bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients with Deliberate Self-Harm Seen by a Consultation-Liaison Service
Authors: Brakoulias Vlasios , Ryan Christopher , Byth Karen 
Published: December 2009

Objective: To examine Australian trends in deliberate self-harm in order to explore aetiological factors and improve clinical practice. Method: A database recording 5 years of activity of a consultation-liaison service from a large tertiary referral hospital in Sydney was analysed to discover trends in types of self-harm, sex, age, marital status, repetition rates, diagnoses and follow up. Results: 1295 patients with deliberate self-harm were referred to the Service over the 5 years. Of these patients, women exceeded men (ratio of 1.48:1). Self-poisoning constituted 79.5% of the referrals. Rates of selfharm referrals increased from 1999 to 2001, but appeared to plateau in 2002 and 2003. Eighty-eight per cent of referrals were first presentations of self-harm. Most referrals received the diagnosis of adjustment disorder with depressed mood, but a significant proportion was diagnosed with major depressive disorder and schizophrenia, particularly in those that violently self-harmed. There was a significant decline in the rate of admission to hospital over the study period. Conclusions: While patient characteristics did not change significantly, there was a decline in admission rates to hospital. Many patients had serious mental illnesses, highlighting the importance of a thorough psychiatric assessment of people who self-harm.
Using Mental Health Outcome Measures in Everyday Clinical Practice
Authors: Patterson Pandora , Matthey Stephen , Baker Martin 
Published: December 2009

Objective: To examine clinicians’ use of Mental Health Outcomes and Assessment Tools (MH-OAT), standardized clinical measures that have been introduced in NSW. Method: Two separate studies are described, which examined the use of MH-OAT within two community child and family mental health service teams in Sydney. Results: It appears that clinicians are often not completing the clinicianrated measures and rarely were they requesting and/or following up clients to complete the Strengths and Difficulties Questionnaire. Further, while clinicians are reviewing the progress of their clients, they rarely use the MH-OAT data for this purpose. Conclusions: Clinicians’ lack of adherence to MH-OAT and use of MHOAT data are discussed in terms of passive resistance and their possible perception that the process is largely irrelevant to the care of their clients.
A Clinical Monitoring System for Clozapine
Authors: Castle David , Lambert Tim , Melbourne Sue , Cox Andrew , Boardman Gaylene , Fairest Katherine , Davy Martin , Goh Joyce , Kuluris Bill , Berk Michael 
Published: December 2009

Objective: To describe a framework for the initiation and ongoing monitoring of patients on clozapine, and detail support materials that can be used in clinical settings, including general practice, to support this process. Conclusions: A framework is described. Clozapine has a special place in the management of treatment-resistant schizophrenia. However, it has certain side-effects that require its use to be carefully evaluated on an individual patient basis, and encompass excellent documentation and discussion with all relevant parties. Comprehensive longitudinal monitoring is required.
Reconsidering the Attention Deficit Paradigm
Authors: Rosenman Stephen 
Published: December 2009

Objective: To examine the inadequacies and criticisms of the current categorical paradigm of Attention Deficit Disorder both in children and adults. Conclusions: An alternative, more dimensional paradigm linking executive functions is described and its advantage over categorical diagnostic paradigms is argued. Consideration of a more discriminating and dimensional behavioural model would help psychiatrists operating in this area.
Outcome Measures in Mental Health Services: Humpty Dumpty is Alive and Well
Authors: Mellsop Graham , Wilson Janice 
Published: December 2009

Objective: To reflect on the surge of interest in ‘outcomes’ in mental health services. Conclusions: Reliable assessments underpin the ability to measure change in clinically relevant health status, and no single measure can represent all relevant variables. The measure of change should be regarded as only one part of a larger and dynamic process. Consumer management and service quality improvement activities may be better enhanced by placing emphasis on assessing those domains, which will inform the development of potential clinical management plans, in a quantitative fashion. Where indicated, repeated assessment will provide information which will inform individual patient care, and by grouping data, service planning and continuous improvement activities.
Addressing the Health and Lifestyle Issues of People with a Mental Illness: The Healthy Living Programme
Authors: O'sullivan Julie , Gilbert Jillian , Ward Warren 
Published: December 2009

Objective: The physical health and well-being of mental health patients have been a concern to health professionals for many years. However, very few positive gains have been made to address this problem. This paper outlines the efforts of the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital, to design and implement a structured educational programme, aimed at addressing and encouraging healthy lifestyle behaviours in its community mental health service recipients. Methods: Three programme modules were designed, addressing the topics of Nutrition and Healthy Eating, Physical Health, and Community Based Activities and Interests. Referral of patients to the programme was by their case manager or doctor. At the conclusion of each module, participants were asked to complete a satisfaction survey evaluating the programmes. The survey also gathered feedback regarding any suggestions and/or recommendations to improve content suitability and relevance. Results: Since commencing the Healthy Living Program, each module has been conducted at least twice, the topic of Healthy Eating receiving the most referrals and therefore conducted most frequently. To date, 35 satisfaction surveys have been evaluated. The overwhelming majority of respondents offered very positive feedback about the programme, most being able to identify some healthy lifestyle changes they planned to make in response to programme attendance. Conclusions: This paper highlights the importance of incorporating healthy lifestyle programmes into mental health service delivery. The majority of patients who have attended the Healthy Living Program have indicated satisfaction with the content, but as yet information pertaining to long-term lifestyle change has not been collated. The next phase aims to examine whether the programme attendance has more long-term outcomes in improving health and well-being and promoting healthy behaviour change of mental health service recipients.
Consultation-Liaison to General Practitioners Coming of Age: The South Australian Psychiatrists' Experience
Authors: Sved Williams Anne , Dodding Jane , Wilson Ian , Fuller Jeffrey , Wade Victoria 
Published: December 2009

Objective: To evaluate outcomes and satisfaction with a consultationliaison service to general practitioners (GPs), provided by a cohort of private and public psychiatrists. Methods: All SA psychiatrists were invited to participate in a project, funded by the Australian Government Department of Health and Ageing, which was operational for 9 months. Participating psychiatrists provided telephone advice in urgent cases to GPs, and where agreed by GP, patient and psychiatrist, a one-off assessment with rapid feedback to the GP. Evaluation was carried out by external evaluators on satisfaction rates of psychiatrists, and barriers to the use of such a service, and the project officers collected information on usage and satisfaction rates by GPs. Results: Thirty-one of the 203 SA psychiatrists undertook a 2 hour training package, with 27 joining the project and 100% of those completing the project. Both GPs and psychiatrists expressed high rates of satisfaction with this mode of service, the GPs reported increases in knowledge and confidence, and the psychiatrists enjoyed the consultant role. Conclusions: A shift towards a consultation-liaison mode with GPs has produced positive benefits for GPs and psychiatrists, and ways to sustain this should be explored. Effects on outcomes for consumers using this approach need evaluation.
Let's Get Physical: An Audit of Medical Practice in First Episode Psychosis
Authors: Mckay Diana , Gorrell Jo , Cornish Alison , Tennant Chris , Rosen Alan , Moss Beverley , Nash Louise 
Published: December 2009

Objectives: To assess aspects of medical examination, diagnosis and side-effect monitoring, and to consider the role of routine investigations in this group as recommended by national guidelines. Method: A retrospective file audit was performed on young people presenting with first episode psychosis (n = 117) over 12 months of treatment contact. Results: Diagnoses were: first episode psychosis (43%), schizophrenia (16%), drug-induced psychosis (12%), affective psychosis (13%) and brief reactive psychosis (2%). Only four of the 52 (8%) subjects undergoing neuroimaging had any abnormality, with only two of these requiring referral. Three of the 33 (9%) electroencephalograms were obviously abnormal, but without epileptiform activity. There was little documentation of the assessment of involuntary movements (4% of sample) or weight (15% of sample). Conclusions: The low rates of clinically important abnormal findings in computed tomography/magnetic resonance imaging and electroencephalogram re-open debate about the need for routine neuroimaging and electrophysiology in this population.
Ethnic Minority Community Patients and the Better Outcomes in Mental Health Care Initiative
Authors: Klimidis Steven , Minas Harry , Kokanovic Renata 
Published: December 2009

Objective: To compare general practitioners registered under the Better Outcomes in Mental Health Care initiative (BOiMHC) and those not registered, in addressing mental disorders in members of ethnic minority communities (EMCs). Methods: We conducted a cross-sectional survey of 597 Melbourne metropolitan general practitioners, leading to 311 meeting criteria for having seen EMC patients with a mental disorder in the last 3 months. Comparisons were made between those registered (n = 61) and those not registered (n = 205) within the BOiMHC on measures of difficulties in: accessing bilingual allied health, accessing interpreters, accessing translated materials, patient compliance, accessing guidelines for working effectively with interpreters, accessing guidelines on cultural and migration factors affecting mental health. Results: Significantly less of those registered in the BOiMHC endorsed problems of access to bilingual allied health, interpreters and translated materials compared with those not registered. No differences between groups were observed in relation to access to guidelines and patient compliance. Those registered with the BOiMHC reported significantly less problems than those not registered. The most prevalent problems of the full sample included lack of access to bilingual allied health (70%), access to translated materials (58%) and low EMC patient compliance with mental health assessment and treatment (64%). Conclusions: Possible impacts of the BOiMHC appear to be modest in relation to EMC patients with mental disorders. The BOiMHC may require additional strategies for its application to EMCs, especially for patient engagement in mental health assessment and treatment. There is a need for a more comprehensive evaluation of EMC issues within the BOiMHC.
Liability of Psychiatrists and Mental Health Services for Failing to Admit or Detain Patients with Mental Illness
Authors: Scott Russ 
Published: December 2009

Objectives: To discuss the findings and the various judgements of the courts in the case of Presland v Hunter Area Health Service and to consider the liability of psychiatrists and mental health services for failing to admit or detain patients with mental illness. Conclusion: In a highly controversial and sometimes misreported decision, the NSW Supreme Court on 21 August 2003 entered judgement for Presland against the Hunter Area Health Service and a third year psychiatry registrar for injury suffered by reason of their negligent failure to care for Presland and, in particular, to detain him in hospital under provisions of the Mental Health Act (NSW). By a majority, the NSW Court of Appeal overturned the decision on 21 April 2005. Judgements in the appeal decision explored the duty of care owed by a psychiatrist to a patient. The decision confirmed that a successful litigant suing for negligence will not recover damages for pain and suffering and economic loss caused as a result of not being admitted for treatment of a mental illness before committing a violent offence.
Genome‐wide identification of chemosensitive single nucleotide polymorphism markers in colorectal cancers
Authors: Kim Jin C. , Kim Seon Y. , Cho Dong H. , Roh Seon A. , Choi Eun Y. , Jo Yoon K. , Jung Sang H. , Na Young S. , Kim Tae W. , Kim Yong S. 
Published: December 2009

Improved methods for predicting chemoresponsiveness involving the identification of polymorphic markers is highly desirable, considering narrow therapeutic index and frequent resistance to anti‐cancer regimens. The genome‐wide screening of chemosensitive single nucleotide polymorphisms (SNPs) was undertaken in association with in vitro chemosensitivity assays in 104 colorectal cancer patients for the initial screening step. Allele frequency, linkage disequilibrium, potential function, and Hardy–Weinberg equilibrium of the candidate SNPs were then determined for the identifying step. Finally, clinical association analysis in the other 260 evaluable patients or cell viability assays of transfected RKO cells was used to verify candidate SNPs for the validation step. In total, 12 SNPs to six regimens were initially chosen during the screening and identifying steps. In patients receiving fluoropyrimidine‐based adjuvant chemotherapy, the substitution alleles of GPC5 rs553717 (AA) correlated significantly with tumor recurrence and shorter disease‐free survival (P = 0.019 and 0.023, respectively). Interestingly, RKO cells expressing mutant GPC5 showed enhanced cell death in response to 5‐FU in cytotoxicity assays. Patients that were homozygous for the reference alleles SSTR4 rs2567608 (AA) and EPHA7 rs2278107 (TT) showed lower disease control rates in response to irinotecan and oxaliplatin regimens, respectively, than those with substitution alleles (P = 0.022 and 0.014, respectively). Thus, we identified chemosensitive SNP markers using a novel three step process of genome‐wide analysis consisting of in vitro screening, identification, and validation. The candidate chemosensitive SNP markers identified in our study, including those identified in vitro, can now be further verified in a large cohort study.(Cancer Sci 2010; 101: 1007–1013)
Activated protein C action in inflammation
Authors: Sarangi Pranita P. , Lee Hyun‐wook , Kim Minsoo 
Published: December 2009

SummaryActivated protein C (APC) is a natural anticoagulant that plays an important role in coagulation homeostasis by inactivating the procoagulation factor Va and VIIIa. In addition to its anticoagulation functions, APC also has cytoprotective effects such as anti‐inflammatory, anti‐apoptotic, and endothelial barrier protection. Recently, a recombinant form of human APC (rhAPC or drotrecogin alfa activated; known commercially as ‘Xigris’) was approved by the US Federal Drug Administration for treatment of severe sepsis associated with a high risk of mortality. Sepsis, also known as systemic inflammatory response syndrome (SIRS) resulting from infection, is a serious medical condition in critical care patients. In sepsis, hyperactive and dysregulated inflammatory responses lead to secretion of pro‐ and anti‐inflammatory cytokines, activation and migration of leucocytes, activation of coagulation, inhibition of fibrinolysis, and increased apoptosis. Although initial hypotheses focused on antithrombotic and profibrinolytic functions of APC in sepsis, other agents with more potent anticoagulation functions were not effective in treating severe sepsis. Furthermore, APC therapy is also associated with the risk of severe bleeding in treated patients. Therefore, the cytoprotective effects, rather than the anticoagulant effect of APC are postulated to be responsible for the therapeutic benefit of APC in the treatment of severe sepsis.
Numerical simulation of the migration and distribution of diamond squid (Thysanoteuthis rhombus) in the southwest Sea of Japan
Authors: ONITSUKA G. , HIROSE N. , MIYAHARA K. , OTA T. , HATAYAMA J. , MITSUNAGA Y. , GOTO T. 
Published: December 2009

AbstractTo elucidate the effects of hydrographic conditions on the migration and distribution of diamond squid (Thysanoteuthis rhombus) in the Sea of Japan, two numerical experiments were conducted using a Lagrangian particle‐tracking model. First, Lagrangian simulations with different horizontal swimming speeds were conducted in the area off the San‐in coast, the southwest Sea of Japan. The comparison results of simulations and experimental tagging records from 2003 suggest that horizontal movement of diamond squid over a few days is influenced by individual swimming, but long‐term migration over more than about 10 days is dependent on the ambient current field. Secondly, further Lagrangian simulations with biological processes, forced by different hydrographic conditions in 2003–2005, were conducted. Temporal variations in distributions and sizes calculated by the model corresponded approximately to those of catch data. A large number of particles simulating squid were distributed over the nearshore region from the San‐in coast to the Noto Peninsula during September–November every year. Differences in the migration route and distribution of particles among years were closely related to differences in hydrographic conditions such as the position of the main stream of the Tsushima Warm Current. Prediction of the catch off the San‐in coast might be improved by considering hydrographic conditions in the southwest Sea of Japan.
The extensive polymorphism of KIR genes
Authors: Middleton Derek , Gonzelez Faviel 
Published: December 2009

SummaryThe functions of human natural killer (NK) cells are controlled by diverse families of antigen receptors. Prominent among these are the killer cell immunoglobulin‐like receptors (KIR), a family of genes clustered in one of the most variable regions of the human genome. Within this review we discuss the vast polymorphism of the KIR gene complex which rivals that of the human leucocyte antigen (HLA) complex. There are several aspects to this polymorphism. Initially there is presence/absence of individual KIR genes, with four of these genes, termed framework genes, being present in all individuals tested to date, except on those very occasional instances when the gene has been deleted. Within each gene, alleles are present at different frequencies. We provide details of a new website that enables convenient searching for data on KIR gene, allele and genotype frequencies in different populations and show how these frequencies vary in different worldwide populations and the high probability of individuals differing in their KIR repertoire when both gene and allele polymorphism is considered. The KIR genes present in an individual may be classified into A and/or B haplotypes, which respectively have a more inhibitory role or a more activating role on the function of the NK cell. Family studies have been used to ascertain the make‐up of these haplotypes, inclusion of allele typing enabling determination of whether one or two copies of a particular gene is present. In addition to genetic diversification the KIR gene complex shows differences at the functional level with different alleles having different protein expression levels and different avidity with their HLA ligand.
The Richmond Agitation‐Sedation Scale: translation and reliability testing in a Swedish intensive care unit
Authors: ALMGREN M. , LUNDMARK M. , SAMUELSON K. 
Published: December 2009

Background: Awareness about adequate sedation in mechanically ventilated patients has increased in recent years. The use of a sedation scale to continually evaluate the patient's response to sedation may promote earlier extubation and may subsequently have a positive effect on the length of stay in the intensive care unit (ICU). The Richmond Agitation‐Sedation Scale (RASS) provides 10 well‐defined levels divided into two different segments, including criteria for levels of sedation and agitation. Previous studies of the RASS have shown it to have strong reliability and validity. The aim of this study was to translate the RASS into Swedish and to test the inter‐rater reliability of the scale in a Swedish ICU.Methods: A translation of the RASS from English into Swedish was carried out, including back‐translation, critical review and pilot testing. The inter‐rater reliability testing was conducted in a general ICU at a university hospital in the south of Sweden, including 15 patients mechanically ventilated and sedated. Forty in‐pair assessments using the Swedish version of the RASS were performed and the inter‐rater reliability was tested using weighted κ statistics (linear weighting).Result: The translation of the RASS was successful and the Swedish version was found to be satisfactory and applicable in the ICU. When tested for inter‐rater reliability, the weighed κ value was 0.86.Conclusion: This study indicates that the Swedish version of the RASS is applicable with good inter‐rater reliability, suggesting that the RASS can be useful for sedation assessment of patients mechanically ventilated in Swedish general ICUs.
Functional intravascular volume deficit in patients before surgery
Authors: BUNDGAARD‐NIELSEN M. , JØRGENSEN C. C. , SECHER N. H. , KEHLET H. 
Published: December 2009

Background: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal‐directed therapy, improves outcome in high‐risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients.Methods: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a ≥10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit.Results: Forty‐two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200–600 ml), with no significant difference between the three groups of patients. The required volume was ≥400 ml in nine patients (15%).Conclusion: The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal‐directed fluid therapy.