bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective study on whether a tension‐free urethropexy procedure affects the residual urine and flow up to 4 years after the operation
Authors: Glavind Karin , Bjørk Jonna , Nøhr Mads , Jaquet Annette , Glavind Laura
Published: December 2009

Background. Sling procedures performed for urinary stress incontinence can be complicated by urinary retention and flow problems. The aim of this study was to evaluate the flow and the residual urine before and after a tension‐free vaginal urethropexy procedure performed for stress urinary incontinence. Methods. A total of 72 women were included in the study. For voiding phase assessment, patients had spontaneous flow and residual urine measurements performed before the operation and 3 months and 1, 2, 3, and 4 years after the operation. Results. The patients experienced an increase in residual urine 3 months postoperatively, but returned toward preoperative values in the following 4 years. A statistically significant decrease in maximum flow, average flow, and corrected maximum flow was observed 3 months after the operation, which was unchanged in time and thus did not increase over the years. Conclusion. The tension‐free urethropexy operation had an influence on flow which did not deteriorate over the years. Whether this change in flow will have any influence on the detrusor function or create voiding problems in years to come is unknown.
Previous aneuploidic offspring in a young woman does not increase the risk for somatic random aneuploidy in subsequent pregnancies
Authors: Biron‐Shental Tal , Amiel Aliza , Fejgin Moshe D.
Published: December 2009

The cause of aneuploidy in fetuses of young women is not fully understood. As such women are considered to be at risk of repeating the “error”, it is customary to recommend chromosomal evaluation (karyotyping) in subsequent pregnancies. Individuals predisposed to meiotic nondisjunction exhibit aneuploidy in their mitotic cells (mosaicism). The aim of this study was to assess the actual risk for repeated aneuploidy in patients who had a previous pregnancy with aneuploidy by estimating the rate of somatic random aneuploidy in their normal pregnancy and to assess whether this risk is heritable. With utilization of FISH, we assessed the number of chromosomes 9 and 18 in amniocytes from the following pregnancies: 1. Fourteen of the women had a history of chromosomal aneuploidy in a previous pregnancy (study group). 2. Ten women had previous normal pregnancies (control). 3. Nine samples were assessed in amniocytes taken from aneuploid pregnancies (positive controls). A mean of 458±65.66 amniocytes were evaluated (range 97–500 nuclei). There was no significant difference in the rate of aneuploidy of both chromosomes between the study and control groups. However, this rate was significantly higher in the aneuploid pregnancies (p<0.05). Conclusion. The known tendency for repeated nondisjunction shown in women with previous aneuploid babies could not be demonstrated in their offsprings.
The role of smoking and alcohol intake in the development of high‐grade squamous intraepithelial lesions among high‐risk HPV‐positive women
Authors: Tolstrup Janne , Munk Christian , Lykke Thomsen Birthe , Svare Edith , van den Brule Adriaan J.C. , Grønbæk Morten , Meijer Chris , Krüger Kjær Susanne
Published: December 2009

Background. Infection with human papillomavirus is considered a necessary factor in developing high‐grade squamous intraepithelial lesions of the cervix. However, most human papillomavirus positive women do not develop high‐grade squamous intraepithelial lesions and other factors may be important for this transition. The objective of the present study was to examine if smoking and alcohol intake are associated with the risk of developing high‐grade squamous intraepithelial lesions in women positive for high‐risk human papillomavirus types. Methods. We used baseline information on exposures on 548 high‐risk human papillomavirus positive women with normal cytology, comparing 94 women who developed high‐grade squamous intraepithelial lesions with 454 women who remained cytologically normal. Logistic regression was applied for statistical analysis. Results. Compared with never smokers, the odds ratio for high‐grade squamous intraepithelial lesions among current smokers was 1.99 (95% CI: 1.21–3.28). Among current smokers, number of cigarettes, years of smoking, and early age at smoking initiation were associated with increased risk. However, when modeled simultaneously, it seemed that smoking duration and age at smoking initiation were more associated with risk of high‐grade squamous intraepithelial lesions than amount of smoking. Alcohol intake was not associated with risk of high‐grade squamous intraepithelial lesions among these women. Conclusion. Smoking is associated with an increased risk of developing high‐grade squamous intraepithelial lesions in women who are infected with oncogenic human papillomavirus.
Short‐ and long‐term results of the tension‐free vaginal tape procedure in the treatment of female urinary incontinence
Authors: Ankardal Maud , Heiwall Bengt , Lausten‐Thomsen Niels , Carnelid Jill , Milsom Ian
Published: December 2009

Background. The aim was to describe the short‐ and long‐term results of treatment for urinary incontinence (UI) in women using the tension‐free vaginal tape (TVT) procedure at a single unit and to identify factors predictive of successful outcome. Material and methods. Consecutive female patients (n=707) treated for UI with the TVT procedure at Karlstad Hospital from November 1996 to June 2004 were included. After a standardized preoperative evaluation, the women were classified as having either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). The results of surgery were evaluated after 1, 2, and 5 years, by means of a postal questionnaire. An objective evaluation was performed after 5 years in a subsample of the first patients included (n=59). Factors influencing the cure rate were analyzed using multiple regression analysis. Results. The subjective cure rate was 83% after 1 year and 73% after 5 years. The objective cure rate was 83% in the subgroup after 5 years. Surgical time was 30±9 min (mean±SD). The rate of bladder perforations was 1.7%. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 54.9% versus 81.0%). Type of incontinence was the only independent variable found to influence surgical outcome. Conclusions. The TVT procedure, performed in over 700 women at a single gynecological unit, was found to be a safe and efficient surgical procedure. Type of incontinence was the only independent variable found to predict for outcome of surgery.
Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997–2004
Authors: NASSAR NATASHA , ROBERTS CHRISTINE L. , CAMERON CAROLYN A. , PEAT BRIAN
Published: December 2009

Background. Probabilistic information on outcomes of breech presentation is important for clinical decision‐making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. Methods. We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997–2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. Results. Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy‐one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset‐of‐labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. Conclusions. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision‐making and ensure optimal management of breech presentation.
Persistence of fetal memory into neonatal life
Authors: GONZALEZ‐GONZALEZ N.L. , SUAREZ M.N. , PEREZ‐PIÑERO B. , ARMAS H. , DOMENECH E. , BARTHA J.L.
Published: December 2009

Objectives. To test the hypothesis that fetal memory persists into the neonatal period. Study design. Forty‐one newborns that had been repeatedly stimulated by using fetal vibroacoustic stimulation were compared with 31 controls. The same vibroacoustic stimulator was used for both fetal and neonatal stimulation tests. For the neonatal test the stimulus was applied against the mastoid of the newborn with the interposition of a specifically designed solid–liquid interface to simulate intrauterine conditions. Student's t‐test was used. Results. Neonatal habituation rate (the number of consecutive stimuli applied before a baby stopped responding) was significantly higher in those newborns who had not participate in the fetal habituation study (7.0±5.4 stimuli) than in those who had (4.1±4.1 stimuli), p = 0.01. Conclusions. Newborns who were stimulated in utero habituated earlier than those who had not previously experienced the stimulation. These results suggest that fetal memory persists into neonatal life.
Sexual experience of partners after hysterectomy, comparing subtotal with total abdominal hysterectomy
Authors: LONNÉE‐HOFFMANN RISA A. M. , SCHEI BERIT , ERIKSSON NILS H.
Published: December 2009

Background. There is a lack of knowledge about partners’ sexual experience after hysterectomy. The aim of this study was to explore potential differences in the experience of sexual intercourse by the partner, related to the operation method (subtotal versus total abdominal hysterectomy). Method. Of all patients having undergone abdominal hysterectomy for benign indications at St Olav Hospital, Trondheim between February 2001 and March 2003, Norway, 120 patients (60 total, 60 subtotal abdominal hysterectomy) were identified. Each patient and partner received a postal questionnaire addressing sexuality in connection with the operation. Results. Of the 240 questionnaires, 111 were returned, a response rate of 46%. Among partners of women having undergone total hysterectomy, proportionally more noticed during sexual intercourse that the uterus had been removed (12%) compared to partners of women having undergone subtotal hysterectomy (4%); this was not significant and all of these partners experienced this as positive. Sexual satisfaction was improved or unchanged in most women and their partners, regardless of operation type. Partners who reported poor satisfaction before the operation were significantly more likely to report poor satisfaction after the operation. A high proportion of partners in both hysterectomy groups had not discussed sexuality in relation to the surgery either before or after the operation (subtotal: 44%; total: 24%; not significant). Conclusion. The majority of women and their partners reported no negative impact on sexual satisfaction after abdominal hysterectomy, regardless if subtotal or total. The only predictor of negative sexual experience of partners after hysterectomy was negative sexual experience before hysterectomy.
Relation between severity of dysmenorrhea and endometrioma
Authors: CHOPIN NICOLAS , BALLESTER MARCOS , BORGHESE BRUNO , FAUCONNIER ARNAUD , FOULOT HERVÉ , MALARTIC CÉCILE , CHAPRON CHARLES
Published: December 2009

Background. To evaluate the relationship between the severity of dysmenorrhea and endometrioma. Methods. Descriptive study with prospective design. Two hundred and thirty‐nine women with histologically proved endometriomas. The severity of dysmenorrhea was assessed prospectively with a 10‐cm visual analog scale. Various indicators concerning the endometrioma and the extent of deep infiltrating endometriosis were recorded during surgery in 239 patients. Correlations were sought with a multiple regression logistic model. Results. According to univariate analysis, the following variables were related to more severe dysmenorrhea: subperitoneal infiltration (uterosacral ligament and rectal infiltration) and R‐AFS score of implants. None of the specific characteristics of endometriomas were associated with severe dysmenorrhea. After multiple regression analysis, rectal infiltration and R‐AFS score of implants were the only factors that remained related to dysmenorrhea severity. Conclusions. When there is an endometrioma, severe dysmenorrhea is not directly related with the characteristics specific to these ovarian cysts. The associated deep infiltrating endometriotic lesions and in particular rectal infiltration could explain these symptoms.
Ureaplasma urealyticum: no independent role in the pathogenesis of bronchopulmonary dysplasia
Authors: AALTONEN RIIKKA , VAHLBERG TERO , LEHTONEN LIISA , ALANEN ANNA
Published: December 2009

Background. Ureaplasma urealyticum has been linked to short and long‐term morbidity of preterm infants. We wanted to analyze if it has an independent role in the pathogenesis of bronchopulmonary dysplasia if prenatal history with possible exposure to intrauterine infection is taken into account. Methods. Lower respiratory tract colonization with U. urealyticum was analyzed from 49 infants born before the 30th week of gestation. The need for supplemental oxygen at the age of 28 days and 36 gestational weeks was studied. Results. Forty‐five percent of the 33 infants born after spontaneous onset of labor were colonized with U. urealyticum, while none of the electively born were. If analyzed based on the Ureaplasma colonization, bronchopulmonary dysplasia was more common in the colonized infants at the age of 28 days (OR 4.57, 95% CI 1.18–17.68), but not at the gestational age of 36 weeks (OR 1.00). Based on the prenatal history, the OR of bronchopulmonary dysplasia in infants born after spontaneous onset of labor was greater than in infants born electively both at the age of 28 days (OR 4.33, 95% CI 0.83–22.75) and at 36 weeks of gestation (OR 2.8, 95% CI 0.30–26.42). Conclusions. If possible exposure to intra‐amniotic inflammation is taken into account, U. urealyticum seems not to have an independent role in the pathogenesis of bronchopulmonary dysplasia. Its role has been overemphasized, as it is the most common cause of intra‐amniotic bacterial infection.
Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy
Authors: SURI VANITA , AGGARWAL NEELAM , SAXENA SHILPI , MALHOTRA PANKAJ , VARMA SUBHASH
Published: December 2009

Background.Idiopathic thrombocytopenic purpura commonly affects women of childbearing age and is associated with maternal and fetal complications. Management of a pregnant patient is difficult and requires combined care of obstetrician and a neonatologist. We report our experience of idiopathic thrombocytopenic purpura during pregnancy during the last 7 years.Method.A retrospective study over the 7‐year period 1997–2003 was carried out in the Department of Obstetrics and Gynaecology in the Postgraduate Institute of Medical Education and Research, Chandigarh, India. The course of pregnancy, disease and perinatal outcome of 19 pregnancies in 16 patients with idiopathic thrombocytopenic purpura was studied.Results.Out of 16 patients with idiopathic thrombocytopenic purpura, eight were already diagnosed while the other eight were diagnosed during pregnancy. Five patients diagnosed during pregnancy had severe thrombocytopenia, and four of them showed hemorrhagic manifestation. Nine patients required steroids during pregnancy. Two patients received immunoglobulin therapy. During the antenatal period one patient developed pre‐eclampsia and one patient had gestational diabetes mellitus. Both of these patients were on steroids. There was no postpartum hemorrhage or maternal death. None of the neonates had bleeding complication, irrespective of mode of delivery.Conclusion.Pregnant patients with idiopathic thrombocytopenic purpura have generally good maternal and perinatal outcomes.
A cost‐effectiveness analysis of tension‐free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence
Authors: VALPAS ANTTI , RISSANEN PEKKA , KUJANSUU ERKKI , NILSSON CARL‐GUSTAF
Published: December 2009

Background. Evaluation of cost‐effectiveness of new surgical techniques is important. As the data on incontinence procedures are scarce, we evaluated the cost‐effectiveness of tension‐free vaginal tape procedure and laparoscopic mesh colposuspension as a primary surgical treatment for female stress urinary incontinence. Methods. In four university teaching hospitals and two central hospitals 128 stress incontinent women were randomized to tension‐free vaginal tape procedure (n = 70) or laparoscopic mesh colposuspension (n = 51) in order to investigate the clinical performance of these two procedures. Primary objective clinical outcome measures were: stress test and 48‐h pad test. Secondary subjective outcome measures were health‐related quality of life measured in terms of visual analogue scale and Urinary Incontinence Severity Score. Alongside the clinical trial, a cost‐effectiveness analysis for the main outcome measures was performed. Results. The changes in the 48‐h pad test result did not reach statistical significance (p = 0.105). When the visual analogue scale or Urinary Incontinence Severity Score are used as the outcome measure, the tension‐free vaginal tape is more cost‐effective than laparoscopic mesh colposuspension over a follow‐up period of one year (p<0.000). Conclusion. The clinical and economic data of the present study suggest that over a follow‐up period of one year the tension‐free vaginal tape procedure is more cost‐effective than laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence.
‘Learning Organizations’: A Clinician's Primer
Authors: O'Connor Nick , Kotze Beth
Published: December 2009

Objectives: Most clinicians are poorly informed in relation to the key concepts of organizational learning. Yet the paradigm may offer clinicians a powerful method for using their knowledge and skills to respond to the demands of a changing environment through experimentation and learning. The concept is critically examined. Organizational learning principles are presented, including a conceptual framework for assessing health services as Learning Organizations. Barriers to organizational learning and strategies to overcome these are discussed.

Methods: The seminal works of Argyris and Senge are reviewed and a framework for assessing organizational learning in health services is proposed. Current area health service actions are evaluated against the ‘diagnostic’ framework for a Learning Organization.

Results: Although critical examination reveals a poor empirical basis for the concept, the metaphor of the Learning Organization provides a useful conceptual framework and tools for individuals and organizations to apply in developing knowledge and effecting change. The Clinical Practice Improvement and Root Cause Analysis programs being conducted across NSW area health services meet the criteria for effective organizational learning.

Conclusions: Key concepts from organizational learning theory provide a diagnostic framework for evaluating area health services as Learning Organizations and support two current strategies for overcoming barriers to organizational learning.
The Wellness Recovery Action Plan (WRAP): Workshop Evaluation
Authors: Doughty Carolyn , Tse Samson , Duncan Natasha , McIntyre Leo
Published: December 2009

Objective: This study evaluated the delivery of a series of workshops on mental health recovery. The aims were to determine if the workshops changed participants’ attitudes and knowledge about recovery, if there were any differences in views between consumers and health professionals of mental health services, and how the delivery and content of the program could be improved.

Methods: A total of 187 consumers and health professionals from mental health services attended a workshop based on the Wellness Recovery Action Plan (WRAP). Questionnaires were administered before and after the workshop.

Results: There was a significant change in total attitudes and knowledge about recovery (p<0.001) in the expected direction, with no differences between consumers and health professionals. The majority of participants found the workshop useful, and the majority of comments were positive.

Conclusions: This study provides preliminary support for the use of WRAP to change consumers’ and mental health professionals’ knowledge and attitudes about recovery.
Interventions to Address Violence Associated with Mental Illness
Authors: Scott Russ
Published: December 2009

Objectives: The aim of this paper is to consider the association between mental illness and violence, and discuss broad intervention approaches.

Conclusion: The necessary elements of intervention to reduce violence by the mentally ill are holistic care, access to services and, where necessary, legal leverage. In the custodial setting, this includes screening, early intervention and treatment in prison, and assertive post-release case management to divert mentally ill offenders away from substance use and to support their return to the community. In the community setting, active case management, including access to inpatient beds and co-ordination between mental health services and other agencies, is crucial to providing continuity of care for patients at risk of violence in the community.
Quality of Life and Cholinesterase Inhibitors: A Qualitative Study of Patients with Alzheimer's Disease and Their Carers
Authors: Smith Bethany , Chur-Hansen Anna , Neale Alice , Symon Jonathon
Published: December 2009

Objectives: Cholinesterase inhibitors’ (ChEIs) impact on cognitive functioning in Alzheimer's disease has been extensively researched. The effect of ChEIs on improving day-to-day living and quality of life in conjunction with level of functioning for patients or their carers has not been investigated.

Method: Five spouse dyads (patient and carer) and one additional carer were interviewed about their perceptions of ChEIs in relation to their influence on daily life for both parties. Interviews were transcribed and thematic analysis conducted.

Results: Themes identified were forgetfulness, differences in long-term versus short-term memory, independence/dependence, negative emotion, no appreciable benefit, sense of hopelessness, carer as motivator, stabilization of the patient, and never regain what has been lost.

Conclusions: This study suggests that ChEI medication does not enhance life for the patient or their primary caregiver. Further qualitative and quantitative research is required into the impact of ChEIs upon both the patient and their caregivers.
Predicament Suicide: Concept and Evidence
Authors: Pridmore Saxby
Published: December 2009

Objective: The aim of this paper is to introduce the term ‘predicament suicide’ and add to the evidence that suicide may occur in the absence of Axis I diagnoses.

Method: The term ‘predicament suicide’ was described as suicide which occurs when the individual without mental disorder is in unacceptable circumstances from which they cannot find an acceptable alternative means of escape. Accounts of suicide that satisfied these criteria, and could be illustrated by images, were sought.

Results: Four accounts were identified: Ajax, Brutus, Mayor Freyberg and Commander Donnicke.

Conclusions: Predicament suicide appears to be a useful designation. This work added evidence indicating that suicide may occur in the absence of an Axis I mental disorder.
Life Events, Gender and Suicidal Behaviours in the Acute Community Setting
Authors: Cupina Denise
Published: December 2009

Objective: The aim of this paper is to examine gender differences in relation to negative life events and suicidal behaviours in patients presenting to an acute community mental health team in Auckland, New Zealand.

Method: Clinical files of all patients referred to one of the Auckland community crisis teams in 2007 were surveyed (n = 442). Those presenting with suicidal behaviours were included in the study (‘suicidal behaviours’ refers to the presence of suicidal ideas or suicide attempts). Demographic information and reasons for presentation were collected from the file.

Results: Seventy patients aged 18–65 years met the inclusion criteria. For 86% of women and 85% of men separation from their partners and relationship conflicts were the main stressors precipitating suicidal behaviours and referral to the local community crisis team. Suicidal behaviours did not differ between males and females.

Conclusion: Irrespective of gender, relationship loss and conflicts were the most commonly identified negative life events precipitating suicidal behaviours in the acute community setting. These findings can have important implications in risk assessment, suicide prevention and provision of acute community services.
The Impact of a Changed Environment on Arousal Levels of Patients in a Secure Extended Rehabilitation Facility
Authors: Olver James , Love Mervyn , Daniel Jeffrey , Norman Trevor , Nicholls Daniel
Published: December 2009

Objective: This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility.

Method: Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility.

Results: Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit.

Conclusions: The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.
Improvised Explosive Devices and Traumatic Brain Injury: The Military Experience In Iraq and Afghanistan
Authors: Wallace Duncan
Published: December 2009

Objective: The current conflicts in Iraq and Afghanistan have seen frequent use of improvised explosive devices resulting in thousands of casualties, with traumatic brain injuries particularly common. The recent literature is reviewed to provide information to clinicians on the management of this condition.

Method: A Medline search from 2001–2008, using the terms Afghanistan, blast injury, improvised explosive devices, Iraq and traumatic brain injury, was performed.

Results: The United States military experience predominates in the literature. The use of body armour and other advances has led to improved survival rates among blast injury victims. Resultant neuropsychiatric injuries, in particular traumatic brain injuries, are discussed. There is debate about the prevalence of traumatic brain injuries. The diagnosis, management, relationship with posttraumatic stress disorder and prognosis of traumatic brain injury are reviewed.

Conclusions: Traumatic brain injury has been described as the ‘signature wound’ of the current conflicts in Iraq and Afghanistan. While this term is highly debatable and probably unhelpful, clinicians need to know about this condition to provide the best management.
Partnerships Between Academic Psychiatry and the Pharmaceutical Industry: The Lilly MAP Initiative
Authors: Singh Bruce , Copolov David , Grainger David , Goh Joyce
Published: December 2009

Objective: To examine the relationship between academic psychiatry and the pharmaceutical industry, focusing on a partnership between academics in Melbourne and Eli Lilly and Company (Lilly Melbourne Academic Psychiatry).

Conclusions: Relationships between the pharmaceutical industry and the medical profession (including psychiatry) are under scrutiny as never before. Despite the complex nature of the relationship, the present paper argues that partnerships with external corporations such as pharmaceutical companies are of increasing importance for academic departments of psychiatry and research institutes, in environments in which core funding for tertiary institutes is being reduced. The partnership between Melbourne psychiatric academics and Eli Lilly and Company shows that benefits accrue to both parties, and suggests that there is a worthwhile place for other industry-academic collaborations of a similar nature in Australia.
Dissociative Disorders: A Personal ‘Work in Progress’
Authors: Middleton Warwick
Published: December 2009

Objective: To identify the core issues contained within the dissociative disorders literature, and synthesize them into a non-polarized, inclusive perspective that emphasizes logic, core psychological principles and mutual professional respect.

Conclusions: A large percentage of all psychiatric patients are traumatized in clinically significant manners. Dissociation, in all its variants, represents a psychological mechanism for the victim of trauma to defend him/herself from being overwhelmed. Debates regarding the validity of dissociative disorders need to be viewed in the context of society's countertransference to trauma, in the context of health professionals feeling vulnerable to controversy, and in terms of their own experience of trauma.
Administrators: Masters or Servants?
Authors: Shea Peter
Published: December 2009

Objective: To question the role of medical administrators of mental health services.

Conclusions: The primary allegiance of medical administrators should be to patients and the clinicians who care for them, not to politicians and those who hold the purse strings.
Psychiatry and Islam
Authors: Pridmore Saxby , Pasha Mohamed Iqbal
Published: December 2009

Objective: To explore psychiatry in Islam, with a view to informing Western psychiatrists working with Islamic patients, and Islamic medical students studying in Western countries.

Methods: The first necessary step was to acquire some understanding of Islam, Sharia and Sharia law, as the basis on which the available psychiatric literature was considered. Standard textbooks on Islam and Englishlanguage papers in the psychiatric literature were examined. Discussions with knowledgeable Muslim people were conducted.

Results: Islam shares roots with the other Abrahamic, monotheistic religions: Judaism and Christianity. A central issues is unity: the unity of God, unity with God and unity within the Islamic community. Islam is more than a religion, because it informs all aspects of behaviour and has been described as ‘a comprehensive way of life’. Individualism is less important than the welfare of the community. The Sharia is a list of rules and regulations derived from authentic sources. Psychiatric services in Islam, according to Western standards, are somewhat limited. This issue is being addressed through epidemiological studies, provision of new services and policy development. Although mental health legislation is not universal, forensic psychiatry has a role, in many ways similar to that in the West.

Conclusion: Islam is based on unity and core values of compassion, justice and benevolence. Islamic psychiatry has a proud early history, and advances are occurring. There is an opportunity for the profession of psychiatry to bridge religious, ethnic and cultural boundaries.
The National Health Performance Framework: An Evaluation Model for Use by Psychiatrists
Authors: Goh Joyce , Singh Bruce
Published: December 2009

Objectives: To demonstrate the use of the National Health Performance Framework as an evaluation framework for clinical interventions and service outcomes in mental health

Conclusions: Evaluation is not a complex process. What is required is a willingness to be accountable for outcomes of care. It does not require complex data systems but openness to scrutiny through reflective practices and a commitment to continue to explore the possibilities of making things better.
Redevelopment of a Consultation-Liaison Service at a Tertiary Paediatric Hospital
Authors: Harden Scott , Stathis Stephen , Wagner Ingrid
Published: December 2009

Objective: This paper aims to describe the way a multidisciplinary team set out to redevelop a consultation–liaison (C-L) service at a tertiary paediatric hospital.

Method: The activities and processes in which the team members engaged were documented within a continuous quality improvement cycle. These activities included literature review, analysis of referral patterns, consultation with extant services, survey of referral sources and consultation with other tertiary paediatricservices.

Results: The outcomes of these initiatives were integrated into a re-formulated multidisciplinaryteam model dedicatedto providing C-L services to the paediatric hospital. Signi?cant challenges identi?ed in the initial process were ongoing issues with caseload management and clari?cation of boundary demarcations.

Conclusion: There has been a gradual acceptance of the new C-L service by medical staff. The structure has resulted in a focused and coordinated C-L team that has contributed to innovations in the C-L process within the hospital.
Mental Health Policy Development: Case Study of Cambodia
Authors: Stockwell Alexis , Whiteford Harvey , Townsend Clare , Stewart Donald
Published: December 2009

Objective: To identify key issues in the mental health policy development process in Cambodia that will contribute to an increased understanding of how mental health policy gets on the public policy agenda, how it stays there and why policy implementation fails or succeeds. The research was formative because mental health policy analysis is a young and newly emerging discipline.

Method: A retrospective case study methodology was used to research the development of the draft Cambodian Mental Health Plan 2003–2022. Ten key informants involved in the policy development process were interviewed using a semistructured questionnaire designed to collect qualitative data about the policy formation process, stakeholders and context.

Results: The research identified key issues influencing mental health policy development. These are the need to include the Ministry of Health (MoH) in the development of mental health plans; the significance of timing; the usefulness of mental health plans; the impact of the post-conflict context on policy development; and the evolution of stakeholder groups and their need to learn how to debate the merits of mental health reform.

Conclusions: The findings are formative given methodology limitations. However, important insight is provided into the dynamics of the policy development processes that occurred in Cambodia. This allows the generation of important hypotheses for future mental health policy process research in both Cambodia and other post-conflict developing countries.
Finding Freud: A Personal Tribute on the 150th Anniversary of Sigmund Freud's Birthday
Authors: Spielman Ron
Published: December 2009

Objective: To briefly describe my own development from medical student, through junior resident and psychiatry registrar and finally qualified psychiatrist, to feeling the need to undertake psychoanalytic training in order to grapple with the complexities of treatment of personality disorders.

Conclusions: My encounter with the concepts developed by the Viennese physician, Sigmund Freud, as represented by a number of significant teachers and clinicians was a formative experience in my early career. My subsequent development as a psychiatrist and psychoanalyst was highly influenced by the understandings of human mental development and function set in train by Freud's clinical findings and ground-breaking thinking in the early 20th century. It is hoped that registrars-in-training and young psychiatrists may be particularly interested in how things ‘once were’ in NSW Mental Health Services which permitted this course of development.
An Aged Persons Mental Health Service in Remote Victoria
Authors: George Kuruvilla , Bradshaw Leesa
Published: December 2009

Objective: To describe an aged persons mental health service in the Sunraysia district in remote Victoria.

Conclusion: The aged persons mental health community team undertakes the bulk of the service's work. The data for 2 years are presented and demonstrate how effective the team is. Good relationships and linkages have been built with the local hospital, general practitioners, aged residential care services and the local aged care assessment service. During the 2 year period, very few elderly patients were admitted to the inpatient psychiatric facility and patients suffering from dementia were rarely admitted.
The Black Dog Institute Depression Clinic: A Subtyping Model in Practice
Authors: Parker Gordon , Fletcher Kathryn , Barrett Melissa , Manicavasagar Vijaya
Published: December 2009

Objective: The new Black Dog Institute Depression Clinic adopts a novel clinical service model that argues for the importance of clinically defining separate mood disorders in order to apply specific management strategies. This paper describes clinic nuances and the impact on diagnosis and management for the first 100 patients assessed.

Method: Patients are assessed via a computerized structured self-report program, a semistructured interview undertaken by a psychiatrist and a colloquium involving several practitioners where diagnostic decisions are formulated. A detailed report with treatment recommendations, incorporating psychiatric and psychological perspectives, is sent to the referring clinician. Such data are examined in this report.

Results: We offered a differing diagnostic and treatment paradigm for nearly 90% of those diagnosed with a primary mood disorder. Difficulties encountered by referring practitioners are highlighted and the need for an alternative diagnostic and management model is discussed.

Conclusions: A subtyping diagnostic management model has the capacity to advance treatment outcome, but requires validation. Our future research will assess the comparative utility of the subtyping model in clinical and research arenas.
Prosecuting Psychiatric Patients who Assault Staff: A New Zealand Perspective
Authors: Kumar Shailesh , Fischer Jesse , Ng Bradley , Clarke Sarah , Robinson Elizabeth
Published: December 2009

Objectives: The prosecution of psychiatric inpatients for violent acts remains controversial but is increasingly considered as a management option for a minority of patients. Most of the literature so far has been based in North America. This study in a rural New Zealand psychiatric unit was undertaken to explore the rates, reasons and outcomes of referring psychiatric inpatients to the police for possible prosecution of violent acts committed while in hospital.

Methods: Data were extracted retrospectively from the log of ward incident forms of the inpatient unit for the 24 months between July 2002 and June 2004 inclusive. Any incident fitting an operationalized definition of physical or verbal aggression was included in this study. The type, time, location and persons involved in each incident were recorded. Case files of all patients were used to extract information on diagnosis, treatment and further details of the incident. The details and outcome of each incident was individually verified with the local police department.

Results: Data were available for 31 incidents. There were three cases of assault by three patients that resulted in police involvement, and one patient was convicted. Brief histories and descriptions of the incidents are provided.

Conclusions: Despite an increasing awareness that prosecution of patients for violent acts is an option for psychiatric staff, such referrals to the police and subsequent convictions remain rare. In the absence of clear national policies, individual hospitals must be proactive in formulating flexible policies to address such incidents on a case by case basis.
To be the First Psychiatrist in the Solomon Islands
Authors: Orotoloa Paul , Williams Tony , De Moore Gregory
Published: December 2009

Objective: Dr Paul Orotoloa is soon to become the first citizen from the Solomon Islands to complete psychiatry training. During this process, he has spent 12 months studying in Australia. This article retraces his training experiences in the Solomon Islands, Papua New Guinea and Australia.

Conclusion: Australian psychiatry has much to offer developing psychiatric services throughout the South Pacific and should continue to offer education and material support to those psychiatric trainees studying at the University of Papua New Guinea.
Suicide for Scrutinizers
Authors: Pridmore Saxby , Ahmadi Jamshid , Evenhuis Michael
Published: December 2009

Objectives: The aim is to present information which may be useful to those who scrutinize mental health professionals and systems in the aftermath of completed suicide.

Conclusion: Suicide has been known in all cultures, throughout history, and may be committed in the absence of mental disorder. Risk factors for suicide are known but they are of limited clinical utility. Prediction and prevention of suicide are beyond current abilities. Criticism of mental health professionals and systems in the aftermath of suicide may be destructive and work to the disadvantage of patients.
Spirituality, Religion and Psychiatry: Its Application to Clinical Practice
Authors: D'souza Russell , George Kuruvilla
Published: December 2009

Objective: Based on evidence obtained from recent Australian psychiatric patient surveys, a need to include the spiritual and religious dimension of patients in their psychiatric care has been identified. This paper aims to review the evidence for this need and to suggest the parameters in which this dimension might be applied.

Methods: The phenomenology of spirituality and its relevance to psychiatry is considered, the concept of the psychiatrist and the clinician as a healer visited, and the evidence for the need for spirituality and religiosity for patients examined.

Results: Patients’ spiritual needs should be addressed at different levels. Using previous data and experience, the authors suggest what psychiatrists might and might not do, in order that these issues are attended to in an ethical and sensitive manner.

Conclusions: In considering the spiritual dimension of the patient, the psychiatrist is able to send an important message that he or she is concerned with the whole person, a message that enhances the patient–physician relationship. This, in turn, is likely to increase the therapeutic impact of psychiatrists’ interventions.
Soothing signals: transplacental transmission of resistance to asthma and allergy
Authors: Holt Patrick G. , Strickland Deborah H.
Published: December 2009

The progressive rise in the prevalence of allergic diseases since the 1970s is widely attributed to diminished exposure to microbial stimuli, resulting in dysregulated immune functions during early life. Most studies investigating the mechanism behind this phenomenon have focused on postnatal microbial exposure. But emerging evidence suggests that such programming may also occur in the developing fetus as a result of microbial stimulation of the pregnant mother.
Salvage treatment for children with refractory first or second relapse of acute myeloid leukaemia with gemtuzumab ozogamicin: results of a phase II study
Authors: Zwaan Christian M. , Reinhardt Dirk , Zimmerman Martin , Hasle Henrik , Stary Jan , Stark Batia , Dworzak Michael , Creutzig Ursula , Kaspers Gertjan J.L. ,   on behalf of the International BFM Study Group on Paediatric AML
Published: December 2009

The prognosis of children with relapsed/refractory acute myeloid leukaemia (AML) is poor, and new therapies are needed. Gemtuzumab ozogamicin (GO) is an anti‐CD33 antibody linked to the antitumor antibiotic calicheamicin. We conducted an investigator‐initiated phase II study with GO to assess its efficacy and safety, administering two dosages of 7·5 mg/m2 with a 14 d‐interval. Thirty children who were refractory to re‐induction at first relapse or suffered from second relapse of AML received a total of 64 infusions of GO. The response rate [complete remission (CR) and CR with insufficient platelet recovery] was 37%. Nine patients were subsequently transplanted (median time to transplant, 4 weeks, range 3–21 weeks), and three of these patients are currently in continuous CR with a median follow‐up of >3 years, and can considered to be cured. This resulted in a statistically significant survival advantage for children who responded to GO versus those who did not [27% (standard error 13%) vs. 0%, respectively, P = 0·001]. All other children died, mainly from progressive disease. The treatment was generally well tolerated by most patients. The frequency of transient transaminatis was low. All but one patient received defibrotide prophylaxis during the transplant procedure, and no cases of veno‐occlusive disease were noted. This study showed a favourable safety/efficacy profile of single‐agent GO in children with refractory first or second relapse of AML.
Temporal trends in the proportion cured among adults diagnosed with acute myeloid leukaemia in Sweden 1973–2001, a population‐based study
Authors: Andersson Therese M.‐L. , Lambert Paul C. , Derolf Åsa Rangert , Kristinsson Sigurdur Yngvi , Eloranta Sandra , Landgren Ola , Björkholm Magnus , Dickman Paul W.
Published: December 2009

Large age‐dependant differences in temporal trends in 1‐ and 5‐year relative survival have been observed in patients with acute myeloid leukaemia (AML) in Sweden. This investigation used an alternative approach to studying patient survival that simultaneously estimated the proportion of patients cured from their cancer and the survival of the ‘uncured’. We conducted a population‐based study including 6439 AML patients aged 19–80 years in Sweden between 1973 and 2001. Mixture cure models were estimated, with age at diagnosis categorised (19–40, 41–60, 61–70 and 71–80) and year of diagnosis modelled using splines. In 1975 the cure proportion was ≤6% in all age groups and the median survival time for ‘uncured’ patients was <0·5 years. In 2000 the cure proportion was 68% (95% confidence interval 56–77%) in the youngest group, and 32% (25–39%), 8% (3–21%), and 4% (2–8%) in the other groups, respectively. The median survival times for ‘uncured’ were 0·74 (0·43–1·26), 0·71 (0·53–0·97), 0·69 (0·51–0·95) and 0·37 (0·31–0·44) years, respectively. A dramatic improvement in the cure proportion was seen in younger patients, whereas improvement in older ages was mainly within the survival of the ‘uncured’. This novel approach of analysing survival data could be a valuable tool for physicians, patients, health care planners and health economists.
INTRAOCULAR LENS IMPLANTATION
Authors: Robinson Lyon P.
Published: December 2009

INTRAOCULAR LENS IMPLANTATION, Edited by Ernanuel S. Rosen, William M. Haiing and Erick Arnott.