bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mental Health Status of Filipinas in Queensland
Authors: Thompson Samantha , Hartel Gunter , Manderson Lenore , Stirling Nicole , Kelaher Margaret
Published: March 2003

Objective: To determine the prevalence and investigate potential predictors of psychological distress in Filipino women living in Queensland, Australia.

Methods: The sample of n = 487 women (88% response rate) was drawn from Filipino organization membership lists and supplemented by snowball sampling. Participants were interviewed in their homes or at a community event in 1996/1997. Follow-up in 1997/1998 involved n = 346 women (71% response rate) who were interviewed either in their homes or by telephone. The two surveys included measurement of demographic, immigration, physical health, satisfaction with life in Australia and life event variables. The GHQ-28 was included in the follow-up survey as a measure of psychological distress.

Results: The proportion of women having an above threshold score (using the cut-off of 4/5) on the GHQ-28 was 23%. Women who were single, dissatisfied with life in Australia, had reported a major change in their financial situation, their relationship or their health in the year between surveys were significantly more likely to have an above threshold score.

Conclusions: The level of mental distress among Filipinas in Queensland appears to be slightly higher than the levels reported in the general population but lower than other migrant groups. The determinants of mental distress in this population contrast with those in the general Australian population and other migrant groups. The social context of these determinants in Filipinas needs to be elicited for an understanding of these differences.
The Esperance Primary Prevention of Suicide Project
Authors: Slaven Janine , Kisely Stephen
Published: March 2003

Background: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia.

Aims: To evaluate the effect of three evidence-based initiatives for the primary prevention of suicide: (i) providing suicide awareness sessions for staff members in health, education and social services; (ii) limiting the sale of over the counter analgesics (aspirin and paracetamol) to packets containing less than the minimum lethal dose; and (iii) implementing Commonwealth media guidelines in the reporting of suicides by media.

Methods: Changes in knowledge, awareness, attitudes, comfort and use, before and after each intervention were assessed using standardized instruments and pro forma derived from previous work, such as the Youth Suicide Prevention Training Manual and Suicide Intervention Beliefs Scale. Percentage changes in the number of retail outlets selling over the counter analgesics to less than potentially lethal quantities (less than 8 g of paracetamol or aspirin) were also measured. Media representatives were interviewed to gain their perceptions of Commonwealth Guidelines for the reporting of suicide, and encouraged to consult the project team before reporting suicide related issues.

Results: The baseline survey illustrated that mental health staff and general practitioners were more aware of suicide issues, risk factors for suicide and awareness of professional and ethical responses than staff from other services, and were more willing to raise the issue with a person at risk. Thirty-three subjects participated in suicide awareness training of whom 21 (66%) returned questionnaires. There were significant increases in awareness of suiciderelated issues and risk factors, as well as reported levels of knowledge of professional and ethical responses and comfort, competence and confidence levels when assisting a person at risk. Only three media representatives were aware of the Commonwealth Health Department Guidelines for reporting suicide and only one believed that the guidelines influenced their reporting. The local newspapers subsequently contacted the researchers to check that their reporting met the guidelines. As regards access to analgesics, one out of seven retailers agreed to implement the strategy (pending agreement from other retailers), another claimed increased awareness of the danger of analgesics, and three maintained that they would attempt to monitor excessive amounts sold to one individual.

Conclusions: Local initiatives can improve the awareness and knowledge of staff in the assessment of suicide risk, as well as of local media. These need to be complemented by initiatives at State or Commonwealth level to produce change in statewide media, or sales of over the counter analgesics.
Cortical Excitability of Psychiatric Disorders: Reduced Post-Exercise Facilitation in Depression Compared to Schizophrenia and Controls
Authors: Reid Philip D. , Daniels Brett , Rybak Marzena , Turnier-Shea Yvonne , Pridmore Saxby
Published: March 2003

Objective: In normal subjects, motor evoked potentials (MEPs) produced by transcranial magnetic stimulation (TMS) from the motor cortex are increased after non-fatiguing exercise of hand muscles. This phenomenon is called post-exercise facilitation. This study aims to test the hypothesis that psychiatric syndromes (major depressive episode, schizophrenia) have different levels of post-exercise facilitation compared to controls.

Methods: Patients with DSM-IV major depressive episode (six female, four male), schizophrenia (two female, nine male) and a control group (nine female, four male) participated. MEPs were elicited pre- and post-exercise from the contralateral abductor pollicis brevis by TMS over the primary motor cortex.

Results: Post-exercise facilitation expressed as a percentage of baseline was 510% in controls, 110% in depression and 190% in schizophrenia. There were significant differences in patients with depression and schizophrenia compared to controls (p = 0.0001, p = 0.0008).

Conclusions: Post-exercise facilitation was reduced in depression and schizophrenia, suggesting impaired cortical excitability in these disorders. Further studies may discriminate between the two groups.
What is Duty/Triage? Understanding the Role of Duty/Triage in an Area Mental Health Service
Authors: Grigg Margaret , Herrman Helen , Harvey Carol
Published: March 2003

Objective: To describe the duty/triage system within one urban area mental health service in Australia and to investigate the factors that affect the decision to organize a comprehensive assessment.

Method: Data was collected from 3 months of duty/triage information and key informant interviews. Policies and procedures related to duty/triage were reviewed. Quantitative and qualitative analyses were conducted.

Results: Two thousand, six hundred and three contacts with duty/triage occurred over a 3-month period. Half of these were related to patients new to the service. Most contacts were self-referrals or referrals from a carer. Few referrals came through the primary health care sector. New patients were more likely to be assessed if the referral was presented in technical language and if it was initiated by a health professional, particularly a general practitioner, emergency department or other mental health service. Assessment was less likely if the patient or carer initiated the referral, if the problem was presented in vague or non-technical terms, if there was a drug or alcohol problem or if the person refused care.

Conclusions: A substantial number of potential patients contact a duty/triage worker every day. However, there is little interaction with the primary care sector, limited documentation of risk and a lack of consistency in the documented reasons for the service response. Further investigation is needed of the conditions conducive to consistent quality decision making at the point of entry to a specialist mental health service.
Allocation of Resources and Psychosis
Authors: Neil Amanda L. , Lewin Terry J. , Carr Vaughan J.
Published: March 2003

Objective: This commentary reviews current expenditure on psychosis in Australia, identifies discretionary expenditure that could be used more efficiently, discusses the factors influencing resource allocation and intervention selection decisions, and suggests priorities for change.

Method: Cost-of-illness findings from the Low Prevalence Disorders Study (LPDS), and related service use and psychosocial data, are used to highlight patterns of expenditure on psychosis and potential resource allocation issues. Arguments are also presented suggesting that mental health resource allocation in Australia should be informed primarily by treatment efficiency, equity and humanitarian considerations, not differences in the global burden of disease. However, our evidence-base about the effectiveness and costs associated with individual treatments, programmes, and organizational structures is also shown to be limited.

Conclusions: The patterns of service use and expenditure on psychosis suggest certain imbalances, including an over-reliance on hospitalization, low levels of supported community accommodation, and inadequate provision of evidence-based psychosocial treatments, rehabilitation and supported employment programmes. We need to identify and develop efficient interventions and programmes, re-orientate our services to better utilize those interventions, increase community awareness, improve monitoring of outcomes and costs, and undertake timely evaluations at multiple levels, from the individual to the societal perspective.
INSURANCE AND THE RISK OF RUPTURED APPENDIX IN THE ADULT
Authors: Wong S. W. , Haxhimolla H. , Grieve D. A. , Fisher R. , Keogh G.
Published: March 2003

Background: Disparities in medical care related to the insurance status of patients have been reported. A retrospective analysis was performed to examine the insurance‐related differences in the risk of appendiceal perforation in the Prince of Wales Hospital (POWH), New South Wales.

Methods: Computerized data of 1179 patient years who had a diagnosis of appendicitis and were admitted to the POWH over the preceding 10 years were examined. The outcome measure was appendiceal perforation. Patient variables examined were insurance status, sex, age, and socio‐economic status (SES). Three hundred patients over the same period were identified who had an appendicectomy but not appendicitis. Multiple logistic regression and Fisher’s exact test were used for statistical analysis.

Results: The overall perforation rate in 1179 patients was 17%. The only factor that was related to an increased risk of perforation was age over 50 years (odds ratio (OR)1.57; 95% confidence interval (CI) 1.04–2.53). Sex, insurance status or SES were not associated with a higher risk of perforation. The overall rate of negative appendicectomy was 20% (300 of 1479 patients), and the rate was higher in the uninsured patients (22 vs 17%, P = 0.014, Fisher’s exact test).

Conclusions: Lack of health insurance was not associated with an increased incidence of appendiceal perforation at the POWH. Age over 50 years was identified as the only risk factor for appendiceal perforation. The lower negative appendicectomy rate in the insured group may be because of better diagnostic ability of consultants compared to registrars.
MULTINODULAR GOITRE PRESENTING AS A CLINICAL SINGLE NODULE: HOW EFFECTIVE IS HEMITHYROIDECTOMY?
Authors: Wadström Carl , Zedenius Jan , Guinea Ana , Reeve Tom , Delbridge Leigh
Published: March 2003

Background: Patients who present with a single thyroid nodule that requires surgery will generally undergo hemithyroidectomy. If, however, the subsequent histological examination shows unsuspected multinodular change, there is a risk of recurrence in the remaining lobe. The aim of this study was to determine the clinical outcome in patients who have had a hemithyroidectomy for a single thyroid nodule that was shown on subsequent histopathological examination to be part of a multinodular goitre.

Methods: A survey was undertaken of patients who were identified from a thyroid surgery database with the following criteria: (i) hemithyroidectomy for clinical single nodule; and (ii) multinodular change on histopathology. Main outcome measures were clinical recurrence rate, the frequency of further thyroid surgery, and the efficacy of thyroxine treatment on recurrence.

Results: In the 229 patients studied, the clinical recurrence rate was 12%. Fourteen of the 28 patients with recurrence required further surgery. Thyroxine therapy did not influence the recurrence rate.

Conclusion: When surgery for a clinically benign single thyroid nodule is indicated, hemithyroidectomy is an adequate surgical procedure in cases where the single nodule is subsequently found to be part of a multinodular goitre. Such patients can be reassured that the chance of clinical recurrence is low. Thyroxine replacement therapy appears not to prevent recurrence.
SURGICAL WOUND INFECTION SURVEILLANCE: THE IMPORTANCE OF INFECTIONS THAT DEVELOP AFTER HOSPITAL DISCHARGE
Authors: Mitchell David H. , Swift Geoffrey , Gilbert Gwendolyn L.
Published: March 2003

Background: The aim of this study was to evaluate two methods of post‐discharge surgical wound surveillance and to compare the incidence and outcomes of wound infections that develop prior to patients’ discharge with those that develop after hospital discharge.

Methods: One thousand, three hundred and sixty inpatients who underwent major elective surgery in an 800‐bed teaching hospital in western Sydney between February 1996 and July 1997 were followed prospectively. Pre‐discharge wound surveillance was performed by clinical assessment by an independent researcher on the fifth (or later) postoperative day. Post‐discharge wound surveillance was performed by a mail out of questionnaires completed independently by patients and surgeons.

Results: Overall, 138 wound infections were diagnosed (incidence 10.1%), of which fewer than one‐third (n = 44) were diagnosed before discharge (average 10.4 days postoperatively) and the remainder (n = 94) after discharge (average 20.6 days postoperatively). Seven hundred and eighty‐two (57.5%) post‐discharge survey forms were returned by patients and 680 (50.0%) by surgeons. When forms were returned by both surgeons and patients for the same wound (641 cases), there was substantial agreement in diagnosing infection or no infection (kappa = 0.73).

Conclusions: The majority of nosocomial surgical wound infections develop after the patients’ discharge from hospital. A post‐discharge surveillance programme including self‐reporting of infections by patients and return of questionnaires by patients and surgeons is feasible in an Australian hospital setting. However, such a programme is labour and resource intensive and strategies to increase return of questionnaires are required.
A PROSPECTIVE RANDOMIZED TRIAL EVALUATING THE HAEMODYNAMIC ROLE OF INCOMPETENT CALF PERFORATING VEINS
Authors: Fitridge R. A. , Dunlop C. , Raptis S. , Thompson M. M. , Leppard P. , Quigley F.
Published: March 2003

Aim: This study was undertaken to determine the haemodynamic effect of incompetent calf perforating veins in patients with uncomplicated varicose veins and long saphenous incompetence.

Methods: Thirty‐eight limbs from 35 patients were studied. All patients had uncomplicated varicose veins with both long saphenous and calf perforator incompetence on duplex ultrasonography. Patients were randomized to have incompetent calf perforators ligated or left intact, in addition to saphenofemoral junction ligation, strip of long saphenous vein to knee and stab avulsion of any visible varicosities in the leg. Patients were assessed with air plethysmography pre‐operatively and 3 months postoperatively.

Results: Superficial venous surgery improved venous volume, venous filling index and ejection fraction in the patient cohort. No significant haemodynamic difference was demonstrated between the two groups of patients who were randomized.

Conclusions: At present, the results of this study do not support the use of routine perforator ligation during superficial surgery for uncomplicated varicose veins.
CONSERVATIVE SURGERY AND RADIATION THERAPY FOR INVASIVE LOBULAR CARCINOMA OF THE BREAST
Authors: Francis Michael , Cakir Burcu , Bilous Michael , Ung Owen , Boyages John
Published: March 2003

Background: There is debate as to whether infiltrating lobular carcinoma (ILC) can be effectively treated with breast conservative surgery (CS) and radiotherapy (RT) because of a perceived high risk of local recurrence. This retrospective study examined the outcome of patients with ILC treated by CS and RT.

Methods: Between November 1979 and December 1994, 57 women with UICC Stage I or II ILC were treated by CS and RT at Westmead Hospital, New South Wales, Australia. The median age was 55 years (range 28–79). Twelve patients (21%) underwent a re‐excision after initial CS. The final margins were clear for 43 patients (75.4%), positive (invasive or in situ) for nine patients (15.8%), and indeterminate for five patients (8.8%). All patients received whole‐breast irradiation (45–50.4 Gy) usually supplemented by a boost (10–30 Gy). Fifty‐three of 57 patients (93%) had their pathology reviewed at Westmead Hospital.

Results: After a median follow up of 69 months (range 36–162) three patients (5.3%) developed a local recurrence. One of 43 patients (2.3%) with known clear margins developed a local recurrence compared with two of 14 patients (14.3%) with positive or indeterminate margins (P = NS). The 5‐ and 10‐year rates of freedom from local recurrence were 96 and 93%, respectively. The 5‐year disease‐free survival was 85% (node‐negative, 92%; node‐positive, 66%). Overall survival was 94% at 5 years. No patient developed a contralateral breast cancer.

Conclusion: Patients with ILC can be effectively treated with CS and RT.
A FELLOWSHIP IN THE USA: ESSENTIAL INFORMATION FOR THE AUSTRALASIAN MEDICAL GRADUATE
Authors: Cozzi Paul J.
Published: March 2003

Background: There have been many recent changes to the immigration and educational requirements necessary to obtain both clinical and research positions in the USA. This paper describes these requirements in detail and examines the cost of obtaining a position.

Methods: An extensive review of Medline and relevant documents from educational and immigration bodies is undertaken in addition to personal and peer experience of the processes necessary to fulfil educational and immigration requirements for funded medical positions in the USA. A cost analysis is performed based upon the latest charges for exam requirements and visa fees. A ‘minimum’ cost for fulfilling exam and visa requirements only and a ‘likely’ cost (which represents a more realistic appraisal of the expenses likely to be incurred) are investigated.

Results: This review shows that many recent changes have made the attainment of a position difficult and expensive. Much foresight and planning is required to obtain the necessary requirements for medical licensure and to obtain working visa status in addition to the application for the position itself. The cost analysis reveals that the minimum cost is $4050 (AU$) and the ‘likely’ cost is $8600 (AU$).

Conclusion: Australasian trainees and Fellows need to be fully aware of the difficulties and expenses likely to be encountered in order to make an informed decision with regard to overseas training in the USA.
VOICE CHANGES AND THYROID SURGERY: IS PRE‐OPERATIVE INDIRECT LARYNGOSCOPY NECESSARY?
Authors: Yeung Philip , Erskine Catherine , Mathews Philip , Crowe PHILIP J.
Published: March 2003

Background: Indirect laryngoscopy (IDL) is often performed prior to thyroid surgery to detect pre‐existing vocal cord pathology.

Methods: A retrospective chart review of 201 patients undergoing thyroid surgery at the Prince of Wales Hospital was undertaken in order to study the patterns of pre‐operative and postoperative voice changes and IDL findings.

Results: A total of 9% of patients had pre‐operative voice symptoms, and 22% of this group had abnormalities detected on pre‐operative IDL. Of 160 documented IDL, 4% revealed vocal cord pathology in asymptomatic patients, including an asymptomatic recurrent laryngeal nerve palsy.

Conclusions: Indirect laryngoscopy remains a useful but flawed pre‐operative screening tool for patients with voice symptoms, but the literature suggests that more advanced phoniatric tests will provide superior diagnostic sensitivity. The role of routine pre‐operative laryngoscopy for asymptomatic patients is of debatable value.
THE DIAGNOSIS OF GASTROINTESTINAL TRACT INJURIES RESULTING FROM BLUNT TRAUMA
Authors: Hughes T. Michael D.
Published: March 2003

Background: This review studies the efficacy of the methods of assessment of the abdomen in blunt trauma for the detection of gastrointestinal tract injuries (GITI).

Methods: MEDLINE searches of English language publications on the subjects of diagnostic peritoneal lavage, abdominal computed tomography (CT) in blunt trauma and gastrointestinal tract injuries between 1980 and 1998 were used to identify relevant material. Earlier publications were identified from reference lists. The methodology, data and conclusions of all studies were examined in detail. The contemporary roles of clinical assessment, diagnostic peritoneal lavage, CT and other diagnostic modalities in detection of significant GITI were determined based on the best available evidence.

Conclusions: The most accurate and safest methods of assessment of the abdomen in haemodynamically unstable patients with suspected abdominal injuries following blunt trauma are immediate laparotomy or diagnostic peritoneal lavage (DPL). The goal of assessment of the abdomen in stable patients is to accurately define the site and extent of intra‐abdominal injury, in order that further management may be tailored to the specific injuries. The most recent evidence suggests that CT of the abdomen fulfils these criteria better than the other modalities of assessment available. The risk of overlooking a significant GITI on CT scan is minimal provided that unexplained free fluid, bowel wall thickening or enhancement, mesenteric fat streaking and bowel dilatation are taken as evidence of GITI. When scan quality is suboptimal or expert interpretation is unavailable, DPL is recommended. Fully cooperative patients with negligible abdominal signs can be safely observed clinically.
Implications of Delayed Diagnosis in Colorectal Cancer
Authors: Young Christopher J. , Sweeney James L. , Hunter Andrew
Published: March 2003

Background: Delayed diagnosis of colorectal cancer (CRC) continues to produce anxiety and is associated with the assumption that disease stage and survival will be worse. The aims of the present study were to assess the prevalence and reasons for delay in the diagnosis of CRC, and the effects of delay, gender, age and tumour site on the stage of disease.

Methods: A retrospective study of 100 patients presenting with CRC during a 1‐year period was performed. Delay was defined to have occurred if more than a 3‐month period had lapsed from the time when initial symptoms were clearly established to the time of operation. Data were collected on principal presenting symptoms, time to first presentation to a doctor, time to diagnosis and treatment, reasons for delay, diagnostic procedures, tumour site, operation, and Australian clinicopathological (ACP) stage of the tumour.

Results: Thirty‐four patients had a delay in diagnosis of their cancer. In 18 patients (53%) delay was attributable to patient reasons; in 13 patients (38%) delay was attributable to doctor‐related delay and in three patients (9%) it was attributable to both. Male patients were more likely to have patient‐related delay (31% for male patients vs 10% for female patients; P = 0.011). Patients with delay were less likely to have a stage A tumour (6% for delay group vs 21% for non‐delay group; P = 0.04). Male patients were less likely to have a stage A tumour than female patients (8% for male patients vs 25% for female patients; P = 0.018), but the effect of delay on stage disappeared when gender and tumour site were controlled in a logistic regression model.

Conclusions: The present study suggests some areas where improvements may be made concerning early diagnosis and treatment of patients with CRC.
High Incidence of Micrometastases in Breast Cancer Sentinel Nodes
Authors: Mann G. Bruce , Buchanan Malcolm , Collins John P. , Lichtenstein Meir
Published: March 2003

Background: Sentinel lymph node biopsy (SLNB) is being investigated as an alternative to formal axillary dissection in early breast cancer. Avoiding the morbidity of unnecessary axillary dissection is seen as the main potential benefit of SLNB. Sentinel lymph node biopsy also allows enhanced pathological analysis. A series of 62 sentinel node (SN) biopsies demonstrating a high incidence of micrometastases is presented here.

Methods: All SN were initially examined and reported by H&E staining. All negative SN were analysed after staining with polyclonal anticytokeratin antibody.

Results: Sixty‐two patients underwent SLNB at Royal Melbourne Hospital between May 1998 and February 2000. One or more SN was identified in 51/62 patients. A total of 10/51 contained metastases identified after H&E staining. There was one false negative. A total of 10/41 patients with H&E‐negative SN had micrometastases identified on immunohistochemistry (IHC). Micrometastases were more common in patients with larger tumours, with disease found in the H&E‐negative SN of 1/17 T1a and T1b (1–10 mm), 4/15 T1c (11–20 mm), and 5/9 T2 (20–50 mm) tumours.

Conclusion: Sentinel lymph node biopsy can accurately assess the axilla in most patients with early breast cancer. A significant proportion of histologically negative SN will have micrometastases identifiable with IHC. Although the clinical significance of such metastases is uncertain, the available evidence suggests that these patients have a poorer prognosis than other patients with negative lymph nodes.
Australian major incident nomenclature: It may be a ‘disaster’ but in an ‘emergency’ it is just a mess
Authors: Nocera Antony
Published: March 2003

Background: A standardized major incident nomenclature has practical applications for medical communication and audit of the medical response to incidents.

Methods: A telephone and fax survey of major incident nomenclature in State and Territory health service emergency management plans and ‘disaster’ legislation was carried out on 13 August 1999.

Results: Within Australia there were a total of 13 different terms to describe incidents that could produce casualties: there were four definitions of the word ‘disaster’, eight definitions of the word ‘emergency’ and one definition of the word ‘incident’.

Conclusion: Australia lacks a uniform system of classifying and recording mass casualty incidents. This prevents both the independent clinical audit of the medical response to an incident and the cross‐border comparison of the effectiveness of trauma systems to deal with multiple casualties. Australia’s geography highlights the need to develop a nomenclature that allows medical practitioners, in isolated environments, to accurately describe an incident and the medical support that is required. The Potential Injury‐Creating Event (PICE) nomenclature is a simple system to describe the functional impact of an event upon a community and the level of medical support required. It can be used to provide the basis for the uniform reporting of the medical management of major incidents within Australia.
Clinical value of magnetic resonance imaging of the knee
Authors: Feller Julian A. , Webster Kate E.
Published: March 2003

Background: Magnetic resonance (MR) imaging is an accurate imaging modality of the knee. The role of MR in clinical practice has not been precisely defined, largely due to the relative expense of the technique.

Methods: For each new patient with a knee problem who was referred for MR, a provisional diagnosis was made together with a level of certainty regarding the diagnosis. The waiting time for the scan was recorded. To assess clinical usefulness the MR diagnosis was compared with the provisional diagnosis and classified according to the following descending order of value: unexpected negative (no intra‐articular pathology), confirmatory negative, unexpected positive or confirmatory positive. To assess accuracy of the MR diagnosis, the operative diagnosis was compared to the MR diagnosis in those patients who underwent arthroscopy.

Results: Fifty‐two per cent of scans were assessed as being very useful and a further 20% were assessed as being moderately useful. Magnetic resonance had a 95% accuracy for medial meniscal tears, 91% accuracy for lateral meniscal tears, and 98% accuracy for anterior cruciate ligament tears, similar to previously reported studies. The diagnostic arthroscopy rate in the patients who underwent MR scanning was similar to that in patients for whom the surgeon was more confident about the diagnosis and who therefore did not undergo MR scanning. The diagnostic arthroscopy rate could have been reduced if surgery had not been performed in 14 patients who had a negative MR scan.

Conclusions: There is a role for selective use of MR in the assessment of knee conditions. In particular, MR can be used to reduce the diagnostic arthroscopy rate.
An individualized food‐skills programme: Development, implementation and evaluation
Authors: Porter Judi , Capra Sandra , Watson Gary
Published: March 2003

Deficits in food skills may have serious implications for nutritional status if food intake becomes compromised. Food‐skills deficits were identified in a group of consumers with chronic mental illness living in hospital‐based care. Some of the consumers with identified deficits were being transferred to the community as a result of hospital downsizing, so a programme was developed to improve their core food skills. An individualized approach was selected for programme implementation, as suggested by nutrition and disability curriculum literature. The present paper describes the development, implementation and evaluation of an individualized food‐skills intervention programme. Key research questions were investigated, including the direction and magnitude of observed changes in food skills of participants; the identification of sessions that were most and least successful and why; and whether sessions were sequenced in an appropriate manner and if other sequences could be used. Improvements in food skills were evident in all three participants undertaking the programme, suggesting that this approach may be an effective method to improve core food skills.
Developing a Clinical Pathway in Depression: Sharing Our Experience
Authors: Wilson Andrew , Tobin Margaret , Ponzio Vince , Moffit Craig , Hudson-Jessop Pamela , Chen Lucy
Published: March 2003

The Second National Mental Health Plan [ 1 ] has as one of its key themes, a focus on the quality and effectiveness of services with an emphasis on outcomes for consumers and carers. This focus on quality and outcomes results in an increasing interest in clinical practice guidelines, benchmarking of services and the development and evaluation of models of best practice. One way to progress these issues within clinical services is to develop clinical pathways for groups of patients with similar conditions.
Substance Abuse and Suicidality
Authors: Tucker Peter
Published: March 2003

The connection between substance abuse and self-harm has been well recognized in the literature for some time, and may even be the basis for rising youth suicide rates [ 1 ]. However, this knowledge is not always reflected in clinical practice. When psychiatric assessments are made of suicide attempters the contribution of substance abuse is often passed over quite lightly. Of even greater concern is the general lack of skills and focus on management of self-harm in specialized drug and alcohol services, despite their high-risk clientele. Furthermore, these services often experience difficulty in accessing psychiatric support.
Twelve Monthly Client Outcomes of a Mobile Assertive Care Service in Suburban Adelaide
Authors: Hugo Malcolm , Brodie Robyn , Clisby Judy , Coulter Robyn , Huettenrauch Heidi , Kurenda Julie , Nagesh Rajan , Pascoe Ian
Published: March 2003

A new community mental health service, the Mobile Assertive Care (MAC) team, offering intensive community based treatment for people with severe and persistent mental illnesses was evaluated twelve months after its commencement. Of the sixty-three clients referred within the first twelve months of operation, twelve-monthly outcome data was available for 54 clients at the time of this study. Results indicated clinically significant reductions in days spent in hospital, and statistically significant improvements in clinical and functional status.
Hallucinations in Deaf People with a Mental Illness: Lessons from the Deaf Clients
Authors: Briffa Dianne
Published: March 2003

The Deaf client is defined as a congenitally or prelingually deaf person whose first language is a sign language and who has schizophrenia.
Psychiatry Registrar Psychotherapy Programme in Victoria
Authors: Thomas Stuart
Published: March 2003

Dr Paul Foulkes wrote to the Victorian branch of the Psychotherapy Section of the RANZCP (13/10/98): ‘The development of a Psychotherapy Training Course continues with General council urging the Section to implement a training course speedily’.
Interpersonal Psychotherapy for Patients Recovering from Bipolar Disorder
Authors: Robertson Michael
Published: March 2003

While our understanding of the biological aspects of the treatment of Bipolar Affective Disorder (BAD) has grown exponentially over the last few decades, our grasp of the psychological aspects of treatment have not evolved as dramatically. Psychosocial factors may contribute 25–30% to the outcome variance of bipolar disorder [ 1 ] and despite optimal pharmacotherapy, up to 50% of sufferers may encounter further episodes [ 2 ]. In recent years, psychotherapies that are focal and structured have enjoyed increasing support in the management of a variety of psychiatric disorders, including severe mood disorder.
A South Australian Coronial Inquiry Into Suicide and Homicide
Authors: Goldney Robert D.
Published: March 2003

Objective: To review the findings of an Australian Coronial inquiry into suicide and homicide associated with mental illness and to compare those findings with a large UK report.

Conclusions: Similar findings emerged from both inquiries. These included recommendations in regard to the adequate documentation of illness; the recognition of the role of relatives and carers; the optimum use of health care legislation to ensure compliance with treatment; and an awareness of the availability of the newer “atypical” anti-psychotic drugs. Such recommendations serve as a useful reminder of what good psychiatric practise should provide in contributing to a reduction in suicide and homicide by those with mental illness.
Building a ‘National Coalition for People with Depression’
Authors: Hickie Ian B.
Published: March 2003

Objective: To describe how the current complex and discontinuous mental health systems in Australia fail to provide high quality care for patients with severe affective disorders. To outline how the development of a ‘National Coalition for People with Depression’ could result in the delineation of the essential aspects of high quality, long-term and continuous mental health care for these consumers of health services. To highlight the key role of educated and responsible consumers, and eventually the wider community, in determining the future shape of mental health service systems and clinical and health services research.

Conclusions: Although in its early stages, the process of developing a ‘National Coalition for People with Depression’ has already led to fundamental shifts in attitudes in some mental health services. By focusing on the consumers' needs for high quality and continuous services, traditional specialist service managers (in both the private and public sectors), and primary care and specialist clinicians will be forced to re-evaluate current assumptions and program developments. In Australia, there is now a considerable opportunity for co-ordinated service enhancement for those consumers with affective disorders.
Does Drug Promotion Adversely Influence Doctors' Abilities to Make the Best Decisions for Patients?
Authors: Jureidini Jon , Mansfield Peter
Published: March 2003

Aim: To increase awareness amongst psychiatrists and trainees of the effects of pharmaceutical promotion and to stimulate careful evaluation of the relationships between psychiatry and the pharmaceutical industry.

Method: Key findings from the literature and from 20 years experience with the Medical Lobby for Appropriate Marketing are summarised.

Results: The relationship between doctors and pharmaceutical companies is shown to be problematic in a way that might negatively impact on patient care.

Conclusions: Patients may benefit if individual psychiatrists, and the profession as a whole, develop more healthy scepticism about the harm to benefit ratios of relationships with the pharmaceutical industry.
Mental Illness is not a Crime: The Impact of the Adversarial Judicial System
Authors: Manovel William
Published: March 2003

Objective: This paper challenges the adversarial judicial model of the Mental Health Review Tribunal. Following a brief history of the adversarial legal system, it questions the impact of imposing a legal environment on the mentally ill and on the traditional doctor/patient relationship. It also examines issues of poor communication and excessive bureaucracy.

Conclusions: The current legal process is inhumane, outdated, and inefficient. There is room for lateral thinking into developing a more appropriate and contemporary model to address issues of civil liberties and medical treatment for the mentally ill. One possible model could be made up of a non-judicial and independent team with appropriately trained staff, recruited from more ‘caring’ professions, with well-defined, but discretionary legal powers.

Editor's note: The continuum of training in psychiatry commences at university. Sydney University's new postgraduate medical program has adopted a different model to train students in aspects of psychological medicine. During their placement, students are being asked to think critically about, and if necessary challenge, current orthodoxies. The following essay, by a final year medical student, was written during a placement at Rozelle Hospital. The essay examines the impact of legal intervention on mental health. The author is currently an Intern at Nepean Hospital in Sydney. He has worked previously as a commercial and naval lawyer.
A Contemporary View of Psychiatry Services in a General Medical Hospital
Authors: Holmes Alex , Judd Fiona , Lloyd John , Dakis Jennifer , Cairns Fiona , Kerr Louise , Kiang Maria , McKinnon Jonathan
Published: March 2003

Objective: To describe the nature of psychiatry work within a general medical hospital and to compare and contrast the nature of that work between emergency department and inpatient settings.

Method: The data from the Royal Melbourne Hospital (RMH) consultationliaison service database relating to referral, patient demographics, psychiatric diagnosis service use, management and discharge arrangements was recorded for all referrals to the RMH C-L service in 1999. The inpatient and emergency department arms of the service were compared.

Results: The referral rate for inpatients and the emergency department was 2.9% and 2.1% respectively. The reasons for referral and frequency of psychiatric diagnosis differed significantly between the two settings.

Conclusions: The provision of C-L services to inpatients and the emergency department needs to be tailored to the different patient populations.
The Case for Mandatory MOPS
Authors: Mayne Keith
Published: March 2003

Objective: To provide background information and a rationale regarding the mandatory Maintenance of Professional Standards (MOPS) Program of the RANZCP.

Conclusions: MOPS has evolved over ten years and will continue to develop and change. MOPS programs have been viewed by Medical Colleges as a major force in unifying the profession against destructive outside influences. MOPS is not an assessment of competence or performance, and not equivalent to “recertification”. Rather, MOPS reflects the belief that participation in continuing medical education and quality improvement processes will maintain and improve standards of practice. There is every reason to be confident that, with ongoing adjustment, MOPS will continue to meet the professional development needs of all RANZCP Fellows.
Labelling and the Boundaries of Psychiatry
Authors: Ellard John
Published: March 2003

Objective: An attempt to discover the meaning of “disease” in general medicine and “disorder” in psychiatry.

Conclusions: There is no satisfactory definition: the terms are social constructs.
Beyond Interdisciplinary Boundaries: Views of Consumers, Carers and Non-Government Organizations on Teamwork
Authors: MacDonald Elspeth , Herrman Helen , Hinds Pauline , Crowe Jim , McDonald Paul
Published: March 2003

Objective: To present the views of consumers, carers, and non-government organizations (NGOs) on interdisciplinary teamwork. The transcript from a symposium organized by the RANZCP Professional Liaison Committee at TheMHS conference of Australia and New Zealand is reviewed and analyzed.

Results: Consumer and carer participation in interdisciplinary teams is important. Consumers, carers and NGOs have useful perspectives on threats to interdisciplinary practice, and their views can assist teams to develop principles that promote positive interdisciplinary partnerships.

Conclusions: Effective and responsive partnerships with consumers and carers require interdisciplinary team members to commit to listening to and responding to the viewpoints of the users of their services. Resourcing and structuring teamwork around the viewpoint of users of mental health services can fundamentally change interdisciplinary teamwork. Furthermore, the commitment to consumer and carer participation has implications for how teams conduct their clinical practice and practice research.
Collaboration to Innovation: Facilitating the Introduction of Intensive Child and Adolescent Psychiatry Treatment Teams
Authors: Nicholls Denise , McDermott Brett
Published: March 2003

Objectives: To describe from an academic and practical perspective the process of organisational change associated with the introduction of an innovative child and adolescent mental health service.

Method: The project consultation process is described. Process redesign literature is reviewed and the application of the principles to the project process is discussed.

Results: The project successfully produced a unified, inter-sector recommendation for a new service which had achieved wide endorsement. Understanding and utilising process redesign principles was confirmed to be advantageous. Further, an evidence based approach was found to be helpful in uniting the sectors and in accelerating change. Obstacles to innovation were identified and specifically addressed by the planning process.

Conclusions: Restructuring of services or the introduction of new services in response to policy changes or to changes in available resources is commonplace. Often it is assumed that the benefits expected from proposed changes will automatically flow and little effort is made to employ current knowledge from the literature regarding the successful implementation of organisational change. A rigorous planning process is required for service change, particularly when innovative treatments are being considered.
A ‘Fair Play’? Comparison of an Objective Structured Clinical Examination of Final Year Medical Students Training in Psychiatry and their Supervisors' Appraisals
Authors: Melding Pamela , Coverdale John , Robinson Elizabeth
Published: March 2003

Objective: Expected standards for student performance in psychiatry can vary between supervisors and institutions. Recently, the University of Auckland required its academic departments to have an objective standard assessment or test for each student on a clinical attachment. We aimed to compare an objective structured clinical examination of final year medical students training in psychiatry and their supervisors' appraisals.

Method: Assessment in psychiatry initially consisted of a two-hour written test. Subsequently, the test in psychiatry changed to a standardised, modified, objective, structured, clinical examination (OSCE) using simulated patients. The clinical supervisor rated each student on a set of clinical parameters using a scale of 1-6. In addition, members of the academic department of psychiatry separately tested the students with a modified OSCE on the last day of their clinical attachment. The results of the OSCE are compared with clinical attachment assessments and the previous method of evaluation, the written test.

Results: There was no correlation between the written test and the supervisor's assessment for the clinical attachment indicating that the written test was not a good method of evaluating student performance. The correlation between the clinical attachment grading and the OSCE for year 1 was 0.4 (p=0.002) and for year 2 was 0.5 (p=0.001). However, marks for the OSCE were consistently lower than those given for the clinical attachment.

Conclusions: The introduction of the modified OSCE had the desired outcome of changing students' focus from the pursuit of theoretical knowledge to the attainment of practical skills.
Interagency Training in Dual Disability
Authors: Mohr Caroline , Phillips Alex , Curran Jenny , Rymill Ann
Published: March 2003

Objective: Mental health care professionals are poorly trained in intellectual disability, and workers in intellectual disability (ID) services are similarly unskilled in mental health care principles. Consequently, the mental health needs of adults with intellectual disabilities and psychiatric disorders are not being adequately met.

Method: A three day training programme was designed to redress this situation and encourage these separate services to work collaboratively. The programme was evaluated with 30 participants drawn from MH and ID services.

Results: Evaluations conducted pre- and post-training indicated increases in participants' confidence in working in and knowledge of DD, and ability to complete study assessments. Post training letters written by participants to their managers indicated their commitment to educate their co-workers in DD, learn more about DD, change their clinical practices, and collaborate with staff from the other service.

Conclusions: This preliminary evaluation suggested the promise of positive outcomes for people with DD following joint training of staff from ID and MH services.
Improved Functioning in a Woman with Schizophrenia on Exclusive Therapy with Oestrogen Pills
Authors: Tunde-Ayinmode Mosunmola , Singh Ashok , Marsden Karen
Published: March 2003

Objective: To highlight the therapeutic potential of oestrogen in schizophrenia and raise awareness about the need for more clinical trials.

Method: Case Report.

Results: The case concerns a woman suffering from chronic paranoid schizophrenia, who complied poorly with antipsychotic medication and had severely impaired psychological and social functioning. Oestrogen therapy in the form of an oral contraceptive pill (brevinor- norethisterone/ ethinyloestradiol) was used with effect.

Conclusions: Oestrogen therapy shows promise in select cases in the treatment of schizophrenia and warrants further study.