bluuebunny/crossref_metadata_2025_split huggingface dataset:
Allocation of Resources and Psychosis
Authors: Neil Amanda L. , Lewin Terry J. , Carr Vaughan J. 
Published: March 2003

Objective: This commentary reviews current expenditure on psychosis in Australia, identifies discretionary expenditure that could be used more efficiently, discusses the factors influencing resource allocation and intervention selection decisions, and suggests priorities for change. Method: Cost-of-illness findings from the Low Prevalence Disorders Study (LPDS), and related service use and psychosocial data, are used to highlight patterns of expenditure on psychosis and potential resource allocation issues. Arguments are also presented suggesting that mental health resource allocation in Australia should be informed primarily by treatment efficiency, equity and humanitarian considerations, not differences in the global burden of disease. However, our evidence-base about the effectiveness and costs associated with individual treatments, programmes, and organizational structures is also shown to be limited. Conclusions: The patterns of service use and expenditure on psychosis suggest certain imbalances, including an over-reliance on hospitalization, low levels of supported community accommodation, and inadequate provision of evidence-based psychosocial treatments, rehabilitation and supported employment programmes. We need to identify and develop efficient interventions and programmes, re-orientate our services to better utilize those interventions, increase community awareness, improve monitoring of outcomes and costs, and undertake timely evaluations at multiple levels, from the individual to the societal perspective.
INSURANCE AND THE RISK OF RUPTURED APPENDIX IN THE ADULT
Authors: Wong S. W. , Haxhimolla H. , Grieve D. A. , Fisher R. , Keogh G. 
Published: March 2003

Background: Disparities in medical care related to the insurance status of patients have been reported. A retrospective analysis was performed to examine the insurance‐related differences in the risk of appendiceal perforation in the Prince of Wales Hospital (POWH), New South Wales. Methods: Computerized data of 1179 patient years who had a diagnosis of appendicitis and were admitted to the POWH over the preceding 10 years were examined. The outcome measure was appendiceal perforation. Patient variables examined were insurance status, sex, age, and socio‐economic status (SES). Three hundred patients over the same period were identified who had an appendicectomy but not appendicitis. Multiple logistic regression and Fisher’s exact test were used for statistical analysis. Results: The overall perforation rate in 1179 patients was 17%. The only factor that was related to an increased risk of perforation was age over 50 years (odds ratio (OR)1.57; 95% confidence interval (CI) 1.04–2.53). Sex, insurance status or SES were not associated with a higher risk of perforation. The overall rate of negative appendicectomy was 20% (300 of 1479 patients), and the rate was higher in the uninsured patients (22 vs 17%, P = 0.014, Fisher’s exact test). Conclusions: Lack of health insurance was not associated with an increased incidence of appendiceal perforation at the POWH. Age over 50 years was identified as the only risk factor for appendiceal perforation. The lower negative appendicectomy rate in the insured group may be because of better diagnostic ability of consultants compared to registrars.
MULTINODULAR GOITRE PRESENTING AS A CLINICAL SINGLE NODULE: HOW EFFECTIVE IS HEMITHYROIDECTOMY?
Authors: Wadström Carl , Zedenius Jan , Guinea Ana , Reeve Tom , Delbridge Leigh 
Published: March 2003

Background: Patients who present with a single thyroid nodule that requires surgery will generally undergo hemithyroidectomy. If, however, the subsequent histological examination shows unsuspected multinodular change, there is a risk of recurrence in the remaining lobe. The aim of this study was to determine the clinical outcome in patients who have had a hemithyroidectomy for a single thyroid nodule that was shown on subsequent histopathological examination to be part of a multinodular goitre. Methods: A survey was undertaken of patients who were identified from a thyroid surgery database with the following criteria: (i) hemithyroidectomy for clinical single nodule; and (ii) multinodular change on histopathology. Main outcome measures were clinical recurrence rate, the frequency of further thyroid surgery, and the efficacy of thyroxine treatment on recurrence. Results: In the 229 patients studied, the clinical recurrence rate was 12%. Fourteen of the 28 patients with recurrence required further surgery. Thyroxine therapy did not influence the recurrence rate. Conclusion: When surgery for a clinically benign single thyroid nodule is indicated, hemithyroidectomy is an adequate surgical procedure in cases where the single nodule is subsequently found to be part of a multinodular goitre. Such patients can be reassured that the chance of clinical recurrence is low. Thyroxine replacement therapy appears not to prevent recurrence.
SURGICAL WOUND INFECTION SURVEILLANCE: THE IMPORTANCE OF INFECTIONS THAT DEVELOP AFTER HOSPITAL DISCHARGE
Authors: Mitchell David H. , Swift Geoffrey , Gilbert Gwendolyn L. 
Published: March 2003

Background: The aim of this study was to evaluate two methods of post‐discharge surgical wound surveillance and to compare the incidence and outcomes of wound infections that develop prior to patients’ discharge with those that develop after hospital discharge. Methods: One thousand, three hundred and sixty inpatients who underwent major elective surgery in an 800‐bed teaching hospital in western Sydney between February 1996 and July 1997 were followed prospectively. Pre‐discharge wound surveillance was performed by clinical assessment by an independent researcher on the fifth (or later) postoperative day. Post‐discharge wound surveillance was performed by a mail out of questionnaires completed independently by patients and surgeons. Results: Overall, 138 wound infections were diagnosed (incidence 10.1%), of which fewer than one‐third (n = 44) were diagnosed before discharge (average 10.4 days postoperatively) and the remainder (n = 94) after discharge (average 20.6 days postoperatively). Seven hundred and eighty‐two (57.5%) post‐discharge survey forms were returned by patients and 680 (50.0%) by surgeons. When forms were returned by both surgeons and patients for the same wound (641 cases), there was substantial agreement in diagnosing infection or no infection (kappa = 0.73). Conclusions: The majority of nosocomial surgical wound infections develop after the patients’ discharge from hospital. A post‐discharge surveillance programme including self‐reporting of infections by patients and return of questionnaires by patients and surgeons is feasible in an Australian hospital setting. However, such a programme is labour and resource intensive and strategies to increase return of questionnaires are required.
A PROSPECTIVE RANDOMIZED TRIAL EVALUATING THE HAEMODYNAMIC ROLE OF INCOMPETENT CALF PERFORATING VEINS
Authors: Fitridge R. A. , Dunlop C. , Raptis S. , Thompson M. M. , Leppard P. , Quigley F. 
Published: March 2003

Aim: This study was undertaken to determine the haemodynamic effect of incompetent calf perforating veins in patients with uncomplicated varicose veins and long saphenous incompetence. Methods: Thirty‐eight limbs from 35 patients were studied. All patients had uncomplicated varicose veins with both long saphenous and calf perforator incompetence on duplex ultrasonography. Patients were randomized to have incompetent calf perforators ligated or left intact, in addition to saphenofemoral junction ligation, strip of long saphenous vein to knee and stab avulsion of any visible varicosities in the leg. Patients were assessed with air plethysmography pre‐operatively and 3 months postoperatively. Results: Superficial venous surgery improved venous volume, venous filling index and ejection fraction in the patient cohort. No significant haemodynamic difference was demonstrated between the two groups of patients who were randomized. Conclusions: At present, the results of this study do not support the use of routine perforator ligation during superficial surgery for uncomplicated varicose veins.
CONSERVATIVE SURGERY AND RADIATION THERAPY FOR INVASIVE LOBULAR CARCINOMA OF THE BREAST
Authors: Francis Michael , Cakir Burcu , Bilous Michael , Ung Owen , Boyages John 
Published: March 2003

Background: There is debate as to whether infiltrating lobular carcinoma (ILC) can be effectively treated with breast conservative surgery (CS) and radiotherapy (RT) because of a perceived high risk of local recurrence. This retrospective study examined the outcome of patients with ILC treated by CS and RT. Methods: Between November 1979 and December 1994, 57 women with UICC Stage I or II ILC were treated by CS and RT at Westmead Hospital, New South Wales, Australia. The median age was 55 years (range 28–79). Twelve patients (21%) underwent a re‐excision after initial CS. The final margins were clear for 43 patients (75.4%), positive (invasive or in situ) for nine patients (15.8%), and indeterminate for five patients (8.8%). All patients received whole‐breast irradiation (45–50.4 Gy) usually supplemented by a boost (10–30 Gy). Fifty‐three of 57 patients (93%) had their pathology reviewed at Westmead Hospital. Results: After a median follow up of 69 months (range 36–162) three patients (5.3%) developed a local recurrence. One of 43 patients (2.3%) with known clear margins developed a local recurrence compared with two of 14 patients (14.3%) with positive or indeterminate margins (P = NS). The 5‐ and 10‐year rates of freedom from local recurrence were 96 and 93%, respectively. The 5‐year disease‐free survival was 85% (node‐negative, 92%; node‐positive, 66%). Overall survival was 94% at 5 years. No patient developed a contralateral breast cancer. Conclusion: Patients with ILC can be effectively treated with CS and RT.
A FELLOWSHIP IN THE USA: ESSENTIAL INFORMATION FOR THE AUSTRALASIAN MEDICAL GRADUATE
Authors: Cozzi Paul J. 
Published: March 2003

Background: There have been many recent changes to the immigration and educational requirements necessary to obtain both clinical and research positions in the USA. This paper describes these requirements in detail and examines the cost of obtaining a position. Methods: An extensive review of Medline and relevant documents from educational and immigration bodies is undertaken in addition to personal and peer experience of the processes necessary to fulfil educational and immigration requirements for funded medical positions in the USA. A cost analysis is performed based upon the latest charges for exam requirements and visa fees. A ‘minimum’ cost for fulfilling exam and visa requirements only and a ‘likely’ cost (which represents a more realistic appraisal of the expenses likely to be incurred) are investigated. Results: This review shows that many recent changes have made the attainment of a position difficult and expensive. Much foresight and planning is required to obtain the necessary requirements for medical licensure and to obtain working visa status in addition to the application for the position itself. The cost analysis reveals that the minimum cost is $4050 (AU$) and the ‘likely’ cost is $8600 (AU$). Conclusion: Australasian trainees and Fellows need to be fully aware of the difficulties and expenses likely to be encountered in order to make an informed decision with regard to overseas training in the USA.
VOICE CHANGES AND THYROID SURGERY: IS PRE‐OPERATIVE INDIRECT LARYNGOSCOPY NECESSARY?
Authors: Yeung Philip , Erskine Catherine , Mathews Philip , Crowe PHILIP J. 
Published: March 2003

Background: Indirect laryngoscopy (IDL) is often performed prior to thyroid surgery to detect pre‐existing vocal cord pathology. Methods: A retrospective chart review of 201 patients undergoing thyroid surgery at the Prince of Wales Hospital was undertaken in order to study the patterns of pre‐operative and postoperative voice changes and IDL findings. Results: A total of 9% of patients had pre‐operative voice symptoms, and 22% of this group had abnormalities detected on pre‐operative IDL. Of 160 documented IDL, 4% revealed vocal cord pathology in asymptomatic patients, including an asymptomatic recurrent laryngeal nerve palsy. Conclusions: Indirect laryngoscopy remains a useful but flawed pre‐operative screening tool for patients with voice symptoms, but the literature suggests that more advanced phoniatric tests will provide superior diagnostic sensitivity. The role of routine pre‐operative laryngoscopy for asymptomatic patients is of debatable value.
THE DIAGNOSIS OF GASTROINTESTINAL TRACT INJURIES RESULTING FROM BLUNT TRAUMA
Authors: Hughes T. Michael D. 
Published: March 2003

Background: This review studies the efficacy of the methods of assessment of the abdomen in blunt trauma for the detection of gastrointestinal tract injuries (GITI). Methods: MEDLINE searches of English language publications on the subjects of diagnostic peritoneal lavage, abdominal computed tomography (CT) in blunt trauma and gastrointestinal tract injuries between 1980 and 1998 were used to identify relevant material. Earlier publications were identified from reference lists. The methodology, data and conclusions of all studies were examined in detail. The contemporary roles of clinical assessment, diagnostic peritoneal lavage, CT and other diagnostic modalities in detection of significant GITI were determined based on the best available evidence. Conclusions: The most accurate and safest methods of assessment of the abdomen in haemodynamically unstable patients with suspected abdominal injuries following blunt trauma are immediate laparotomy or diagnostic peritoneal lavage (DPL). The goal of assessment of the abdomen in stable patients is to accurately define the site and extent of intra‐abdominal injury, in order that further management may be tailored to the specific injuries. The most recent evidence suggests that CT of the abdomen fulfils these criteria better than the other modalities of assessment available. The risk of overlooking a significant GITI on CT scan is minimal provided that unexplained free fluid, bowel wall thickening or enhancement, mesenteric fat streaking and bowel dilatation are taken as evidence of GITI. When scan quality is suboptimal or expert interpretation is unavailable, DPL is recommended. Fully cooperative patients with negligible abdominal signs can be safely observed clinically.
Implications of Delayed Diagnosis in Colorectal Cancer
Authors: Young Christopher J. , Sweeney James L. , Hunter Andrew 
Published: March 2003

Background: Delayed diagnosis of colorectal cancer (CRC) continues to produce anxiety and is associated with the assumption that disease stage and survival will be worse. The aims of the present study were to assess the prevalence and reasons for delay in the diagnosis of CRC, and the effects of delay, gender, age and tumour site on the stage of disease. Methods: A retrospective study of 100 patients presenting with CRC during a 1‐year period was performed. Delay was defined to have occurred if more than a 3‐month period had lapsed from the time when initial symptoms were clearly established to the time of operation. Data were collected on principal presenting symptoms, time to first presentation to a doctor, time to diagnosis and treatment, reasons for delay, diagnostic procedures, tumour site, operation, and Australian clinicopathological (ACP) stage of the tumour. Results: Thirty‐four patients had a delay in diagnosis of their cancer. In 18 patients (53%) delay was attributable to patient reasons; in 13 patients (38%) delay was attributable to doctor‐related delay and in three patients (9%) it was attributable to both. Male patients were more likely to have patient‐related delay (31% for male patients vs 10% for female patients; P = 0.011). Patients with delay were less likely to have a stage A tumour (6% for delay group vs 21% for non‐delay group; P = 0.04). Male patients were less likely to have a stage A tumour than female patients (8% for male patients vs 25% for female patients; P = 0.018), but the effect of delay on stage disappeared when gender and tumour site were controlled in a logistic regression model. Conclusions: The present study suggests some areas where improvements may be made concerning early diagnosis and treatment of patients with CRC.
High Incidence of Micrometastases in Breast Cancer Sentinel Nodes
Authors: Mann G. Bruce , Buchanan Malcolm , Collins John P. , Lichtenstein Meir 
Published: March 2003

Background: Sentinel lymph node biopsy (SLNB) is being investigated as an alternative to formal axillary dissection in early breast cancer. Avoiding the morbidity of unnecessary axillary dissection is seen as the main potential benefit of SLNB. Sentinel lymph node biopsy also allows enhanced pathological analysis. A series of 62 sentinel node (SN) biopsies demonstrating a high incidence of micrometastases is presented here. Methods: All SN were initially examined and reported by H&E staining. All negative SN were analysed after staining with polyclonal anticytokeratin antibody. Results: Sixty‐two patients underwent SLNB at Royal Melbourne Hospital between May 1998 and February 2000. One or more SN was identified in 51/62 patients. A total of 10/51 contained metastases identified after H&E staining. There was one false negative. A total of 10/41 patients with H&E‐negative SN had micrometastases identified on immunohistochemistry (IHC). Micrometastases were more common in patients with larger tumours, with disease found in the H&E‐negative SN of 1/17 T1a and T1b (1–10 mm), 4/15 T1c (11–20 mm), and 5/9 T2 (20–50 mm) tumours. Conclusion: Sentinel lymph node biopsy can accurately assess the axilla in most patients with early breast cancer. A significant proportion of histologically negative SN will have micrometastases identifiable with IHC. Although the clinical significance of such metastases is uncertain, the available evidence suggests that these patients have a poorer prognosis than other patients with negative lymph nodes.
Australian major incident nomenclature: It may be a ‘disaster’ but in an ‘emergency’ it is just a mess
Authors: Nocera Antony 
Published: March 2003

Background: A standardized major incident nomenclature has practical applications for medical communication and audit of the medical response to incidents. Methods: A telephone and fax survey of major incident nomenclature in State and Territory health service emergency management plans and ‘disaster’ legislation was carried out on 13 August 1999. Results: Within Australia there were a total of 13 different terms to describe incidents that could produce casualties: there were four definitions of the word ‘disaster’, eight definitions of the word ‘emergency’ and one definition of the word ‘incident’. Conclusion: Australia lacks a uniform system of classifying and recording mass casualty incidents. This prevents both the independent clinical audit of the medical response to an incident and the cross‐border comparison of the effectiveness of trauma systems to deal with multiple casualties. Australia’s geography highlights the need to develop a nomenclature that allows medical practitioners, in isolated environments, to accurately describe an incident and the medical support that is required. The Potential Injury‐Creating Event (PICE) nomenclature is a simple system to describe the functional impact of an event upon a community and the level of medical support required. It can be used to provide the basis for the uniform reporting of the medical management of major incidents within Australia.
Clinical value of magnetic resonance imaging of the knee
Authors: Feller Julian A. , Webster Kate E. 
Published: March 2003

Background: Magnetic resonance (MR) imaging is an accurate imaging modality of the knee. The role of MR in clinical practice has not been precisely defined, largely due to the relative expense of the technique. Methods: For each new patient with a knee problem who was referred for MR, a provisional diagnosis was made together with a level of certainty regarding the diagnosis. The waiting time for the scan was recorded. To assess clinical usefulness the MR diagnosis was compared with the provisional diagnosis and classified according to the following descending order of value: unexpected negative (no intra‐articular pathology), confirmatory negative, unexpected positive or confirmatory positive. To assess accuracy of the MR diagnosis, the operative diagnosis was compared to the MR diagnosis in those patients who underwent arthroscopy. Results: Fifty‐two per cent of scans were assessed as being very useful and a further 20% were assessed as being moderately useful. Magnetic resonance had a 95% accuracy for medial meniscal tears, 91% accuracy for lateral meniscal tears, and 98% accuracy for anterior cruciate ligament tears, similar to previously reported studies. The diagnostic arthroscopy rate in the patients who underwent MR scanning was similar to that in patients for whom the surgeon was more confident about the diagnosis and who therefore did not undergo MR scanning. The diagnostic arthroscopy rate could have been reduced if surgery had not been performed in 14 patients who had a negative MR scan. Conclusions: There is a role for selective use of MR in the assessment of knee conditions. In particular, MR can be used to reduce the diagnostic arthroscopy rate.
A South Australian Coronial Inquiry Into Suicide and Homicide
Authors: Goldney Robert D. 
Published: March 2003

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

Objective: To describe how the current complex and discontinuous mental health systems in Australia fail to provide high quality care for patients with severe affective disorders. To outline how the development of a ‘National Coalition for People with Depression’ could result in the delineation of the essential aspects of high quality, long-term and continuous mental health care for these consumers of health services. To highlight the key role of educated and responsible consumers, and eventually the wider community, in determining the future shape of mental health service systems and clinical and health services research. Conclusions: Although in its early stages, the process of developing a ‘National Coalition for People with Depression’ has already led to fundamental shifts in attitudes in some mental health services. By focusing on the consumers' needs for high quality and continuous services, traditional specialist service managers (in both the private and public sectors), and primary care and specialist clinicians will be forced to re-evaluate current assumptions and program developments. In Australia, there is now a considerable opportunity for co-ordinated service enhancement for those consumers with affective disorders.