bluuebunny/crossref_metadata_2025_split huggingface dataset:
Undergraduate nursing students’ views of mental health nursing in the forensic environment
Authors: Martin Trish , Happell Brenda 
Published: March 2003

ABSTRACT The literature clearly demonstrates that mental health nursing tends to be viewed negatively by undergraduate nursing students. While positive clinical experiences have been found to encourage more favourable attitudes towards mental health nursing, suitable placements are becoming scarce. An evaluation of clinical placements at the Victorian Institute of Forensic Mental Health (VIFMH) was undertaken to determine whether appropriate learning opportunities were offered, and identify the impact of the placement on students’ attitudes to mental health nursing. The results suggest that VIFMH provides valuable learning experiences to increase students’ understanding of mental health nursing and is effective in producing more positive attitudes towards this area of practice.
THE DEVELOPMENT OF THE ADVANCED ROLE OF RURAL NURSES IN NEW ZEALAND
Authors: Ross Jean 
Published: March 2003

ABSTRACTThis paper offers an informative insight into the development of the advanced role of rural nursing practice in New Zealand. Provided is a futuristic vision of nurses’ contribution for the provision of primary rural health care. The concept of advanced nursing practice will be discussed within the context of the interdisciplinary healthcare team. It is argued that as nurses take on advanced practice, it is essential they receive appropriate clinical and theoretical skills to ensure they are in a position to provide competent and clinically safe, effective health care in an ethical, efficient manner. A description of a survey, undertaken by the author, studying rural nurses’ skills provides the recommendation for the development of an appropriate postgraduate course at Masters level, designed specifically for primary rural nurses for the advanced role. The provision of this advanced education together with preparation and support, can pave the way for the highly skilled and knowledgeable nurses of the future working in collaboration with the interdisciplinary rural healthcare team and rural community.
‘SWALLOWING THE MEDICINE’: DETERMINING THE PRESENT AND DESIRED MODES FOR DELIVERY OF CONTINUING MEDICAL EDUCATION TO RURAL DOCTORS
Authors: Hoyal Francis Michael Digby 
Published: March 2003

ABSTRACTA National Needs Assessment of the continuing professional educational needs of Australian rural medical practitioners was conducted on a model previously successfully used in Queensland. The objective was to describe and quantify the continuing education needs of rural medical practitioners in order that service providers might more expeditiously set educational curricula in continuing medical education (CME) provision. A major component of the study was to determine which modes of CME delivery rural doctors currently use and which they would prefer to use. Rural doctors were perceived to be slow to access new technologies and training may be required in order for the doctors to use them.
Farm‐related fatal injury of young and older adults in Australia, 1989–1992
Authors: Mitchell Rebecca J. , Franklin Richard C. , Driscoll Timothy R. , Fragar Lyn J. 
Published: March 2003

Abstract:This paper describes the types of, and circumstances surrounding, unintentional farm‐related fatal injuries involving young and older adults in Australia. Information was obtained from an inspection of coronial files for the period 1989–1992.Around 14% of all farm‐related fatalities in Australia during 1989–1992 were of young adults aged 15–24 years and approximately one‐quarter were of older adults aged ≥ 55 years. Young adults were commonly fatally injured in motor vehicle incidents and in incidents involving firearms. Tractors were the most common agent involved in fatal incidents involving older adults.Intervention measures to prevent fatalities of older adults in agriculture should focus on the safe use of tractors, while for young adults it appears prevention efforts should centre around safe use of firearms and operation of motor vehicles on the farm. Ways to overcome barriers to the use of injury prevention measures in rural Australia should be further explored.
New South Wales rural general practice from a Yank's perspective
Authors: Benzie Daniel 
Published: March 2003

ABSTRACT: The author, a family practice specialist from Minnesota in the United States, worked as a locum in rural New South Wales for 6 months. This provided him with the opportunity to reflect on the differences between the specialty of family practice in his home state of Minnesota and general practice in New South Wales; and to recognise that general practice in New South Wales is at a crossroads. This paper highlights the need for general practitioners (GPs) to work together and support each other, to provide quality care and to lobby both State and Commonwealth governments on the importance of broadly trained GP specialists in rural communities. To influence the future of their profession, GPs in New South Wales need to focus on quality of care and on educating themselves, their colleagues and the communities in which they work.
Starting out in rural New South Wales: the experiences of new graduate occupational therapists
Authors: Lee Sarah , Mackenzie Lynette 
Published: March 2003

ABSTRACT: The current shortage of health personnel in rural Australia is compounded by the difficulty in recruiting and retaining new graduate health professionals in rural practice. This qualitative study aimed to explore the experiences of five new graduate occupational therapists who began their careers in rural New South Wales (NSW). Data were collected via semi‐structured, individual interviews. Results indicated that new graduates were attracted to their rural positions by multiple factors, especially their previous rural experience. Participants experienced low self‐confidence during their transition from student to therapist. Rewarding and challenging aspects of rural practice were identified. New graduates valued challenging aspects of rural practice as opportunities for skill development. Results suggest that increasing the number of occupational therapy graduates with rural experience may attract more graduates to rural practice. Furthermore, enhancing the support available to new graduates in rural positions may help retain graduates in rural practice.
Child Sexual Abuse I: Psychopathology
Authors: Nurcombe Barry 
Published: March 2003

Objective: To review scientific literature concerning the prevalence, childhood outcome and adult outcome of child sexual abuse, and the hypothetical models that have been postulated to explain its psychopathology.Method: Selective critical review of literature.Results: Estimates of prevalence of sexual abuse suggest that a significant number of children of both sexes are affected. Research into the psychopathology of sexual abuse is hindered by methodological problems. However, sexual abuse has been associated with a number of psychiatric disorders and maladaptive lifestyles in childhood and adulthood. Several theoretical models of the psychopathology of child sexual abuse are examined and compared.Conclusions: A transactional model is the most comprehensive and encompassing.
Cannabis Use and Psychosis: A Review of Clinical and Epidemiological Evidence
Authors: Hall Wayne , Degenhardt Louisa 
Published: March 2003

Objective: This paper evaluates evidence for two hypotheses about the relationship between cannabis use and psychosis: (i) that heavy cannabis use causes a ‘cannabis psychosis’, i.e. a psychotic disorder that would not have occurred in the absence of cannabis use and which can be recognised by its pattern of symptoms and their relationship to cannabis use; and (ii) that cannabis use may precipitate schizophrenia, or exacerbate its symptoms. Method: Literature relevant to drug use and schizophrenia is reviewed. Results: There is limited clinical evidence for the first hypothesis. If ‘cannabis psychoses’ exist, they seem to be rare, because they require very high doses of tetrahydrocannabinol, the prolonged use of highly potent forms of cannabis, or a preexisting (but as yet unspecified) vulnerability, or both. There is more support for the second hypothesis in that a large prospective study has shown a linear relationship between the frequency with which cannabis had been used by age 18 and the risk over the subsequent 15 years of receiving a diagnosis of schizophrenia. Conclusions: It is still unclear whether this means that cannabis use precipitates schizophrenia, whether cannabis use is a form of ‘self-medication’, or whether the association is due to the use of other drugs, such as amphetamines, which heavy cannabis users are more likely to use. There is better clinical and epidemiological evidence that cannabis use can exacerbate the symptoms of schizophrenia.
DECREASING LENGTHS OF STAY: THE COST TO THE COMMUNITY
Authors: Caplan Gideon , Board Neville , Paten Anne , Tazelaar‐Molinia Jodie , Crowe Philip , Yap Su‐Jen , Brown Ann 
Published: March 2003

Background: Patients who are discharged earlier from hospital frequently require support from professional and unpaid carers at home after discharge. Hospitals save money per patient by discharging earlier, but it is not known whether the costs to community services and unpaid carers outweigh the savings to the hospital. Methods: We prospectively studied the total costs, patient satisfaction, time off work and pain scores of 224 patients who underwent elective herniorrhaphy or laparoscopic cholecystectomy and who lived locally before and after re‐engineering the elective surgical service. The components of the re‐engineered surgical service were a peri‐operative unit, pre‐admission anaesthetic assessment based on self‐reported questionnaires, day of surgery admissions, enhanced patient education, clinical pathways, and post‐acute care. Results: The patients treated through the re‐engineered surgical service had a significantly shorter length of stay (LOS) (mean LOS: 2.2 vs 3.2 days; P < 0.001) but neither they nor their carers required more time off work. Significant determinants of time off work were smoking, heavy lifting at work and a higher pain score at day 7. Patients treated through the re‐engineered surgical service recorded significantly higher satisfaction with their treatment. The cost saving to the hospital outweighed the cost of increased services provided in the community, so that the overall cost of providing treatment was over $200 less per patient through the re‐engineered service. Conclusions: This study demonstrates that changes in care provision that result in shorter LOS and greater cost effectiveness may better meet patients’ needs than existing systems.
HIGH PRESSURES ARE GENERATED AT THE TIP OF LAPAROSCOPIC GRASPERS
Authors: Cartmill J. A. , Shakeshaft A. J. , Walsh W. R. , Martin C. J. 
Published: March 2003

Background: Despite its importance the interface between tissue and instrument is poorly understood. Methods: A thin film pressure transducer was deployed between the jaws of eight different laparoscopic instruments and a simulated tissue to study the forces generated at the tip of laparoscopic graspers and the effect of a change in angle of tissue tension at the interface between tissue and laparoscopic grasper. Results: Pressure was concentrated at the tip of the instrument. Localized pressures increased on average from 210 kPa to 650 kPa as the angle of grasp was increased from 0 to 135°. There was a wide variation between instruments with some exhibiting increases in tip pressure of a factor of eight as the angle was increased. Conclusion: High pressures are generated at the tip of laparoscopic graspers. Pressures increase as the angle of incidence of the grasper in relation to the tissue increases. The changes in pressure with change in angle are independent of load and handle pressure.
EFFECTS OF ADRENALINE OR ENDOTOXIN TOLERANCE STATES ON MESENTERIC BLOOD FLOW IN ENDOTOXAEMIA
Authors: Baykal A. , Iskit A. B. , Kaynaroglu V. , Guc M. O. , Sayek I. , Sanaç Y. 
Published: March 2003

Background: Endotoxic shock is associated with release of catecholamines as well as decreased mesenteric vascular perfusion, which is thought to cause remote organ injury. Adrenaline tolerance was reported to decrease mortality in endotoxic shock and have cross‐tolerance with endotoxin tolerance. Our aim was to investigate the effect of these two tolerance conditions on the lipopolysaccharide (LPS)‐induced decrease in mesenteric blood flow (MBF). Methods: Adrenaline tolerance was developed by injecting 0.03 mg/kg adrenaline to Swiss‐albino mice, gradually increasing the dose to 2 mg/kg over 5 days. Endotoxin tolerance was developed by injecting saline for 4 days and LPS 1 mg/kg at the fifth day. Control animals were injected with saline for 5 days. At 72 h after completion of injections, half of the animals in each group were challenged with saline and the other half with 20 mg/kg LPS, at 0 h. Mesenteric blood flow was measured at 4 and 24 h. Results: Neither endotoxin nor adrenaline tolerance prevented an LPS‐induced decrease in MBF. Conclusion: A low dose of LPS prior to a higher dose does not prevent an LPS‐induced decrease in MBF and may actually prime for a decrease. Also, catecholamines are not primary mediators of LPS‐induced decreases in MBF.
IS THE ‘TUNNEL OF DEATH’ A SUITABLE MODALITY FOR INVESTIGATING THE SEVERELY TRAUMATIZED CHILD?
Authors: Mackay Athol 
Published: March 2003

Background: The child who has suffered severe physical trauma and is physiologically unstable can often present a diagnostic dilemma to the clinician in the emergency room. Methods: In an attempt to clarify the situation there is often a decision made to perform computed tomographic scanning in such children. Results: This is an extremely dangerous investigation in this situation given that the child has to have a GA as well as being unstable from the injuries. Conclusion: Ultrasound is easier, less expensive, can be performed in the emergency room and can be performed by relatively inexperienced operators with good diagnostic accuracy.
AN AUSTRALIAN MASS CASUALTY INCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPON TRIAGE MISTAKES OF THE PAST: THE HOMEBUSH TRIAGE STANDARD
Authors: Nocera Antony , Garner Alan 
Published: March 2003

Background: The purpose of this study was to create a system of mass casualty incident triage that provides a common language platform for both ambulance and hospital personnel based upon standard daily operating procedures for both groups. Methods: An annotated literature review was conducted. Results: The Homebush Triage Standard taxonomy consists of five categories: immediate, urgent, not urgent, dying and dead, which are given the phonetic alphabet designations of Alpha, Bravo, Charlie, Delta and Echo, respectively, to facilitate radio voice communications. Colours are assigned to each category: red (Homebush Red), yellow (Homebush Gold), green (Homebush Green), white and black comply with Standards Australia AS‐2700 1996 Colour Standard for General Purposes, to ensure triage materials have consistent production standards. Numbers are reserved to either quantify or stratify individuals within a particular triage category. The Homebush Triage Standard methodology is based on START (Simple Triage Assessment and Rapid Transport) and SAVE (Secondary Assessment of Victim Endpoint) and documents triage priority using geographic triage with triage flags, instead of triage tags. Conclusion: The Homebush Triage Standard provides a basis for both seamless patient reassessment at all points along the casualty evacuation chain and the audit of the medical response to mass casualty incidents. It allows hospital and ambulance staff to keep working using familiar routines and removes fundamental barriers to good communication during a time of crisis.
MANAGEMENT OF BILIARY TRACT COMPLICATIONS FOLLOWING LIVER TRANSPLANTATION
Authors: Jeffrey Gary P. , Brind Alison M. , Ormonde Donald G. , Frazer Christopher K. , Ferguson John , Bell Roger , Kierath Anthony , Reed William D. , House Anthony K. 
Published: March 2003

Background: A review of biliary tract complications was performed in 32 patients who underwent liver transplantation by the Western Australian Liver Transplantation Service during a 2‐year period. Methods: A review was made of patient data collected prospectively, and confirmed by retrospective casenote review. Results: A total of 30 patients (31 grafts) survived more than 2 days after transplantation, and of these 28 had an end‐to‐end biliary anastomosis. Analysis of these 28 patients found that eight of 17 patients with T‐tubes had complications: three leaks at T‐tube removal; two strictures and leaks; and three strictures. Six of 11 patients without a T‐tube had complications: one leak; three strictures and leaks; and two strictures. Predisposing factors were present in eight of the 14 patients with biliary tract complications: hepatic artery stenosis in three; and one each with hepatic artery thrombosis; biliary calculi; donor–recipient bile duct mismatch; severe cellular rejection; and prolonged postoperative hypotension. Acute rejection, steroid‐resistant rejection and cytomegalovirus infection were all significantly more common in those patients with biliary tract complications compared with those without. There was no difference in cold ischaemic time or donor age. Twelve of the 14 patients with biliary complications required endoscopic stenting with or without balloon dilation, and eight patients required radiological percutaneous drainage of bile collections. Only one patient required biliary reconstruction and two patients required re‐transplantation. One patient died of uncontrolled infection. Of three patients who underwent choledochojejunostomy, biliary leak developed in two patients, both of whom required operative biliary and hepatic repair. One of the three patients died from disseminated Aspergillus infection. The median total hospital stay of patients with biliary complications was 61 days (range: 30–180 days) compared with 33.5 days (range: 22–70 days) for patients without. Of patients with end‐to‐end biliary anastomosis, 50% had biliary tract complications and more than half of these had predisposing factors. The majority of biliary complications were managed without the need for surgery. Conclusion: A total of 50% of patients with end‐to‐end biliary anastomosis had biliary tract complications. Biliary strictures presented later than leaks, and the majority of these complications were managed without the need for surgery.
SKIN WRINKLING FOR THE ASSESSMENT OF SYMPATHETIC FUNCTION IN THE LIMBS
Authors: Vasudevan T. M. , Rij A. M. Van , Nukada H. , Taylor P. K. 
Published: March 2003

Background: Wrinkling of the skin of the palm and sole is considered to be dependent on the presence of intact sympathetic nervous activity. Loss of sympathetic integrity could be simply and usefully assessed by the absence of wrinkling. To test this hypothesis, the skin wrinkle test was compared with the starch–iodine sweat test and sympathetic skin response (SSR) in patients with abnormal sympathetic function. Methods: The three tests were carried out in 34 patients (68 limbs) undergoing temporary or permanent disruption of the sympathetic chain to upper or lower limbs. Included in this group were six diabetics undergoing chemical or surgical sympathectomy, lumbar epidural infusions following vascular surgery, and patients for whom sympathectomy was being considered. Sensitivity and specificity analysis and predictive values of the wrinkling response and the starch‐iodine test were related to the SSR as the standard. Results: The wrinkle test showed a sensitivity of 97% and specificity of 95%, and bore good correlation to the SSR. The starch–iodine test showed sensitivity of 55% and specificity of 93%. A hypothesis for the mechanism of wrinkling based on the observations of the present study is proposed. Conclusion: The wrinkle test is a reliable test of sympathetic function, is inexpensive and is easy to perform at the bedside. The sweat gland myo‐epithelial cells and absence of sebum could play an important role in the wrinkling response. It can be used to select patients who will benefit from sympathectomy, and can adequately evaluate sympathetic blockade.
Cost of Endovascular Versus Open Surgical Repair of Abdominal Aortic Aneurysms
Authors: Birch Simone E. , Stary David R. , Scott Alan R. 
Published: March 2003

Background: Endovascular repair of abdominal aortic aneurysms (AAA) is a new minimally invasive method of aneurysm exclusion that has been adopted with increasing enthusiasm, and with acceptable clinical results. It is important, however, to assess new health‐care technologies in terms of their economic as well as their clinical impact. The aim of the present study was to compare the total treatment costs for endovascular (EVR) and open surgical repair (OSR) for AAA. Methods: A retrospective review of patient hospital and outpatient records for 62 patients undergoing either EVR (n = 31) or OSR (n = 31) was carried out between June 1996 and October 1999. Resource utilization was determined by a combination of patient clinical and financial accounting data. Costs were determined for preoperative assessment, inpatient hospital stay, cost of readmissions and follow up, and predicted lifetime follow‐up costs. Results: The two groups were well matched, with no significant difference with respect to age, gender, maximum aneurysm diameter or comorbid factors. Endovascular treatment resulted in a shorter intensive care unit (ICU) and hospital stay (mean: 0.07 vs 2.9 days, P < 0.001; mean: 6.0 vs 13.4 days, P < 0.001; respectively) and fewer postoperative complications (P = 0.003). The cost of hospitalization was less for EVR ($7614 vs $15 092, P < 0.001), but this was offset by the more costly vascular prosthesis ($10 284 vs $686). Costs were higher for the EVR group for preoperative assessment ($2328 vs $1540, P < 0.001) and follow up ($1284 vs $70, P < 0.001). Lifelong follow up could be expected to cost an additional $4120 per patient after EVR. Total lifetime treatment costs including costs associated with readmission for procedure‐related complications were higher for EVR ($26 909 vs $17 650). Conclusion: Treatment costs for endovascular repair are higher than conventional surgical repair due to the cost of the vascular prosthesis and the greater requirement for radiological imaging studies.
Intramuscular haemangiomas: Hookwire localization prioir to surgical excision: Report of four cases
Authors: Quinn Paul S. , Sieunarine Kishore , Lawrence‐Brown Michael , Tan Patrick 
Published: March 2003

Background: Haemangiomas of skeletal muscle are a rare entity, although they are still noted to be one of the most common deep tissue tumours of the lower limb. All such lesions are benign with no recorded evidence of metastasis; but they are associated with a 17–20% local recurrence rate which is thought to be related to inadequate primary surgical excision rather than histological subtype. Methods: The present case series briefly discusses the pathophysiology, clinical manifestations, diagnostics, differential diagnosis and treatment modalities of intramuscular haemangiomas. The article then focuses on the recent introduction of ultrasound‐guided hookwire localization, which has enabled a great increase in complete surgical excision, resulting in much lower rates of local recurrence and a more pleasing functional and cosmetic result because unnecessary dissection is avoided. Results: Preoperative ultrasound‐guided hookwire localization of deep and often non‐palpable intramuscular haemangiomas was very helpful in enabling a more complete surgical excision to be carried out. Conclusion: Hookwire localization using ultrasound guidance is an invaluable tool in directing the surgeon intraoperatively when excising deep intramuscular haemangiomas.