bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy‐induced changes in insulin‐like growth factor I (IGF‐I), insulin‐like growth factor binding protein 3 (IGFBP‐3), and acid‐labile subunit (ALS) in patients with growth hormone (GH) deficiency and excess
Authors: Wiesli Peter , Zwimpfer Cornelia , Zapf Jürgen , Schmid Christoph 
Published: December 2009

AbstractBackground. Under most circumstances with altered growth hormone (GH) secretion, the changes of insulin‐like growth factor I (IGF‐I), insulin‐like growth factor binding protein 3 (IGFBP‐3), and acid‐labile subunit (ALS) are in parallel. The aim of the present study was to compare the effects of pregnancy in a hypopituitary patient with those of pregnancy in an acromegalic patient on IGF‐I, IGFBP‐3, and ALS. Methods and results. IGF‐I and ALS were low before pregnancy in the hypopituitary patient under glucocorticoid and thyroxine treatment. Gonadotropin treatment allowed her to become pregnant; IGF‐I and ALS levels rose in the second half of pregnancy and fell again after delivery. IGF‐I concentrations were elevated in the patient with persistent acromegaly before and dropped into the normal range during the first half of pregnancy. In the second half of pregnancy and following delivery, IGF‐I levels increased again. IGFBP‐3 levels (as assessed by immunoblot analysis as well as by 125I‐IGF II ligand blotting) decreased markedly during pregnancy in both patients, suggesting that the placenta rather than pituitary GH regulates IGFBP‐3 proteolysis in human pregnancy. The increase of IGF‐I (and ALS) during the second half of pregnancy in the individual with pituitary GH deficiency may be attributed to placental GH. The fall of IGF‐I (and ALS) into the normal range in the acromegalic patient during the first trimester of pregnancy may be related to decreased production or decreased half‐life of these proteins. Conclusion. Our data suggest that measures to continuously replace GH or to suppress GH secretion during pregnancy in patients with GH deficiency or excess, respectively, may not be warranted.
Prenatal risk indicators of a prolonged pregnancy. The Danish Birth Cohort 1998–2001
Authors: OLESEN ANNETTE W. , WESTERGAARD JES G. , OLSEN JØRN 
Published: December 2009

AbstractBackground. Few prenatal risk factors of prolonged pregnancy, a pregnancy of 42 weeks or more, are known. The objective was to examine whether sociodemographic, reproductive, toxicologic, or medical health conditions were associated with the risk of prolonged pregnancy. Methods. Data from the Danish Birth Cohort in Denmark were used. Interview data from 53,392 participants with live‐born singleton deliveries in the period 1998–2001 were available at the time of this study. The participants were interviewed by telephone at 12 and 30 weeks’ gestation, and 6 and 18 months after delivery. Statistical analyses were done using logistic regression. Results. Women with a pre‐pregnancy body mass index of 25 kg/m2 or more had a high risk of prolonged pregnancy. If the pre‐pregnancy body mass index was 35 kg/m2 or more the odds ratio was 1.52 (95% CI 1.28–1.82). Nulliparity also increased the risk of prolonged pregnancy (OR (95% CI) = 1.35 (1.27–1.44)). Conclusions. The risk of post‐term delivery was high in women with a pre‐pregnancy body mass index of 25 kg/m2 or more, and in nulliparous women.
Fertility preserving surgical treatment of ovarian borderline tumour: long‐term consequence for fertility and recurrence
Authors: MARCICKIEWICZ JANUSZ , BRÄNNSTRÖM MATS 
Published: December 2009

AbstractBackground. Borderline tumours of the ovary comprise >10% of all epithelial ovarian tumours, and about one‐quarter of these tumours are seen in women of fertile age. In the present study, the outcomes with regard to fertility and recurrence were followed in patients with borderline tumours, who were treated with ovarian and uterus preserving surgery. Methods. Of 101 women surgically treated for borderline tumours in our institution, 22 underwent fertility preserving surgery, defined as the preservation of at least part of one ovary and the uterus. A retrospective follow up of these patients was conducted. Results. The 22 patients (mean age 30.5 years) underwent surgery with either unilateral salpingoophorectomy (USO; n = 14) or USO combined with cystectomy of the contralateral ovary (n = 8). All these patients had tumours of FIGO‐stage 1 (1a = 13; 1b = 3; 1c = 6). No recurrence was seen during the follow up time (mean 8.1 years; range 5–12 years). Thirteen of the 22 patients have, since the surgery, been given a chance of pregnancy (10 actively aimed to achieve pregnancy; 3 with no contraceptive during the follow up period), and 9 of the 13 patients have become pregnant. Seven patients conceived spontaneously and 2 became pregnant through IVF. Eight of the 9 pregnant patients have given birth to a total of 14 infants, all born at term. Conclusion. This study shows that borderline ovarian tumours in patients of fertile age can be successfully treated conservatively to preserve fertility with no apparent risk of recurrence.
Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration
Authors: LARSSON CHRISTINA , SALTVEDT SISSEL , WIKLUND INGELA , PAHLEN SARA , ANDOLF ELLIKA 
Published: December 2009

AbstractBackground. Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. Methods. Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. Results. Inter‐individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over‐estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2 = 0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2 = 0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. Conclusions. The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over‐estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions.
Amniotic fluid neutrophil elastase and lactate dehydrogenase: association with histologic chorioamnionitis
Authors: Kidokoro Kumiko , Furuhashi Madoka , Kuno Naohiko , Ishikawa Kaoru 
Published: December 2009

AbstractBackground. Chorioamnionitis (CAM) is considered to be one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. The diagnosis of acute histologic CAM requires delivery and examination of the placenta. Although numbers of markers have been reported to predict histologic CAM before birth, it is unknown whether the levels of neutrophil elastase and lactate dehydrogenase (LDH) in amniotic fluid are associated with histologic CAM.Methods. Sixty women at gestational age of 16–35 weeks underwent transabdominal amniocentesis within 48 hr before delivery. Amniotic fluid was analyzed for white blood cell count, glucose level, LDH level, and neutrophil elastase level. The levels of neutrophil elastase were measured by latex immunoassay. Following delivery, tissue samples were obtained from umbilical cord, chorionic plate, and placental membranes. Histologic CAM was diagnosed based on Blanc's criteria.Results. Receiver‐operator characteristic curve analysis showed that the amniotic fluid neutrophil elastase had the best screening efficiency in predicting histologic CAM. Using amniotic fluid cut‐off levels of 0.15 μg/ml for neutrophil elastase and 250IU/l for LDH, the sensitivity, specificity, and positive and negative predictive values for predicting histologic CAM were 88.9% versus 84.1%, 73.3% versus 66.7%, 90.9% versus 88.1%, and 68.8% versus 58.8%, respectively.Conclusion. Amniotic neutrophil elastase and LDH are useful markers in predicting histologic CAM.
Anxiety Disorders no More?
Authors: Starcevic Vladan 
Published: December 2009

Objective: The aim of this article was to critically examine options for the future classification of the current Diagnostic and Statistical Manual (DSM) group of anxiety disorders. Conclusions: There is a strong trend towards the narrowing of the current DSM group of anxiety disorders and to the adopting of a different name for it. A future conceptualization of the conditions currently classified as anxiety disorders will be useful to the extent that it espouses a longitudinal diagnostic approach and acknowledges a lack of clear boundaries between anxiety and related disorders.
Metaphor, Meaning and Psychiatry
Authors: Rosenman Stephen 
Published: December 2009

Objective: The aim of this paper is to examine the scientific and cognitive role of metaphor and the use of metaphor in the conceptualization of depression as an example of mental illness. Conclusions: Metaphors from the creative arts have been used to support existing psychiatric diagnostic concepts. The existing concepts are themselves built on embedded metaphors now treated as literal facts. The choice of metaphor dictates not only the description of the condition but also its treatment and research. The use of unacknowledged and unchanging metaphors in current diagnostic practice affects progress in knowledge and practice. Some alternative borrowings of basic metaphors are provided.
The Mental Health Literacy of Rural Adolescents: Emo Subculture and SMS Texting
Authors: Scott Lydia , Chur-Hansen Anna 
Published: December 2009

Objective: This study sought to explore the mental health literacy of adolescents living in a rural area in Australia through in-depth, semi-structured interviews, with a view to identifying areas for further research and making recommendations for improved education programs around mental health. Method: Nine Year 10 students (two boys and seven girls) from a rural secondary school in South Australia read two vignettes, one portraying depression and the other schizophrenia. Semi-structured individual interviews that focussed on the vignettes were audio-taped, transcribed and analysed for thematic content. Results: The data yielded a number of main themes, many of which have been previously identified in the literature. Two new findings also emerged. These were the role of Emo subculture and dealing with distress, and the value of confiding in another person through short message service (SMS) texting. Conclusions: The impact of Emo subculture and SMS texting on mental health literacy requires further exploration. It is suggested that these two findings are not confined to rural youth, but may have national and international relevance.
Consumer-Clinician Co-Taught Training About Borderline Personality Disorder
Authors: Krawitz Roy , Jackson Wendy 
Published: December 2009

Objective: The aim of this paper is to provide further outcome data on a novel consumer-clinician co-taught borderline personality disorder training program. Method: Participants (n=216) who attended consumer-clinician co-taught borderline personality disorder training had their ratings of the training compared to ratings of participants who attended the previous clinician-only borderline personality disorder training. Results: Mean training ratings of the consumer-clinician co-taught borderline personality disorder trainings were 37 percentile points higher (77th vs 40th percentile) than the ratings of the previous clinician-only borderline personality disorder training, which already had evidence of effectiveness. Conclusion: Data confirm preliminary findings that adding a consumer-presenter to training adds considerable value.
Risk Assessment and Management in Practice: TheForensicareRisk Assessment and Management Exercise
Authors: Carroll Andrew 
Published: December 2009

Objective: There is an emerging consensus that the assessment and management of adverse outcomes in mental health, such as violence and self harm, is best achieved by approaches which incorporate validated tools using “structured professional judgement”. Although several useful tools have emerged from the literature, there is no clear consensus on the best way to integrate these with clinical practice. This paper describes a framework, the Forensicare Risk Assessment and Management Exercise (F.R.A.M.E.), employed by a statewide community forensic mental health service, which incorporates two structured professional judgement tools, and explicitly integrates these into case management and psychiatric treatment. The potential benefits of the framework are discussed in the context of contemporary trends in risk assessment and management.Conclusions: The F.R.A.M.E. appears to assist with the task of integrating risk assessment with clinical management. Formal evaluative research is indicated before it can be recommended for use by other services.
Changes to Inpatient Consultation-Liaison Psychiatry Service Delivery Over a 7-Year Period
Authors: Devasagayam Dhayanthi , Clarke David 
Published: December 2009

Objective: The aim of this paper was to examine the effect of changes to a consultation-liaison (C-L) service at Maroondah Hospital on referral and service delivery patterns across a period of 7 years. There is no national benchmarking of C-L service. Local services respond to local political and service demands. There have been significant changes to the C-L service at Maroondah Hospital between 1999 and 2006. During the intervening years, psychogeriatric referrals have been included and gazetting of general hospital beds has resulted in detention of patients under the Mental Health Act (MHA). Method: Clinical audit data from assessments by the C-L service during the above period were entered into a database and analysed. Results: The annual referral rate increased as did the mean age of referred patients. The main reason for referral changed from suicide evaluation and history of psychotic symptoms to depression. Referral lag time did not change significantly. A higher proportion of patients received a single consultation and a greater number required psychiatric inpatient care. Conclusion: The nature of referral changed towards older, sicker patients and away from younger, suicidal patients which, together with an increased referral rate, significantly increased demand on available resources.
Expensive Detour or a Way Forward? The Experience of Routine Outcome Measurement in an Aged Care Psychiatry Service
Authors: McKay Roderick , McDonald Regina 
Published: December 2009

Objective: This paper describes and reflects upon the experience of a small, integrated aged care psychiatry service that has utilized the National Outcomes Casemix Collection (NOCC) routine outcome measurements within clinical practice, service management and evaluation. The goals of the NOCC initiative are reviewed in light of this experience. Conclusion: Routine outcome measurement has the potential to significantly improve aged care psychiatric service delivery. The service described has developed a model that the authors believe demonstrates the potential for routine outcome measures to improve the monitoring of patient progress, care planning, team communication, management and the understanding of service effectiveness – goals that are consistent with NOCC philosophy. However, this requires both ongoing development of infrastructure support and the willingness of clinicians to explore their utility.
A Model for Consultation with Aboriginal Stakeholders About Young People's Mental Health and Wellbeing: the NSW School-Link Training Program
Authors: Hillin Anthony , McAlpine Rob , Bennett Bindi , Brideson Tom , Worral Vanessa , Montague Ros 
Published: December 2009

Objective: The aim of this paper is to describe a model for consultation with Aboriginal stakeholders used in the development of a training course, by the NSW Institute of Psychiatry, about young people's mental health and wellbeing. Historical, social and political factors contribute to the elevated rates of mental distress and disorder experienced by many Aboriginal young people. However, these young people often do not receive the help they need. Knowledge, skills and attitudes of clinicians are associated with the uptake of services. Therefore, a training course for clinicians was developed utilizing a detailed consultation process with Aboriginal stakeholders. Conclusions: The course was delivered as part of an ongoing comprehensive interagency training program for 2000 clinicians. The course was positively evaluated by participants and stakeholders, suggesting that the course development, including the consultation process with Aboriginal stakeholders, was effective in meeting participant and stakeholder needs. Agencies may be interested in the application of this model to consultation processes with Aboriginal communities and with other populations.
Community Treatment Orders in Victoria: A Clinico-Ethical Perspective
Authors: Patel Gunvant 
Published: December 2009

Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria. Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders.
Is There a Role for Music Therapy in the Care of the Severely Mentally Ill?
Authors: Grocke Denise , Bloch Sidney , Castle David 
Published: December 2009

Objective: The role of music therapy in psychiatric care in Australia is briefly traced from the early 1990s to the present. With the shift to community-based care, contemporary music therapy practice for the severely mentally ill is reappraised alongside the principles of the recovery model. Conclusions: Music therapy is a viable option within the creative arts therapies for enhancing quality of life in people with severe and enduring mental illness.
A Prison Mental Health Screening Unit: A First for New South Wales
Authors: Adams Jonathon , Ellis Andrew , Brown Allison , Owens Dale , Halsey Rebecca 
Published: December 2009

Objective: The aims of this paper are to provide a description of a newly available service the Mental Health Screening Unit (MHSU), within the NSW prison system and to present the first 12 months in terms of the patients, its adaptations and its limitations. Methods: The first section of this paper provides a thorough description of the MHSU. The second looks at data collected for the period 1 July 2006 to 30 June 2007. A variety of databases were utilized as sources. Results: There were a total of 604 admissions. The most common primary diagnoses were schizophrenia-related disorders. There were relatively few adverse incidents, and 18% of the acute unit population were transferred to the Long Bay Prison Hospital. Conclusion: The MHSU had a considerable throughput of patients and managed a range of severe mental illnesses. The initial objectives of the MHSU have broadly been achieved. There are several future areas of research discussed.
Clinical Utility of Health of the Nation Outcome Scales for Older Persons in a Memory Clinic
Authors: Cheung Gary , Williams Gwyneth 
Published: December 2009

Objective: The aim of this paper is to report the findings from a routine collection of Health of the Nation Outcome Scales for older persons (HoNOS65 +) in a memory clinic and to explore its clinical utility with clinicians working in old age psychiatric services. Methods: We conducted a retrospective analysis of HoNOS65+ ratings collected during a 12-month period in a newly established memory clinic. Results of this part of the study were presented to 34 clinicians. Results: The mean total HoNOS65+ score was 6.8 and 7.0 for the initial and follow-up episodes respectively. Between 60 and 65% of the clinicians indicated that they ‘disagree’, ‘strongly disagree’ or were ‘unsure’ whether HoNOS65+ (i) can contribute to clinical decision making; (ii) is useful in monitoring progress; (iii) is useful in supporting consumers to assess their progress; and (iv) is assisting in assessing, planning and evaluating service delivery. Conclusions: Service users had timely diagnostic assessment and interventions at the memory clinic. The lack of change on the HoNOS65+ suggests the positive effect of the clinic was not captured by this outcome measure. Although HoNOS65+ is routinely collected, its clinical utility as perceived by clinicians is relatively limited.
Liability of Mental Health Services for Injuries Incurred During Community Treatment
Authors: Scott Russ 
Published: December 2009

Objectives: The aim of this paper is to examine the recent decision of the NSW Supreme Court, which considered a personal injuries action brought by a patient treated in the community following a 6 day voluntary hospital admission. Conclusions: The judicial reasoning in Walker v Sydney West Area Health Service provides some comfort to mental health professionals practising in other jurisdictions whose legislative provisions are similar to those contained in the Civil Liability Act (NSW). In applying the Bolam principle, rather than the higher common law standard previously imposed by the High Court in Rogers v Whitaker, the decision is encouraging for mental health professionals whose management accords with accepted current good practice. The infrequent scrutiny by courts and coroners of management practice and systems in mental health is a further incentive to maintain continuous improvement of quality of care (by clinical audits, active risk management, professional development and supervision, and patient/family participation) consistent with the principles of clinical governance.
Merleau-Ponty and Me: Some Phenomenological Reflections Upon my Recent Bone Marrow Transplant
Authors: Morstyn Ron 
Published: December 2009

Objective: During my illness and transplant I experienced an overwhelming existential crisis involving a complex intertwining of meaning and body which was often ignored, rejected, or misunderstood by others and at times by myself, which led to painful feelings of alienation. My treatment and my own conceptualizations seemed founded on assumptions of a separation of body and mind that were not true to what I was experiencing. I searched for a more accurate understanding, which I eventually found in the writings of the French existential philosopher Merleau-Ponty. Conclusions: Merleau-Ponty's extensive elaboration of the deep ambiguity of our existence as body-subjects provides an alternative model to those of the mind/body dichotomy currently in vogue in medicine and psychiatry. I found his writings a useful framework within which to comprehend my experiences. I wanted to write about these experiences and how they relate to Merleau-Ponty's insights because I found that those individuals who were able to relate to me at this level of existential ambiguity were invaluable to my recovery.