bluuebunny/crossref_metadata_2025_split huggingface dataset:
Follow‐up after incomplete hysteroscopic removal of uterine fibroids
Authors: VAN DONGEN HELEEN , HANS EMANUEL MARK , SMEETS MADDY J. , TRIMBOS BAPTIST , WILLEM JANSEN FRANK 
Published: December 2009

AbstractBackground. In this observational study, we analysed whether a period of wait and see was reasonable following incomplete removal of submucous fibroids, with regard to symptoms of abnormal uterine bleeding, and whether factors predicting subsequent surgery could be identified. Methods. In 3 affiliated hospitals, patients with incomplete removal of submucous fibroids, treated with hysteroscopic myomectomy for abnormal uterine bleeding, between January 1997 and January 2005, were followed over time. Using life‐table analysis (Kaplan‐Meier method), the cumulative proportion of women having surgery‐free survival following incomplete removal of submucous fibroids was calculated. Cox‐proportional hazard analyses were used to analyse relationships of variables with recurrence of symptoms. Results. Forty‐one consecutive patients met the inclusion criteria, and were followed over time. The mean age was 42.5 years (range 27–55). The majority of patients with incomplete removal of submucous fibroids were diagnosed with type 2 fibroids. Termination of the procedure before complete removal was achieved, was principally caused by reaching the maximum fluid deficit (90.2%). The surgery‐free percentages were 70.2% (95%‐CI: 55.3–85.1) at 1 year, 54.8% (95%‐CI: 38.1–70.7) at 2 years, and 44.2% (95%‐CI: 26.9–61.5) at 3 years. Size of fibroid (diameter) pre‐operatively turned out to be of statistically significant influence, with a hazard ratio of 1.762 (95%‐CI: 1.114–2.787) per cm increase in diameter (p = 0.016). Conclusions. The results indicate that incomplete removal does not always seem to necessitate subsequent surgery. Instead of subsequent surgery immediately post‐operatively, a wait and see policy is worth considering after incomplete removal.
Informed consent: providing information about prenatal examinations
Authors: DAHL KATJA , KESMODEL ULRIK , HVIDMAN LONE , OLESEN FREDE 
Published: December 2009

AbstractBackground. Choice in prenatal care has moved on from a paternalistic approach, to increased patient autonomy and informed decision‐making. This review summarises the existing literature on the information of pregnant women about prenatal examinations. The extent to which information about Down syndrome and screening tests empowers informed decision‐making are investigated, as are different ways of expressing a risk estimate. Results. Knowledge scores can be improved and decisional conflict reduced by group counselling, individual sessions, and by use of leaflets. None of the interventions leads to a raise in anxiety scores or influence uptake rates. Satisfaction with information provided was found unrelated to level of knowledge, but associated with having expectations for information met. Information on Down syndrome is missing (13–21%), or restricted (13%), limitations of screenings tests rarely mentioned, and written materials often insufficient. Women experience risk expressed as proportions or relative risk ratio significantly higher than percentage, number needed to treat, or absolute risk reduction. More women correctly understand relative risk reduction compared to absolute risk reduction and number needed to treat (60 versus 42 and 30%). Using medical words rather than lay terms significantly alter risk perception. Conclusions. Information can increase the level of knowledge and reduce decisional conflict, without raising anxiety scores. A clarification of the women's expectations seems paramount to obtain a perception of good information and informed consent. The information provided about Down syndrome and screening tests does not empower an informed consent based on relevant knowledge.
Collagens in the human ovary and their changes in the perifollicular stroma during ovulation
Authors: LIND A.‐K. , WEIJDEGÅRD B. , DAHM‐KÄHLER P. , Mölne J. , SUNDFELDT K. , BRÄNNSTRÖM M. 
Published: December 2009

AbstractBackground. Remodeling of the collagens around the follicle is a major event in ovulation. The aim of the present study was to investigate the distribution of collagen I, III, and IV in the human ovary. Methods. Biopsies of the perifollicular stroma were obtained at sterilization during the preovulatory phase (follicle size >14 mm) or at any of three intervals (12–18 h after human chorionic gonadotrophin: early ovulatory phase; >18–24 h: late ovulatory phase; 44–77 h: postovulatory phase) after human chorionic gonadotrophin. Excised dominant follicles and whole ovarian sections were also obtained. Immunohistochemistry using antibodies against collagen I, III, IV, vimentin, and CD 45 was performed. Results and conclusions. Collagens I and III were distributed in concentric layers in the capsular stroma with bundles of collagens connecting these layers to form a mesh. Collagen I was present in larger quantities in the outer layers and collagen III showed the inverse distribution. In the theca, collagen I was present in the externa and collagen III in the entire layer. The staining intensity of collagens I and III in the perifollicular stroma decreased from the preovulatory stage. Collagen IV was present in the basal lamina separating granulosa and theca cells. This study shows that collagen I and III are abundant in and around the ovulating human follicle with typical patterns of distribution. Collagen IV is present in the basal membrane that separates the granulosa from the theca cells. Taking into account the abundance of collagens in the follicular wall and their specific localization, major site‐directed degradation of collagens seems to be necessary for follicular rupture to occur.
The Use of the Health of the Nation Outcome Scale in an Outreach Rehabilitation Program
Authors: Prabhu Radha , Oakley Browne Mark 
Published: December 2009

Objective: The aim of this paper is to describe the use of the Health of the Nation Outcome Scale (HoNOS) in an outreach-based rehabilitation program in regional Victoria, Australia. Method: Routine outcome measures (ROM), including the HoNOS, were introduced in the Stepping Stones Recovery Program (SSRP) in 2002. HoNOS data routinely collected for 122 patients between 2003 and 2006 was examined for sensitivity in capturing clinical changes by using paired t-tests. Results: There was a statistically significant decrease in total HoNOS scores as well as scores on subsets of ‘impairment’ and ‘symptomatic problems’. HoNOS scores reflected positive changes in patients and were useful as a global overview, but did not tap into process issues that are more clinically meaningful. Conclusions: The SSRP provided a wide range of interventions and promoted a structured collaborative approach which could be the main reason for the uptake of ROM in this service. There are significant hurdles in integrating ROM in routine clinical practice, such as feasibility issues and clinician attitudes, along with larger systemic issues that need to be addressed. The introduction of ROM in Australia has resulted in strongly polarized viewpoints. Suggestions for facilitating the administration and use of ROM in routine clinical practice are discussed.
Continuing Professional Development for Australian Rural Psychiatrists by Videoconference
Authors: Greenwood James , Williams Rachael 
Published: December 2009

Objective: The Rural Special Interest Group (RSIG) of the Royal Australian and New Zealand College of Psychiatrists provided a program of educational meetings for psychiatrists and trainees in rural locations to decrease professional isolation and facilitate opportunities to obtain credit for continuing professional development (CPD) purposes in ongoing professional registration. A pilot peer review group by videoconference was also implemented in Western Australia, to provide peer review for psychiatrists working in isolation. Method: Six national interactive videoconferenced education seminars were provided. The membership was polled prior to the program for topic preferences and requested speakers, who were subsequently approached to present the seminars. A West Australian peer review group was formed, involving psychiatrists from five different rural locations and one psychiatrist from the metropolitan area. Results: National seminars were attended by 106 individuals (67% consultant psychiatrists, 17% trainees and 16% allied health professionals). Evaluation demonstrates favourable views of the content and quality of the presentations and impact on practice patterns. Conclusions: Attendance at seminars via videoconferencing provided rural psychiatrists with opportunities to obtain CPD credit without the need to travel, providing a cost-effective alternative for accessing education. Involvement enabled interaction among peers throughout Australia, alleviating professional isolation and generating networking opportunities. The West Australian peer review group demonstrated sustainability with a commitment to continuation and positive impact on practice.
Reflections of a Retiring Examiner
Authors: Handrinos Dennis 
Published: December 2009

Objective: This article is a transcript of an invited talk given to the Victorian Branch of the Australian and New Zealand Association of Psychiatrists in Training in February 2008, as part of an annual function designed to assist trainee psychiatrists as they prepare for the Royal Australian and New Zealand College of Psychiatrists’ clinical examination. Six points of reflection are discussed from the perspective of the examiner. The talk focuses on the Observed Clinical Interview component of the clinical examination as this is where many candidates seem to struggle to meet the required standard. Conclusion: While specific examination preparation is essential, breadth of clinical experience, supervision and an opportunity to think and reflect on one's learning seem to be essential elements in success at these high stakes examinations.
Prescribing and Monitoring Clozapine in Christchurch
Authors: McKean Andrew , Vella-Brincat Jane , Begg Evan 
Published: December 2009

Objective: The aim of the study was to identify the pattern of usage of clozapine in Christchurch, New Zealand, including daily dose, indication and use of drug concentration monitoring. Method: Patients (n=353) were identified retrospectively from the pharmacy computer system. Data gathered included patient demographics, the daily clozapine dose and the number of occasions that clozapine drug concentration monitoring occurred. In addition, each psychiatrist who had prescribed clozapine was surveyed, regarding their indications for the use of clozapine and their use of clozapine drug concentration monitoring. Results: The majority (63%) of patients on clozapine were male. The mean age of the patients was 43 years (range 15–88 years). The mean daily dose of clozapine was 325 mg (range 12.5–900 mg). Patients over the age of 65 years were on a significantly lower dose (mean=143 mg, 95% CI=103–183 mg) compared with those under 65 years of age (mean=350 mg, 95% CI=330–370 mg). The median duration of treatment on clozapine was 4 years. Fifty-one percent of patients had undergone drug concentration monitoring, the majority on multiple occasions. In females, increasing age correlated with an increase in dose-corrected plasma clozapine concentrations (r2=0.29, p<0.001). This was not demonstrated in the male population. Of the psychiatrists surveyed, 44% prescribed clozapine for unlicensed indications and 79% used clozapine drug concentration monitoring in their patients. This was most commonly performed to assess compliance or confirm toxicity. Conclusions: The mean daily dose of clozapine of 325 mg was similar to that found in other studies. An age-related decline in dose was observed, probably due to different indications, with many of the elderly patients receiving clozapine for Parkinsonian related symptoms. There was also an age-related decline apparent in clearance in females. Clozapine was often used for unlicensed indications, and a clear majority of psychiatrists use drug concentration monitoring.
Forensic Mental Health Orders: Orders Without Borders
Authors: Carroll Andrew , Scott Russ , Green Bob , Dalton Tom , Brett Adam , McVie Ness 
Published: December 2009

Objective: Persons subject to forensic mental health orders imposed by the courts form a small but politically salient group. Their management provides a number of challenges for mental health services and for governments throughout Australia. Although their overall management has been enhanced by recent developments in forensic services, there is a lack of consistent cross-border agreements between states and territories. This paper will discuss how this situation is not conducive to effective risk management and is a denial of patients’ legitimate demands for freedom of movement. A proposal for the adoption of appropriate principles to improve the current state of affairs is outlined. Conclusion: Legislative reform is required to ensure the safe and ethical management of mentally disordered offenders subject to forensic mental health orders in Australia.
Integration Through Relatedness in the Conversational Model: A Case Study
Authors: Haliburn Joan 
Published: December 2009

Objective: The aim of this paper is to demonstrate the principles of the conversational model in two therapies with a patient, at 16 years of age and again 20 years later. Method: Described is the first therapy of L, which commenced in hospital and continued twice weekly after discharge. L was an acutely disturbed 16-year-old female admitted for 4 months to the psychiatry ward, a dynamically oriented milieu of a University teaching hospital where I was training. This is followed by a brief description of L's second therapy. Supervision was through audiotape of sessions. Results: At the conclusion of the first therapy, L was functioning well. Five years later, she married and had a child. She was referred to me again after she attempted suicide following an acute stressful event which resulted in hospitalization. She is more aware and reflective at present but continues to be vulnerable. Conclusions: Attention to certain aspects of the psychotherapeutic relationship is important as demonstrated in the conversational model.
A University Psychotherapy Training Program in a Psychiatric Hospital: 25 Years of the Conversational Model in the Treatment of Patients with Borderline Personality Disorder
Authors: Haliburn Joan , Stevenson Janine , Gerull Friederike 
Published: December 2009

Objective: The aim of this paper is to describe the development, delivery and experience of a university psychotherapy training program for psychiatry trainees in a public psychiatric hospital, demonstrating that patients with severe borderline personality disorder can be treated successfully with psychodynamic psychotherapy and stressing the need for structured psychodynamic psychotherapy training in psychiatry. Method: Two of the authors (JH and JS) were part of the first group of eight trainees supervised by Professor Russell Meares and several other experienced psychiatrists. Results: Ninety trainees have successfully completed the course. Two hundred and forty patients have been treated by trainees in this program to date; 49 patients have dropped out. Conclusions: The training program provided a sound psychodynamic base and an improved capacity to relate with our patients, not only in the program but also in our routine work as psychiatrists. An important public health issue and community need was addressed, which also proved to make sound economic sense as the number of patients who were treated might not have otherwise received long-term psychotherapy. An integrated process model of psychoanalytic psychotherapy – the conversational model – has evolved and continues to be offered as a 3-year part-time clinically oriented course leading to a Masters in Medicine, Psychotherapy at the University of Sydney. Several outcome studies and papers have been published and workshops have been presented both in Australia and overseas. The patients improved considerably – their self harming behaviour stopped within 6 months and they were no longer clinically depressed at the end of 1 year.
Glenside Hospital's Role in the Introduction of Electroconvulsive Therapy and Psychosurgery to Australian Psychiatry
Authors: Goldney Robert , Adams Rob 
Published: December 2009

Objective: This paper records the introduction of electroconvulsive therapy (ECT) and psychosurgery to Australia at Parkside Mental Hospital (present day Glenside Hospital) in South Australia. Method: A review of treatment provided at Glenside Hospital since its inception in 1870. Results: The desperate plight of patients and the limited array of interventions leading up to the introduction of ECT and psychosurgery are noted. Their introduction and the early results from the treatments are described. Conclusion: Glenside Hospital, as Parkside Mental Hospital, pioneered the use of ECT and psychosurgery in Australia.
Implementation of Indigenous Mental Health Training in Victoria
Authors: Duke Michael , Ewen Shaun 
Published: December 2009

Objective: This article aims to describe the process of implementation of the 2004 Indigenous Mental Health Royal Australian and New Zealand College of Psychiatrists (RANZCP) Training By-Laws within Victoria. Conclusions: It is likely that the challenges of ensuring access to this training experience, within the Victorian RANZCP Training Program, have been experienced to varying degrees within other Australian training programs. The vertical integration of an Indigenous health curriculum extends work being done in all undergraduate medical schools in Australia and New Zealand, and which the Australian Medical Council has incorporated into the accreditation of medical schools.
What Does ‘Clinical Significance’ Mean in the Context of the Health of the Nation Outcome Scales?
Authors: Burgess Philip , Trauer Tom , Coombs Tim , McKay Rod , Pirkis Jane 
Published: December 2009

Objective: The aim of this paper was to improve understanding of what ‘clinical significance’ means in relation to the Health of the Nation Outcome Scales (HoNOS) and its older persons and child/adolescent equivalents (the HoNOS65+ and HoNOSCA). Method: An anonymous, web-based survey was completed by 94 outcome measurement experts, most of whom had clinical responsibilities. Respondents were asked to indicate for acute inpatient and ambulatory settings: the rating on each item which represented a clinically significant problem; the relative importance of each item in determining overall clinical severity; and the items which would not be expected to improve between admission and review, admission and discharge, review and review, and review and discharge. Results: A score of 2 (‘mild problem but definitely present’) on each HoNOS/HoNOS65+/HoNOSCA item resonates with experts as being evidence of a clinically significant problem that requires active monitoring or intervention. In the main, all items on these instruments are viewed as equally important in making an overall judgement of clinical severity. The items making up the impairment and, to a lesser extent, social subscales are least likely to demonstrate change during the course of an episode of care, according to expert opinion. Generally, these findings apply across instruments and service settings. Conclusions: Overall, the findings provide support for the content validity and clinical utility of the HoNOS/HoNOS65+/HoNOSCA. Further exploration of the question of clinical significance as reflected in these instruments could take a number of forms.
The Doctrine of Integration in Psychiatry and the Pre-Socratics
Authors: Plastow Michael 
Published: December 2009

Objective: The notion of the integration of the mental and the physical, and of a number of other divisions, is widely promoted in psychiatry. René Descartes is often held responsible for divisions that appear in our profession and in our practice. The wish for integration, though, fails to recognize the way in which such divisions might be fundamental and necessary in our profession. This paper describes the endeavour in psychiatry and in Western thought more generally to cover up such divisions. It traces the drive towards integration to the origins of contemporary thought in Plato and Aristotle, in order to examine what preceded such thought. Conclusions: The pre-Socratic thinkers were able to articulate fundamental and radical divisions, an ability which has been lost since the writings of Plato and Aristotle. A reappraisal of the pre-Socratics can lead to a reconsideration of the ongoing attempt to cover over the necessary divisions which mark our clinical practice, in order to be able to value what is most fundamental in our profession.
The PTSD Supremacy: Criterion F in Three Voyager Cases
Authors: Gaughwin Peter 
Published: December 2009

Objective: The aim is to consider whether the courts and experts in their application of Criterion F for posttraumatic stress disorder (PTSD) have applied it consistently in civil claims brought years after the event. Method: Three cases for compensation relating to the Voyager disaster are considered. Results: It appears, from the cases considered in this paper, that while courts consider that Criterion F is crucial in making a diagnosis of PTSD, there are some inconsistencies in terms of understanding and applying this criterion, both by the courts and experts. This may be because of a lack of guidance in psychiatric texts as to how to apply Criterion F. Conclusions: Criterion F is, after the satisfaction of Criterion A(1), arguably the most important of the criteria for PTSD for, while the symptoms referred to in Criteria B–D have been shown to be fairly easy to simulate, it is arguably harder to do this with Criterion F, particularly in cases that arise a long time after the event. It is important therefore that psychiatrists assessing persons so long after an event adhere rigorously to Criterion F, because it is based on facts open to objective corroboration, while criteria B, C and D tend to rely on subjective experiences which are the most sensitive to distortion. Thus, it is to be hoped that if DSM-V is to maintain a criterion of clinically significant distress or impairment in the majority of the disorders described therein, it will provide some assistance as to how this criteria should be applied.
Gender-Sensitive Mental Health Care
Authors: Judd Fiona , Armstrong Sue , Kulkarni Jayashri 
Published: December 2009

Objective: The aim of this paper is to examine aspects of mental health and mental health care through a gender lens. Conclusion: Gender differences have an impact on mental health and the experience and course of women's mental illness. Comprehensive gender-sensitive mental health care requires the planning, delivery, monitoring and quality improvement initiatives of mental health care to be informed by a knowledge and understanding of gender differences in women and men and their inter-relationship with respect to childhood and adult life experiences (e.g. violence and abuse); day-to-day social, cultural, and family realities; expression and experience of mental ill health and treatment needs and responses.