recommendations for intervention were made based on the individual HDS profile. The recommendations for modifying her behaviour were focused on maximizing strengths and minimizing weaknesses identified by the HDS profile. Findings revealed that there was observable reduction in the occurrence of the problem behaviour after the introduction of the intervention. These findings suggested that using results from the HDS to tailor interventions might assist in the management of behavioural problems in people with AD.
Multiple authorship in published occupational therapy reports
Authors: Mahmoud Hossam , Paterson Janis , Abu‐Zidan Fikri M.
Published: March 2003

This study aimed at evaluating the extent of multiple authorship in published occupational therapy reports. Multiple authorship is the listing of more than one author for a paper. A review of the original articles of five English‐language occupational therapy journals published during the last 10 years (1989–1998) was carried out. The total number of articles examined was 2131. There was no statistically significant change over time in the number of authors in the five journals when combined together. However, when each journal was studied individually, there was a significant change in the American Journal of Occupational Therapy ( P < 0.001, Kruscal–Wallis test) and the Occupational Therapy Journal of Research ( P < 0.05, Kruscal–Wallis test). The maximum number of authors from a single department was significantly higher in the Australian Occupational Therapy Journal. There was a significant correlation between the number of authors per article and the maximum number of authors from a single department ( R = 0.70, F = 2106, P < 0.0001) and a significant correlation between the number of authors per article and the number of departments involved in the study ( R = 0.68, F = 1822, P < 0.0001). This study shows that multiple authorship is not a major problem in the published occupational therapy reports.
Older people enhancing self‐efficacy in fall‐risk situations
Authors: Cheal Beth , Clemson Lindy
Published: March 2003

A falls prevention programme based on Bandura’s self‐efficacy theory was evaluated using qualitative interviews. This programme aimed to enhance older people’s self‐efficacy in fall‐risk situations. The mastery‐building component of the programme was the key factor distinguishing it from other falls prevention programmes. It was also one of the most successful aspects of the programme for increasing self‐efficacy in community mobility activities. Seven of the eight participants experienced increased self‐efficacy in at least some daily activities, particularly those practised during the programme. Awareness of fall risks and how to minimise these increased. Participants took action to reduce environmental hazards and reported increased activity participation. Occupational therapists recognise the importance of self‐efficacy as a useful concept in occupational therapy practice due to its emphasis on self‐perception of capabilities within the context of specific activities. However, an understanding of self‐efficacy has not yet been integrated into occupational therapy practice. This study found that Bandura’s self‐efficacy theory was easily translated into practice and was readily applicable to the area of falls prevention among older people. The findings of this study support the inclusion of activity participation and mastery experiences being a primary focus of falls prevention programmes.