bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemoprevention of colorectal cancer
Authors: Courtney E. D. J. , Melville D. M. , Leicester R. J.
Published: December 2004

Colorectal cancer is a disease with a high mortality at present, due to the late stage at which many cases present. Attention is therefore focusing on preventative strategies for colorectal cancer given that polyps appear to be identifiable and treatable precursor lesions of this disease. Endoscopic polypectomy has been shown to reduce the incidence of colorectal cancer and there is a good case for endoscopic screening of the general population. However, this will require a large amount of manpower and resources and its success will also depend on the overall compliance of the population.

Epidemiological studies have shown that individuals reporting a regular intake of aspirin and other non‐steroidal anti‐inflammatory drugs have a reduced risk of developing colorectal polyps and cancer. Similarly, a number of natural substances, such as calcium and folate, when supplemented regularly in the diet, have also been linked to a possible decreased incidence of colorectal cancer. This has led to the concept of using such agents to reduce the number of cases of colorectal cancer. In this article, we review the current evidence for the use of these and other agents for the chemoprevention of colorectal cancer, together with theories as to their possible mechanisms of action.
The ageing bowel and intolerance to aspirin
Authors: Newton J. L. , Johns C. E. , May F. E. B.
Published: December 2004

Aspirin has a role in the prevention of cardiovascular and cerebrovascular disease, Alzheimer's dementia and several cancers. Encouraging all 50 year olds to take low‐dose aspirin doubles their chances of living a healthy life into their nineties. The widespread use of aspirin, however, is limited as many older subjects are currently unable to take aspirin because of gastrointestinal side‐effects.

This review explores why gastrointestinal events occur with aspirin use and how a net benefit from prophylactic aspirin might be achieved in older subjects. It is suggested that, by understanding the age‐related changes in upper gastrointestinal physiology and the mechanisms by which aspirin leads to the risk reductions associated with its use, it may be possible to direct interventions to improve tolerability in older subjects. This would allow greater numbers of older subjects to gain the benefits associated with aspirin use.
A comparison of hepatitis C treatment and outcomes at academic, private and Veterans' Affairs treatment centres
Authors: Jensen D. M. , Cotler S. J. , Lam H. , Harb G. , Shillington A.
Published: December 2004

Background : Currently, there is a lack of published data examining hepatitis C treatment practices in different care settings.

Aim : To provide data describing treatment practices for patients with hepatitis C virus infection in actual clinical practice, and to examine clinical outcomes in patients treated with interferon alpha‐2b/ribavirin combination therapy in academically affiliated centres, private treatment centres and Veterans' Affairs treatment centres.

Methods : This multi‐centre, retrospective, cohort study of 231 patients examined hepatitis C virus treatment practices in patients receiving interferon alpha‐2b from January 1997 to May 2001 and explored outcomes in academically affiliated, private and Veterans' Affairs centres.

Results : Differences in treatment practice and use of diagnostic procedures were found. Genotype testing was under‐utilized in non‐academic sites (academic centres, 79.2%; private centres, 33.7%; Veterans' Affairs centres, 35.9%; P < 0.001). Liver biopsies were performed less often in private sites (academic centres, 95.8%; private centres, 80.0%; Veterans' Affairs centres, 92.2%; P < 0.01). End‐of‐treatment viral response (academic centres, 40.0%; private centres, 31.3%; Veterans' Affairs centres, 17.2%; P < 0.05) was lower than that found in published trial data. Multivariate analysis revealed genotype 1 as the single significant predictor of treatment failure (P < 0.01).

Conclusions : Outside of the academic setting, there is significantly less diagnostic work‐up performed prior to the initiation of hepatitis C virus therapy. This suggests a need for a standardization of care across treatment settings.
Rabeprazole 10 mg twice daily is superior to 20 mg once daily for night‐time gastric acid suppression
Authors: Shimatani T. , Inoue M. , Kuroiwa T. , Horikawa Y.
Published: December 2004

Background : Insufficient acid suppression is one of the main causes of proton pump inhibitor‐refractory gastro‐oesophageal reflux disease.

Aim : To achieve more potent and long‐lasting acid suppression, different dosage regimens of rabeprazole were compared in relation to the CYP2C19 genotype status.

Methods : In a cross‐over study, 18 healthy Helicobacter pylori‐negative males (six homozygous extensive metabolizers, six heterozygous extensive metabolizers and six poor metabolizers) were given rabeprazole 10 mg once daily, 20 mg once daily or 10 mg twice daily, or water only (baseline data), for 7 days each. On day 7 of each regimen, 24‐h intragastric pH‐metry was performed.

Results : No significant differences were observed in median pH values and pH > 4 holding time ratios between rabeprazole 10 mg once daily and 20 mg once daily. However, with rabeprazole 10 mg twice daily, these parameters were significantly higher than those with 20 mg once daily. The potency of acid suppression by rabeprazole was influenced by the CYP2C19 genotype status. The differences were somewhat significant but not large. The incidence of nocturnal acid breakthrough was lowest with rabeprazole 10 mg twice daily.

Conclusions : Rabeprazole 10 mg twice daily, not 20 mg once daily, should be administered to achieve more potent and long‐lasting acid suppression.
High‐dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost‐effectiveness analysis
Authors: Barkun A. N. , Herba K. , Adam V. , Kennedy W. , Fallone C. A. , Bardou M.
Published: December 2004

Background : The efficacy of high‐dose intravenous proton pump inhibition has recently been shown, yet its cost‐effectiveness remains poorly studied.

Aim : To assess the cost‐effectiveness of this approach separately for American and Canadian health care settings.

Methods : A validated decision model included patients with bleeding ulcers after successful endoscopic haemostasis. Probabilities were determined from the literature, and charges and lengths of stay from national databases. A third‐party payer perspective was adopted over a 30‐day time horizon.

Results : Re‐bleeding rates were 5.9% for patients who received high‐dose intravenous proton pump inhibition and 22.9% for those who did not. Hospitalization costs for patients with and without re‐bleeding were US$11 802 and US$7993, and CAN$5220 and CAN$2696, respectively. High‐dose intravenous proton pump inhibition was more effective and less costly than the alternative of not administering it. The cost‐effectiveness ratios for high‐dose and no high‐dose intravenous proton pump inhibition were US$9112 and US$11 819 (CAN$3293 and CAN$4284 for the Canadian case), respectively. Sensitivity and threshold analyses showed that the results were robust across a wide range of clinically relevant assumptions.

Conclusion : In the USA and Canada, administering high‐dose intravenous proton pump inhibition for 3 days is both more effective and less costly than not doing so for patients with bleeding ulcers after successful endoscopic haemostasis.
Sequential treatment for Helicobacter pylori does not share the risk factors of triple therapy failure
Authors: De Francesco V. , Zullo A. , Margiotta M. , Marangi S. , Burattini O. , Berloco P. , Russo F. , Barone M. , Di Leo A. , Minenna M. F. , Stoppino V. , Morini S. , Panella C. , Francavilla A. , Ierardi E.
Published: December 2004

Background : Predicting factors for the outcome of conventional Helicobacter pylori triple therapy have been identified. Of these, the presence of the CagA gene is a strong predictor of successful treatment. Our preliminary data show that this factor becomes irrelevant when sequential therapy is used.

Aim : To identify predicting factors for the outcome of H. pylori eradication using two therapeutic schemes (triple and sequential) of equal duration (10 days).

Methods : Ninety‐six patients with H. pylori infection were randomly assigned to receive one of the following therapeutic schemes: group A: rabeprazole (20 mg b.d.) plus amoxicillin (1 g b.d.) for 5 days, followed by rabeprazole (20 mg b.d.) plus tinidazole (500 mg b.d.) and clarithromycin (500 mg b.d.) for a further 5 days; group B: rabeprazole (20 mg b.d.) plus amoxicillin (1 g b.d.) and clarithromycin (500 mg b.d.) for 10 days. Age, sex, smoking, endoscopic and histological findings, and CagA and VacA status were considered as candidates for a model of multivariate analysis which used therapeutic outcome as the dependent variable. CagA and VacA status were assessed by polymerase chain reaction on DNA isolated from gastric antral specimens.

Results : The sequential scheme was significantly more effective than prolonged triple therapy (P < 0.05). Smoking (P < 0.001) and the absence of the CagA gene (P < 0.05) were significantly associated with the failure of triple therapy, but the effectiveness of sequential treatment was not predicted by these factors.

Conclusion : Our data suggest that sequential therapy is not affected by bacterial and host factors which have, until now, predicted the outcome of conventional eradication treatments.
Monitoring methotrexate‐induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified?
Authors: Aithal G. P. , Haugk B. , Das S. , Card T. , Burt A. D. , Record C. O.
Published: December 2004

Background : Reports that up to 26% of subjects with psoriasis develop cirrhosis have led to a recommendation of serial liver biopsies after each cumulative dose of 1500 mg of methotrexate.

Aim : To evaluate the progression of liver injury in patients with psoriasis and the impact of monitoring by liver biopsy on their management.

Methods : One hundred and twenty‐one liver biopsies from 66 subjects (aged 11–79 years) with psoriasis, receiving a median cumulative dose of 3206 mg of methotrexate over a period of 280.5 weeks, were evaluated.

Results : The assessment of advanced fibrosis according to the Ishak system (≥ 4) correlated perfectly with that of the Scheuer system (≥ 3) and poorly with that of the Roenigk scale (≥ 3b) (r2 = 1.0 and 0.31, respectively). Two of 24 pre‐treatment biopsies showed advanced fibrosis and both subjects were heavy drinkers. The cumulative probabilities of advanced fibrosis (Ishak ≥ 4) were 0%, 2.6%, 2.6%, 8.2% and 8.2% at cumulative doses of 1500, 3000, 4500, 5000 and 6000 mg, respectively. None of the subjects developed cirrhosis during follow‐up or discontinued therapy on the basis of liver biopsy findings.

Conclusions : Advanced hepatic fibrosis with low‐dose methotrexate therapy is much less frequent than previously reported. Pre‐treatment or monitoring liver biopsies in accordance with the current guidelines have little impact on patient management.
Effects of capsaicin on the sensorimotor function of the proximal stomach in humans
Authors: Lee K.‐J. , Vos R. , Tack J.
Published: December 2004

Background : Capsaicin‐sensitive afferents have been implicated in the control of visceral sensorimotor functions.

Aim : To study the effects of capsaicin on the sensorimotor function of the proximal stomach in humans.

Methods : In 10 healthy subjects, a gastric barostat was used to study the effect of saline or capsaicin‐containing red pepper sauce on the sensitivity to gastric distension and on gastric accommodation to a meal.

Results : The administration of capsaicin was accompanied by a relaxation of the proximal stomach. After capsaicin, the compliance of the proximal stomach was increased and higher perception scores were reached for the same distending pressures. Dosing with capsaicin significantly decreased the pressures and corresponding wall tensions at the discomfort threshold. Gastric accommodation to a meal was not altered by capsaicin.

Conclusion : The acute administration of capsaicin decreases proximal gastric tone, inhibits phasic contractility of the proximal stomach and increases sensitivity to proximal gastric distension. These data suggest the involvement of vanilloid receptor 1 in the modulation of gastric sensorimotor function in humans.
Double‐blind, randomized controlled study to assess the effects of lansoprazole 30 mg and lansoprazole 15 mg on 24‐h oesophageal and intragastric pH in Chinese subjects with gastro‐oesophageal reflux disease
Authors: Wong W. M. , Lai K. C. , Hui W. M. , Lam K. F. , Huang J. Q. , Hu W. H. C. , Wong N. Y. H. , Lam C. L. K. , Xia H. H. X. , Chan A. O. O. , Lam S. K. , Wong B. C. Y.
Published: December 2004

Background : Previous studies have suggested that the acid secretory capacity of the Chinese population is lower than that of the Western population.

Aim : To compare the effect of lansoprazole 30 mg and 15 mg once daily on the 24‐h oesophageal and intragastric pH profiles in Chinese patients with gastro‐oesophageal reflux disease.

Methods : Forty‐four patients (male to female ratio, 27 : 17; mean age, 53 years; 55% with oesophagitis) with gastro‐oesophageal reflux disease were randomized to receive lansoprazole 30 mg or 15 mg once daily for 4 weeks. Measurement of the 24‐h oesophageal and intragastric pH, gastro‐oesophageal reflux disease symptoms and quality of life was performed at baseline and during the last week of each dosing period.

Results : Lansoprazole 30 mg maintained an intragastric pH > 4 for 10.5 h vs. 9.6 h for lansoprazole 15 mg (P = 0.44). The percentage total time at oesophageal pH < 4 was similar for lansoprazole 30 mg and 15 mg (2.0% vs. 2.3%, P = 0.30). The proportion of patients with complete cure of heartburn and acid regurgitation and the quality of life assessment were similar for lansoprazole 30 mg and 15 mg. Both dosages of lansoprazole were well tolerated and the compliance was 100% in both groups.

Conclusion : Lansoprazole dosages of 30 mg and 15 mg once daily provide a satisfactory decrease for oesophageal acid exposure and are equally effective for the treatment of gastro‐oesophageal reflux disease in the Chinese population.
Prevalence and characteristics of familial hepatocellular carcinoma caused by chronic hepatitis B infection in Hong Kong
Authors: Chan A. O. O. , Yuen M. F. , Lam C. M. , Fong C. Y. , Wong B. C. Y. , Lai C. L.
Published: December 2004

Background : Hepatitis B virus infection is an important aetiological factor for hepatocellular carcinoma. Clusters of hepatocellular carcinoma have been observed in families infected with hepatitis B virus.

Aim : To investigate the prevalence and characteristics of hepatocellular carcinoma associated with familial hepatitis B virus in Hong Kong.

Methods : Hepatitis B virus patients were screened for familial hepatocellular carcinoma using a standardized questionnaire. The clinical features of patients with familial hepatocellular carcinoma were compared with those of 118 patients with sporadic hepatocellular carcinoma attending the clinic during the same period.

Results : A total of 5080 patients were interviewed. Validation of the questionnaire indicated that the reliability was high. There were 22 families with familial hepatocellular carcinoma, giving a prevalence of 4.3 families/1000 hepatitis B virus carriers. The mean age of onset was 48.5 ± 13 years in familial hepatocellular carcinoma and 62 ± 11 years in sporadic hepatocellular carcinoma (P = 0.005). The ages of onset were 59 ± 11, 40 ± 10 and 18 ± 4 years in the first, second and third generations, respectively (P < 0.0001), suggesting an anticipation phenomenon. Familial hepatocellular carcinoma patients were more likely to present with pain (70% vs. 10%, P < 0.0001), but not on routine screening (14% vs. 52%, P < 0.0001), than sporadic hepatocellular carcinoma patients.

Conclusion : The prevalence of familial hepatocellular carcinoma is significant in Hong Kong. These patients show specific clinical features when compared with patients with sporadic hepatocellular carcinoma.
Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole
Authors: Borjesson M. , Rolny P. , Mannheimer C. , Pilhall M.
Published: December 2004

Background : Nutcracker oesophagus is characterized by high‐amplitude oesophageal contractions. Recent data have shown a high prevalence of gastro‐oesophageal acid reflux in patients with nutcracker oesophagus and, in open‐label trials, patients seemed to benefit from acid suppression. Therefore, it has been suggested that non‐cardiac chest pain in patients with nutcracker oesophagus may be related to reflux rather than to the motor abnormality itself.

Aims : To investigate the effect of intensive acid‐suppressive treatment on chest pain in patients with nutcracker oesophagus.

Methods : Nineteen patients with nutcracker oesophagus received lansoprazole or placebo in a double‐blind, randomized, cross‐over study.

Results : Significant reductions in pain intensity (P < 0.006) and pain duration (P < 0.05) were registered during the study. The magnitude of symptom relief achieved with lansoprazole did not differ significantly from that achieved with placebo. The motility pattern did not change during the study.

Conclusions : This study does not prove that acid‐suppressive therapy is effective for pain relief in nutcracker oesophagus. As the amelioration of pain was not accompanied by any change in the nutcracker oesophagus pattern, it is unlikely that the high‐amplitude oesophageal contractions are the cause of pain. Thus, the possible role of acid in the pathophysiology of pain in nutcracker oesophagus needs further study.
Neuroretinitis associated with cat‐scratch disease in Japanese patients
Authors: Kodama Tatsuo , Masuda Hisashi , Ohira Akihiro
Published: December 2004

Purpose:  To clarify the prevalence and clinical profile of neuroretinitis associated with cat‐scratch disease (CSD) in Japan.

Methods:  Japanese patients were searched using a computer web site, Japana Centra Revuo Medicina. Location of patients, medical history, systemic and intraocular findings, treatments and visual outcome were examined.

Results:  We reviewed 15 eyes of 14 patients, including our own case. Incidences of the disease were more common in summer than in winter and presented in the warmer parts of Japan. All patients had been previously healthy and had been exposed to cats or flea bites. Of the 14 patients, 13 (93%) had febrile illness and seven of these (54%) had lymphadenopathy. Uveitis and macular stars were observed in 11 of 15 eyes (73%). Most patients were treated with antibiotics and systemic steroids and visual prognoses were good.

Conclusions:  The clinical features of CSD‐associated neuroretinitis in Japan are similar to those in other countries. Its distribution may correlate with the prevalence of Bartonella henselae‐seropositive cats in Japan.
Standards for wheelchair prescription
Authors: Di Marco Allie , Russell Mary , Masters Margot
Published: December 2004

Wheelchair prescription for individuals with a spinal cord injury is a highly complex and challenging clinical intervention. Evidence exists that successful outcomes are not always achieved for the wheelchair user and that therapists are experiencing increasing pressure to be accountable for and to justify their wheelchair prescription practice. This paper describes the process of establishing an evaluation of wheelchair prescription practices by occupational therapists in a spinal injury rehabilitation unit in South Australia. The evaluation process centred on the development of standards of practice to monitor performance and led to improvements in: (i) service delivery practices; (ii) wheelchair user participation; and (iii) accountability and justification of service delivery. Steps taken to develop the standards of practice to monitor performance and the benefits and limitations of the evaluation are described.
Perceptions of evidence‐based practice: A survey of Australian occupational therapists
Authors: Bennett Sally , Tooth Leigh , McKenna Kryss , Rodger Sylvia , Strong Jenny , Ziviani Jenny , Mickan Sharon , Gibson Libby
Published: December 2004

Evidence‐based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients’ perspectives. Currently, little is known about occupational therapists’ attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.
Ethics, occupational therapy and discharge planning: Four broken principles
Authors: Atwal Anita , Caldwell Kay
Published: December 2004

Occupational therapists play a significant role in the discharge process and are often exposed to ethically challenging decision‐making. This paper examines the moral basis of discharge planning, relating it to the four fundamental bio‐ethical principles of respect for autonomy, beneficence, non‐maleficence and justice. Using a case study design, data was collected from 10 occupational therapists and two elder care patients using the critical incident approach, as part of a wider study to determine their perceptions of discharge planning and multidisciplinary teamwork. Direct observation of interaction within multidisciplinary teams was also undertaken. The findings from the research suggest that occupational therapists are unintentionally breaching these four principles and therefore their code of ethics and professional conduct. It is suggested that further research is needed to determine how occupational therapists overcome these challenges. Furthermore, this research has important implications for education establishments regarding the teaching of ethics to occupational therapists.
Outcomes after stroke: Basic and instrumental activities of daily living, community reintegration and generic health status
Authors: Hoffmann Tammy , McKenna Kryss , Cooke Deirdre , Tooth Leigh
Published: December 2004

This study describes the discharge destination, basic and instrumental activities of daily living (ADL), community reintegration and generic health status of people after stroke, and explored whether sociodemographic and clinical characteristics were associated with these outcomes. Participants were 51 people, with an initial stroke, admitted to an acute hospital and discharged to the community. Admission and discharge data were obtained by chart review. Follow‐up status was determined by telephone interview using the Modified Barthel Index, the Assessment of Living Skills and Resources, the Reintegration to Normal Living Index, and the Short‐Form Health Survey (SF‐36). At follow up, 57% of participants were independent in basic ADL, 84% had a low risk of experiencing instrumental ADL difficulties, most had few concerns with community reintegration, and SF‐36 physical functioning and vitality scores were lower than normative values. At follow up, poorer discharge basic ADL status was associated with poorer instrumental ADL and community reintegration status, and older participants had poorer instrumental ADL, community reintegration and physical functioning. Occupational therapists need to consider these outcomes when planning inpatient and post‐discharge intervention for people after stroke.
MentorLink: Empowering occupational therapists through mentoring
Authors: Wilding Clare , Marais‐Strydom Elza , Teo Nicholas
Published: December 2004

The MentorLink program of facilitated mentoring is an OT AUSTRALIA Victoria (Australian Association of Occupational Therapists ‐ Victoria Inc.) initiative, which aimed to meet the need of occupational therapists, as expressed at the Victorian Occupational Therapy State Conference in 1997, for more professional support and assistance to be provided to Victorian occupational therapists. In 2003, the MentorLink program continues to thrive, and has now been renamed MentorLink — Allied Health as it has been expanded to include the professions of podiatry and physiotherapy, with speech pathology and social work soon to join. Wilding and Marais‐Strydom (2002) present a brief overview of the program and highlight how it can be used as a method of continuing professional development, while this paper aims to inspire Australian occupational therapists to consider empowering themselves through mentoring, by presenting a case story of a mentoring relationship in action.
Powerful practices: The legacy of Margaret Mort
Authors: Lyons Michael
Published: December 2004

History is our present in the making. An appreciation of occupational therapy's origins, and of key people who contributed to its development, are important to understanding the current place of our profession in health care. This paper sketches the story of Margaret Mort, an historically significant Australian occupational therapist, from her early years as a wartime therapist to her later years as a pioneer in geriatric rehabilitation. Her work exemplifies principles which underpin contemporary occupational therapy practice and which this article chronicles for the edification of those curious about our profession's rich history.
Understanding play: The Implications for play assessment
Authors: Stagnitti Karen
Published: December 2004

This article reviews the current literature on play and play assessment in occupational therapy. The concept of play and play theories are examined and reasons are investigated for the low use of play assessment in paediatric occupational therapy practice. Within contemporary occupational therapy practice, the concept of play is being readdressed and play behaviour is understood to be important in child development. Available assessments of play in occupational therapy assess the child in a familiar environment to the child. Since many paediatric occupational therapists work in clinical settings, it is concluded that a clinically viable assessment of observation of play behaviour is required within occupational therapy. Parameters for such an assessment are proposed.
Treatment approaches for clients with a stroke‐affected upper limb: Are we following evidence‐based practice?
Authors: Gustafsson Louise , McKenna Kryss
Published: December 2004

Stroke rehabilitation is an area of practice that many occupational therapists encounter during their career. The literature promotes a wide range of management techniques and support devices for people who have a stroke‐affected upper limb, but little is known about the validity of those that occupational therapists actually use in practice. A questionnaire was sent to occupational therapists working in Queensland and northern New South Wales facilities (n = 35), in which adults with a stroke were likely to be treated. Eighteen respondents answered questions about the management techniques and support devices used in their facility, and their perception of the benefit of these devices in the reduction of hemiplegic shoulder pain. Results are discussed with reference to evidence‐based practice and indicate an urgent need for the collation and dissemination of the best current evidence available for the management techniques and support devices used in this area, as well as further research to extend this evidence.
Incorporating a Spiritual History into a Psychiatric Assessment
Authors: D'Souza Russell
Published: December 2004

Objective: To explore the importance of incorporating spiritual history into a psychiatric assessment and to develop and test a format for taking a spiritual history.

Methods: An overview of training and practice issues involved in taking a spiritual history is dealt with, and then the formal requirements developed, which include questioning style, content and form of the spiritual history, the evaluation of values and precautions to be considered. Finally its integration into clinical practice is considered.

Results: There are training exercises the clinician can do before taking a spiritual history. Clinicians must develop a trusting therapeutic relationship with the patient and approach the topic of spirituality with sensitivity. For a spiritual history to be useful an evaluation of the patient's value structure and possible expectation system needs to be undertaken and then available resources need to be identified.

Conclusions: A spiritual history needs to be incorporated into a psychiatric assessment. Clinicians should be trained to explore the patient's spirituality with sensitivity and skill so that the information obtained can be integrated into the greater psychiatric assessment and management of the patient, thus fulfilling the much required whole person assessment and therapy in the biomedical model.
Will the Atypical Antipsychotics be Analgesics?
Authors: Pridmore Saxby , Samilowitz Hazel , Oberoi Gajinder
Published: December 2004

Objective: To review the literature for evidence suggestive of a potential role for the atypical antipsychotics that are available in Australia in the management of pain.

Method: PubMed was searched for appropriate papers, and drug companies were invited to provide information.

Results: Two preclinical and six clinical reports suggested that the atypical antipsychotics may have analgesic properties.

Conclusions: There is justification for further trials of atypical antipsychotic medications in chronic pain. Should such studies bear fruit, psychiatrists are well qualified to use these medications in the management of chronic pain.
Australian and New Zealand Clinical Practice Guidelines for Specialist Adult Mental Health Care: An Introduction
Authors: Boyce Philip , Ellis Peter , Penrose-Wall Jonine
Published: December 2004

Objective: To introduce, for College Fellows, Associates and Trainees and other readers of Australasian Psychiatry, the Australian and New Zealand Clinical Practice Guidelines for Specialist Adult Mental Health Care.

Conclusions: For clinical practice guidelines to be applied appropriately and with confidence in practice, their development process, quality characteristics and limitations must be transparent to health systems, guideline users and consumers. Moreover, their status as evidence-based guidelines or consensus guidelines, or mixed-status guidelines, must be made explicit. This introduction to the Australian and New Zealand Clinical Practice Guidelines for Specialist Adult Mental Health Care is designed to assist you in implementing the guidelines in your practice. These are guidelines to assist practice. They are not a set of prescriptions about what to do. The process for developing the six guidelines is summarized. It involved over 70 individuals directly, who worked over a 2-year period in six independent guideline development teams to synthesize the research findings and to consult on draft recommendations. The teams included consumer and carer writing panels for most of the consumer guidelines. The series includes titles on schizophrenia; bipolar disorder; depression; panic and agoraphobia; anorexia nervosa; and deliberate self-harm. Full versions of the guidelines are to be published in the Australian and New Zealand Journal of Psychiatry. Consumer versions are published elsewhere. Extended versions and background material is available on the RANZCP website.
Perianal infections: Reader agreement and diagnostic performance of fat‐suppressed contrast‐enhanced MRI
Authors: Erden Ayşe , Geçim Ethem , Fitoz Suat , H Elhan Atilla , Erden .llhan , Tükel Selma
Published: December 2004

We aimed to determine the diagnostic performance of the contrast‐enhanced fat‐suppression technique in the detectability of perianal infections and to compare this technique with different MR sequences used for this purpose. Thirty consecutive patients with clinically suspected anorectal infections were examined with fast spin‐echo (FSE) T2‐weighted, short‐inversion‐time inversion recovery (STIR), and fat‐suppressed and non‐fat‐suppressed T1‐weighted spoiled gradient‐echo (SGE) (in‐phase) dynamic contrast‐enhanced sequences. The results of MRI were correlated with the findings of surgery, which was considered as the standard of reference. Receiver‐operating‐characteristic curves were reconstructed to describe and compare the diagnostic value of each MR technique. The values of kappa were used as a measure of observer reliability. Diagnostic performances of STIR, FSE T2‐weighted and fat‐suppressed and non‐fat‐suppressed, contrast‐enhanced SGE T1‐weighted techniques showed statistically insignificant differences in detection of perianal infections. There was almost perfect interobserver agreement regarding the presence of lesions on each MR technique. Fat‐suppressed, contrast‐enhanced SGE T1‐weighted MRI showed adequate diagnostic performance in the detection of perianal infections. However, its significance is not different from the other MR sequences used for the present study.
Ultrasonic fetal weight estimation and tolerance to measurement error: A comparative analysis
Authors: Mongelli Max , Tambyraja Ranjit
Published: December 2004

The objective of the present study was to test the hypothesis that volumetric formulae for fetal weight estimation are more tolerant to measurement error than exponential models. A mathematical model of normal fetal growth was constructed, using published British reference standards for biometric variables. Observed measurements were computer‐generated by contaminating reference measurements with error terms according to their published coefficients of variation. The error in weight estimation was computed as the percentage difference between weight estimates derived from the observed biometric variables and the true measurements. A total of nine weight estimation formulae were tested. Campbell's formula appeared to be most affected by observational errors, especially before 38 weeks. In this range, they varied up to 9%. The most tolerant was Shepard's formula, with errors of only approximately 2.8%. Other formulae showed errors of approximately 5−6%. With the exception of Campbell's formula, the effect of gestational age was minimal. There was no correlation between percentage error and fetal size. Combining ultrasound biometric variables into a fetal weight estimate does not always exaggerate the errors of the original measurements. There were no significant differences between volumetric and exponential formulae.
Role of radiology in the treatment of malignant hilar biliary strictures 2: 10 years of single‐institution experience with percutaneous treatment
Authors: Hii Michael WJ , Gibson Robert N , Speer Anthony G , Collier Neil A , Sherson Noel , Jardine Cate
Published: December 2004

We reviewed the results of percutaneous intervention of hilar biliary malignancy over a 10‐year period at a single institution: the Royal Melbourne Hospital. Ninety‐nine patients (100 treated in total) were included. Information was retrieved by retrospective examination of patient notes and radiology, combined with interviews with family and relevant physicians. Sixty‐nine patients were treated with insertion of semipermanent stents, 19 had external drain tubes, and 25 received percutaneous access for Iridium brachytherapy. Adequate drainage was achieved in 87% of the patients stented, and percutaneous access was successful in 96% of patients planned for brachytherapy. Of those patients undergoing endoprosthesis insertion, early complications occurred in 39% and late complications in 23%. Average survival for the entire patient population was 227.3 days, with a median of 167 days. Longer survival times (213 vs 142 days) and lower complication rates (44 vs 64%) are observed with metal stents in comparison with plastic stents. Percutaneous intervention is an important treatment option in hilar biliary malignancy, particularly in patients unfit for surgery. Reasonable survival with good palliation is the most common outcome, and most patients do not require further intervention.
Type of consent does not influence patient recall of serious potential radiation toxicity of adjuvant breast radiotherapy
Authors: Graham Peter
Published: December 2004

In a sample of 174 women who had received verbal consent (n = 35), general written consent (n = 34) or detailed toxicity‐specific written consent (n = 105), no significant differences were found in recall of serious potential toxicities by consent type. Age younger than 70 years and employment outside of the home were significantly associated with better recall. Factors not significantly associated with different recall rates were work status, use of interpreters for consent, time elapsed from treatment or the extent of radiotherapy (tangents only vs other). Overall recall was poor. Twenty‐eight percent of women could not correctly recall if their treatment risked any of four nominated complications (lymphoedema, pneumonitis, rib fracture or brachial plexopathy). Significant numbers of women erroneously attributed a number of ‘complications’ or symptoms to radiotherapy.
How safe is Australian radiotherapy?
Authors: Hamilton Chris , Oliver Lyn , Coulter Kristine
Published: December 2004

Many incidents and near‐incidents are known to occur in Australian radiation oncology departments. The vast majority of incidents are minor in nature; however, a small percentage represent major threats to good patient care, administrative structures and public confidence. A small, but regular, number of incidents result in ad hoc local and/or state committees of enquiry or tort actions, and inevitably have substantial personal and departmental repercussions. Apart from some local databases on treatment‐delivery incidents maintained by radiation therapists, no systematic data collection or analysis of treatment incidents exists for radiation oncology in Australia. The present paper argues the case for a prospective, systematic approach to the recording and analysis of treatment‐related incidents and near incidents. Major barriers to such a scheme, including fear of litigation, misuse of information and lack of understanding on the nature of an incident are discussed.
Cystosarcoma phyllodes: Our institutional experience
Authors: Joshi Sanjeev C , Sharma Daya N , Bahadur Anil K , Maurya Rajesh , Kumar Sanjeev , Khurana Nita
Published: December 2004

Twenty‐six patients of Cystosarcoma phyllodes, treated between July 1994 and July 2001, were analysed retrospectively. Median age at presentation was 38 years (range 13−61 years). Mean size of the lesion was 6 cm. There were 77% left‐sided lesions and 23% right‐sided lesions. Histologically, 58% lesions were benign, 11% borderline and 31% malignant lesions. All patients underwent definitive surgical procedure in the form of wide local excision or mastectomy. Four patients received postoperative radiotherapy. Median follow‐up period was 35 months. Six patients showed recurrence, and four of these were malignant. Median disease‐free survival period was 34 months.
Hemimegalencephaly with tuberous sclerosis: A longitudinal imaging study
Authors: Parmar Hemant , Patkar Deepak , Shah Jeshil , Patankar Tufail
Published: December 2004

Hemimegalencephaly is a rare cerebral malformation characterized by asymmetry of the hemispheres and cortical dysplasias. We report clinical and imaging findings in a child with hemimegalencephaly involving the right cerebral hemisphere with associated manifestations of tuberous sclerosis complex. Gross abnormal myelination pattern and gyral abnormalities were seen in the enlarged hemisphere. Subsequent scans showed atrophy of the frontoparietal region in the enlarged hemisphere and normal growth of the opposite hemisphere exceeding the size of the abnormal hemisphere in the frontoparietal region. A few white‐matter lesions that were seen in the normal hemisphere on neonatal scan were difficult to appreciate on subsequent MR studies. The white‐matter lesions were better seen in the neonatal period, whereas cortical tubers were better detected at a later age.
Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis
Authors: Hui Cathryn L , Naidoo Parm
Published: December 2004

The role of MR in the early diagnosis of acute osteomyelitis is well known. In the context of florid cellulitis, abnormalities of marrow signal are not uncommon, although they are often non‐specific. Marrow oedema and enhancement in the context of deep cellulitis might reflect either reactive marrow oedema or true osteomyelitis. More specific signs lend favour to the diagnosis of osteomyelitis: these include focal bone destruction, periosteal reaction and sequestra. The observation of an extramedullary fat‐fluid sign is also a specific sign for osteomyelitis, as illustrated in the following case report. This sign is an indication of cortical breach and, thus, in the setting of infection and in the absence of trauma confirms the presence of osteomyelitis. To our knowledge, this additional specific sign of osteomyelitis has not been previously reported on MR.
Unsuspected bilateral central acetabular fractures diagnosed with nuclear scintigraphy
Authors: McEwan Louise M
Published: December 2004

Unsuspected bilateral undisplaced acetabular fractures were diagnosed on a three‐phase bone scan in a patient unable to weight‐bear after an epileptic seizure.
Small bowel CT fat density target sign in chronic radiation enteritis
Authors: Chen Steven , Harisinghani Mukesh G , Wittenberg Jack
Published: December 2004

On CT, a thickened intestinal wall configured with a middle layer of low attenuation surrounded on each side by layers of higher attenuation has been termed the target sign. The presence of fat within the submucosal layer of the small intestine is a well‐known manifestation of Crohn's disease, but has not been reported in other chronic intestinal diseases. We describe CT findings of fat density target sign in a patient with prior radiation.
Follicular lymphoid hyperplasia simulating intussusception in a 6‐year‐old boy: Clinical, radiological and histopathological findings
Authors: Poll Ludger W , Lackmann Gerd‐M , May Philip , Willnow Ulrich , Braunstein Stefan , Engelbrecht Volkher , Kemperdick Helmut
Published: December 2004

We report the case of a 6‐year‐old boy who initially presented with recurrent abdominal pain. Diagnostic imaging, including ultrasound and CT, showed findings typical of an ileocecal intussusception with abdominal lym‐phadenopathy. Sonographically, the morphological appearance of the intussusception did not change during a 4‐week follow‐up period. Surgery was performed on the tentative diagnosis of a tumour versus lymphoma. Upon laparatomy, intussusception was ruled out and a large, broad‐based tumour of the caecum was palpable. The histopathology after ileocecal resection revealed follicular lymphoid hyperplasia. Where there is radiological suspicion of an intussusception in children with no or insignificant symptoms, follicular lymphoid hyperplasia should be included in the differential diagnosis.
Endovascular treatment for bilateral vertebral arteriovenous fistulas in neurofibromatosis 1
Authors: Siddhartha W , Chavhan Govind B , Shrivastava Manish , Limaye Uday S
Published: December 2004

We report a rare case of a 36‐year‐old woman with neurofibromatosis 1 (NF1) with bilateral vertebro‐vertebral arteriovenous fistulas. The patient presented with quadriparesis and had neck pain. Angiography revealed vertebral arteriovenous fistulas bilaterally with dilated epidural venous plexuses compressing the cervical cord resulting in quadriparesis. Endovascular treatment using coils and balloons resulted in successful occlusion of both fistulas. At 6‐months postembolization, the patient had improved significantly and is now able to walk with support.
Isolated intrapetrous carotid canal atraumatic internal carotid artery dissection: MRI and digital subtraction angiography findings
Authors: Robertson David I , Stuckey Stephen L
Published: December 2004

A case of spontaneous internal carotid artery (ICA) dissection confined to the intrapetrous carotid canal that was confirmed by angiography and magnetic resonance imaging is presented. Isolated dissection involving the intrapetrous ICA is rare; however, whenever arterial dissection is a consideration, specific review of imaging in this region is warranted.
Intractable massive ascites following radical gastrectomy, treatment with local intraperitoneal administration of OK‐432 using a unified CT and fluoroscopy system
Authors: Inaba Yoshitaka , Arai Yasuaki , Matsueda Kiyoshi , Aramaki Takeshi , Kodera Yasuhiro
Published: December 2004

The case of a patient who developed intractable massive ascites caused by hepatic lymphorrhea derived from surgical injury to the hepatoduodenal ligament is presented. OK‐432 was injected intraperitoneally through a catheter advanced to near the hepatoduodenal ligament, so as to expose this site to a high concentration of OK‐432. Under ultrasound guidance, it was difficult to reach this site due to massive ascites, and so we performed this procedure under CT and fluoroscopic guidance using a unified CT and angiography system. Subsequently, local administration of OK‐432 on five separate occasions resulted in resolution of the ascites. We ascribe this favourable result to the use of this unified CT and angiography system to advance the catheter to the suitable site, making possible the local administration of OK‐432.
‘Better than numbers…’ a gentle critique of evidence‐based medicine
Authors: Little Miles
Published: December 2004

Evidence‐based medicine (EBM) has achieved cult status in the last 10 years or so. It is an altogether admirable movement in medicine, capable of a great deal of good. Its privileged status, however, has prevented critics from being heard, and there are problems with EBM. Eight features need further discussion if EBM is not to be discredited and superseded. They are its reductionism; its unwitting paternalism; its privileging of restricted kinds of evidence; its dependence on the questionable concept of equipoise; the instability of the ‘truths’ it produces; its capacity to eliminate individuals in favour of categories; its historical arrogance; and its contempt for the wisdom and integrity of our predecessors. Evidence‐based medicine is here to stay; for the moment, at least. It is sufficiently well established to withstand critique. It needs criticism if it is to survive and flourish.
Methotrexate in the management of granulomatous mastitis
Authors: Kim Joon , Tymms Kathleen E. , Buckingham John M.
Published: December 2004

Granulomatous mastitis is a rare benign inflammatory breast disease that often clinically simulates carcinoma. Surgical resection of the entire lesion has been the main method of treatment but recurrence, infection, sinus formation and delayed wound healing can occur relatively commonly. Corticosteroids are also effective in recurrent or resistant cases but are associated with side‐effects and relapse of disease after steroid withdrawal. A low weekly oral dose of methotrexate was used in five resistant cases after surgery plus corticosteroid. All cases achieved remission, withdrawal of corticosteroid without relapse and no methotrexate side‐effect.