bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMMUNITY VENTURES IN RURAL HEALTH: THE ESTABLISHMENT OF COMMUNITY HEALTH TRUSTS IN SOUTHERN NEW ZEALAND
Authors: Barnett Pauline , Barnett J. Ross 
Published: March 2003

ABSTRACT:During the 1990s, a shortage of funds and a competitive market for public sector health services created both threats and opportunities for rural health services in New Zealand. In three of the four regional funding areas, rural health services experienced increased levels of closure or privatisation. In the fourth area, the Southern Region, the initiative of the community and the response of the funder combined to produce an alternative response; the formation of community health trusts that allowed local communities to own their own health facilities and to contract to run the services. Through a survey of community trusts this research analyses the process of trust formation and assesses the critical success factors in the community (local leadership, local financial and other commitment, involvement of local professionals, learning from each other, local operational efficiency) which allowed the trusts to survive and thrive.
Use of eye care services by older Australians: the Blue Mountains Eye Study
Authors: Wang JJ , Mitchell P , Smith W 
Published: March 2003

Purpose: To assess utilization of eye care services in an older Australian population. Methods: The Blue Mountains Eye Study examined 3654 permanent residents aged 49 years or older from two New South Wales postcode areas. At interview, we collected information about past attendance to eye care practitioners, demographic and socio‐economic status variables and past medical and eye history. Full‐time optometric and part‐time ophthalmic services were available in this community. Results: Almost all participants (99%) had seen either an ophthalmologist or optometrist in the past, with 62, 27, 7 and 3% having last attended in the last 2, 2–5, 5–10 and >10 years, respectively. Among those participants (2251) who had been seen in the last 2 years, 50.2% (1131) last saw an ophthalmologist, 48.6% (1094) last saw an optometrist and 26 (1.2%) could not state whom they saw. After adjusting for age and sex, factors statistically significantly associated with attending an ophthalmologist included older age, female gender, higher socio‐economic status, moderate to high myopia and presence of systemic disease (diabetes, hypertension) or any significant eye pathology. Factors statistically significantly associated with attending an optometrist were younger age, living alone, not currently married, being able to go out alone, having better presenting visual acuity, hyperopia and absence of diabetes or significant eye pathology, including moderate to high myopia. Conclusions: Findings from this study indicate that whether people use eye care services and whom they visit is mainly driven by need factors. Although there was considerable overlap, this study found relatively appropriate utilization of eye care services by this population.
Constructing Mental Illness as Dangerous: A Pilot Study
Authors: Wilson Claire , Nairn Raymond , Coverdale John , Panapa Aroha 
Published: March 2003

Objective: There is a dearth of studies examining how dangerousness is constructed in media depictions of mentally ill individuals who are frequently portrayed as acting violently. The aim of the present study was to identify the contribution of diverse technical, semiotic and discursive resources utilised in portraying a character with a mental illness in a prime-time drama as dangerous. Method: Discourse analytic techniques, involving systematic, repeated, critical viewings, were applied to a single program drawn from a sample of prime-time television drama episodes touching on mental illness. Results: Nine devices (appearance, music and sound effects, lighting, language, intercutting, jump-cutting, point of view shots, horror conventions and intertextuality) were identified as contributing to the signified dangerousness of person receiving care in the community for a mental illness. Conclusions: These techniques combine in signifying mental illness and a person suffering from it as dangerous. The findings suggest that mental health professionals working to reduce the stigma of mental illness need to have a reasonably sophisticated understanding of the practices and priorities of television production if they are to collaborate effectively with producers to create dramas that convey more human and sympathetic understandings of mental illness or to combat the negative effects of such portrayals.
Awareness and Unawareness of thought Disorder
Authors: McGrath John , Allman Rebecca 
Published: March 2003

Objective: There is little systematic evidence to determine if patients with thought disorder are aware of their impaired communication. Awareness versus unawareness of deficit has important implications for neurocognitive models of thought disorder. The aims of this study were to assess awareness of impaired communication in patients prone to thought disorder, and to explore associations between degree of awareness of thought disorder, objective measurement of thought disorder and performance on tests sensitive to impaired executive ability.Method: Thirty-one patients with schizophrenia, 16 patients with mania and 20 well controls were included. Subjects completed a new instrument to assess awareness of thought disorder, the Communication Awareness Scale (CAS). Thought disorder was rated from free speech samples scored with Andreasen's Scale for the Assessment of Thought Language and Communication. Four tests sensitive to impaired executive ability were administered.Results: Subjects with higher levels of positive thought disorder had significantly higher CAS scores. Unexpectedly, those with lower scores on executive ability had significantly higher scores on the CAS.Conclusions: The significant correlation between objective levels of positive thought disorder and higher scores on the CAS suggests that, overall, patients with thought disorder are aware of their deficit. A neurocognitive model of thought disorder is described that involves a dissociation between the ability to monitor errors (required for accurate awareness of deficit) and the ability to correct errors (required for the production of efficient communication).
An Evolutionary Approach to Psychiatry
Authors: Joness Ivor , Blackshaw Judith K. 
Published: March 2003

Objective: The current mainstream approach to psychiatry, characterised as empirical and phenomenological is questioned here and a new aetiological approach based on evolutionary theory is proposed. Method: A brief description of an evolutionary approach to animal behaviour is presented. The psychiatric states of anxiety, depression, ‘hysterical’ obsession and some aspects of psychosis are compared with related behaviours in other species. Results: It is argued that this approach can be applied to psychiatric behaviour, that behavioural similarities exist between many psychiatric states and normal behaviour in species other than humans and many of these can be understood as adaptive. Some psychiatric states represent abnormally prominent adaptive behaviours, others represent distortions of these behaviours by a pathological process. An important line of thought in current animal behaviour research examines the concepts of self-awareness, consciousness, thought and affect in species other than man. These ideas, from an evolutionary perspective, are extended to psychiatry. A scheme illustrating this process is presented. Conclusions: We have drawn on relevant behavioural similarities between humans and other animals to show that many psychiatric states are distortions of evolved behaviour. The implications for classification, research and treatment are considerable. In particular this approach may form a bridge between fundamental research in molecular biology and the anthropomorphic approach of psychodynamics.
ENDOSCOPIC THORACIC SYMPATHECTOMY FOR PRIMARY PALMAR HYPERHIDROSIS: INTERMEDIATE TERM RESULTS
Authors: Erak S. , Sieunarine K. , Goodman M. , Lawrence‐Brown M. , Bell R. , Chandraratna H. , Prendergast And F. 
Published: March 2003

Background: The authors’ experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined. Methods: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview. Results: Follow‐up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner’s syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X‐ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction. Conclusions: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.
GOOD OUTCOME FROM SURGERY FOR AMPULLARY TUMOUR
Authors: Toh S. K. C. , Davies N. , Dolan P. , Worthley C. , Townsend N. , Williams J. A. R. 
Published: March 2003

Background: Ampulla of Vater tumours are rare but usually resectable. There is debate as to the better surgical approach between the standard radical procedure, which provides adequate resection margins, and local resection, which may carry a lower mortality. This study reports the 16‐year experience of a specialist unit with these tumours, and compares our results with that of recently published series. Method: A retrospective review of patients admitted with an ampullary tumour to the Hepatobiliary and Pancreatic Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia, between January 1981 and April 1997. Results: Twenty‐five patients (13 men, 12 women) of median age 65 years were admitted with an ampullary tumour to the unit during this period. The most common presentation was obstructive jaundice. Multiple endoscopic biopsy was found to be very reliable in distinguishing between benign and malignant tumours. Five patients, all male, had benign neoplasms: three adenomas, one carcinoid and one gangliocytic paraganglioma. Transduodenal local excision was performed in four patients. One patient had a Whipple procedure resulting in the only in‐hospital death at 3 months. Twenty patients had adenocarcinoma, of which 13 patients had a pancreaticoduodenectomy, two local excisions, two palliative bypasses, two were unfit for surgery and one declined surgery. The resectability rate was 88%, with no operative mortalities. The 5‐year actuarial survival of patients who underwent radical resection was 49%. Conclusions: Proximal pancreaticoduodenectomy, preferably a pylorus‐preserving procedure, is safe and effective in the treatment of ampullary carcinoma, with low operative mortality and good long‐term survival. Local resection is only recommended for small benign tumours and for patients who may be unfit for radical surgery.
SURGICAL TREATMENT OF ATYPICAL MYCOBACTERIAL CERVICOFACIAL ADENITIS IN CHILDREN
Authors: Fergusson James A. E. , Simpson Erroll 
Published: March 2003

Background: Atypical mycobacteria have long been recognized as a cause of cervicofacial adenitis in otherwise healthy children. The disease is nearly always localized but if left untreated the involved lymph nodes caseate and discharge. The management of this condition has been considered to be surgical with techniques including aspiration, incision and drainage, curettage and excision. Methods: Cases of atypical mycobacterial cervicofacial adenitis treated by curettage at the Canberra Hospital, ACT, Australia, are reviewed. Results: Ten cases successfully treated with curettage are reported. Two patients experienced delayed healing of their wounds and one required a second curettage 7 months after primary excision for recurrent disease. Conclusion: Curettage is a safe and effective means of treating atypical mycobacterial cervicofacial adenitis in children. The primary cure rate of 70% is less than that for excision of the involved nodes (92% cure rate), which is the standard treatment for this disease.
ADULT SPLENIC INJURIES: TREATMENT PATTERNS AND PREDICTIVE INDICATORS
Authors: Sanders Mark N. , Civil Ian 
Published: March 2003

Background: With the trend towards conservation in splenic trauma, the ability to identify a group of patients for whom we can safely offer conservative treatment becomes an important factor. Methods: Data were reviewed from the trauma register at the Auckland Hospital, Auckland, New Zealand, in an attempt to isolate any predictive factors that may allow more appropriate allocation of treatment modalities in the future. Methods of treatment were determined and the success or failure of conservative management noted. Differences in the demographics, Injury Severity Score (ISS) and computed tomographic (CT) findings were particularly sought. Results: Over a period of 111 weeks 48 patients were admitted with splenic injuries. Fifteen (31.2%) had immediate splenectomy, 27 (56.2%) were initially treated non‐operatively and six (10.1%) died pre‐operatively. Of the non‐operative group eight (29.6%) failed this management at an average of 4.125 days into their hospital stay. No differences were found in age, mechanism, gender or ISS between the failed and successfully treated group. Using the Buntain classification of CT‐graded splenic injury, 13 (87%) who had successful non‐operative treatment had a grade II or III compared with six (86%) who failed this management being grade IV. Conclusion: Although these results did not reach statistical significance, by coupling the trends seen together with other work, CT grading of splenic injury is a predictive indicator and does appear to have a role in the early allocation of patients to appropriate treatment plans.
MANAGEMENT OF CYCLICAL MASTALGIA IN ORIENTAL WOMEN: PIONEER EXPERIENCE OF USING GAMOLENIC ACID (EFAMAST®) IN ASIA
Authors: Cheung K. L. 
Published: March 2003

Background: In most Western countries gamolenic acid is the first‐line treatment for women with cyclical mastalgia. Methods: A prospective study was carried out in the breast referral clinic of the Department of Surgery, University of Hong Kong to evaluate the treatment of cyclical mastalgia using gamolenic acid provided in evening primrose oil (Efamast®, Scotia Pharmaceuticals Ltd, Scotia House, Stirling, Scotland) as a pioneer experience in Asia. In addition, the features of cyclical mastalgia in Oriental women were studied by conducting a survey using anonymous questionnaires. Results: Sixty‐six women with disturbing cyclical mastalgia seen by one breast surgeon were followed up with a breast pain diary. Thirty‐four women had persistently disturbing mastalgia and were commenced on Efamast®. Responses were measured at 3 and 6 months according to a standardized protocol. An overall useful response rate of 97% was observed at 6 months. Side‐effects were found in 12% but all were insignificant. Conclusions: Efamast® may be recommended as a first‐line specific treatment for Oriental women with disturbing cyclical mastalgia.
CHOLECYSTOSTOMY: A REVIEW OF RECENT EXPERIENCE
Authors: Ghahreman A. , Mccall J. L. , Windsor J. A. 
Published: March 2003

Background: Operative (OC) and percutaneous cholecystostomy (PC) are rarely undertaken for severe acute cholecystitis in patients in whom cholecystectomy is technically difficult or those with significant comorbidity. Methods: A retrospective review was undertaken of the clinical, radiological and audit records of patients who were treated by cholecystostomy between 1988 and 1997 at Auckland Hospital. Results: During the 10‐year period 19 patients (eight male, 11 female; median age: 70 years, range: 35–90 years) had a cholecystostomy (OC: n = 8; PC: n = 11). The main indication for PC was high anaesthetic risk (10 cases). The main indication for OC was failed cholecystectomy (six cases). The patients undergoing PC tended to have a higher American Society of Anesthesiologists (ASA) grade than patients undergoing OC. The median delay from presentation to cholecystostomy was 3 days. More than half (11/19) were done during the 3 years (1992–94) after the introduction of laparoscopic cholecystectomy. The number of tube‐related complications was significantly higher in PC patients (10/11 vs 3/8; P = 0.04), and the number of systemic complications was higher in the OC patients (4/8 vs 0/11; P = 0.018). The median duration of tube drainage was 17 days (range: 0–82 days) for OC and 24 days (range: 5–93 days) for PC. Four patients had stone extraction at the time of OC, including two who also had a partial cholecystectomy. One OC patient had stone extraction via the cholecystostomy tract. A cholecystectomy was performed in four patients. Conclusion: The data indicate that PC is a safe approach for high‐risk patients. Operative cholecystostomy had a role following failed cholecystectomy. But PC might be safer in these patients if they could be identified pre‐operatively.
THE EARLY OPERATION FOR ACUTE SEVERE CHOLECYSTITIS: THE RIEDEL PAPER; AN INTRODUCTION AND TRANSLATION
Authors: Scheele S. , Miller D. A. , Hardy K. J. 
Published: March 2003

Background: For acute cholecystitis in the latter 19th century and early 20th century, the diagnosis was difficult and the management not defined. Methods and Results: Bernhard Riedel of Jena in Germany documented his patients, analysed his results, and described his method of cholecystectomy. Conclusions: Riedel advocated early operation for acute cholecystitis when the conditions were favourable, as for acute appendicitis. He stressed the importance of good lighting, an experienced surgeon and trained assistants. He advocated conservative treatment for minor cholecystitis (biliary colic) until the diagnosis was certain, followed by elective cholecystectomy to reduce the risk of subsequent acute cholecystitis or bile duct stones. Caution was advised when analysing previous statistics, to ensure appropriate patient comparison.
PANCREATICODUODENECTOMY WITH PANCREATICOGASTROSTOMY: ASSESSMENT OF PATIENTS’ NUTRITIONAL STATUS, QUALITY OF LIFE AND PANCREATIC EXOCRINE FUNCTION
Authors: Ong Hock Soo , Ng Eng Hen , Heng Germaine , Soo Khee Chee 
Published: March 2003

Background: The changes in digestive function of patients with pancreaticoduodenectomy (PD) and pancreaticogastrostomy reconstruction have not been well‐documented. The present study sought to assess the nutritional status, quality of life and pancreatic exocrine function in this group of patients. Methods: The study group consisted of 11 PD with pancreaticogastrostomy patients. The control group consisted of 11 consecutive patients who had subtotal gastrectomy (SG) for distal stomach tumours. Results: The median ages for the PD and SG groups were 57 and 59 years, respectively. The median intervals between surgery to assessment were 68 and 60 weeks, respectively. The PD group attained a mean of 92.7% of their pre‐surgery weight compared to 91.3% in the SG group. Both groups had a comparable gastrointestinal quality of life index and Visick scale scores. Exocrine insufficiency using the faecal chymotrypsin test was present in 36% of patients with PD. None of the patients in the SG group had exocrine insufficiency. Conclusion: Pancreaticoduodenectomy patients had a significant occurrence of pancreatic exocrine insufficiency compared to the SG group. But patients with PD and pancreaticogastrostomy reconstruction maintained a nutritional status and quality of life similar to those with curative SG for stomach malignancy. Apart from exocrine insufficiency, the concomitant gastrectomy in the PD group is an important factor responsible for their inability to gain weight.
Laparoscopic Heller Myotomy For Achalasia
Authors: Hunt D. R. , Wills V. L. 
Published: March 2003

Background: Laparoscopic Heller myotomy provides similar results to open Heller myotomy for the treatment of oesophageal achalasia with the advantage of quicker recovery. The present series examines the evolution of operative technique, postoperative outcome and the effect of the ‘learning curve’ in a group of 70 consecutive patients.Methods: Between 1992 and 1999, details of all patients undergoing oesophagogastric myotomy for achalasia were prospectively entered on a database. Patients were followed with a biannual postal symptom questionnaire and scores were obtained for dysphagia, heartburn, regurgitation and chest pain. Comparison between preoperative and postoperative symptom scores, and case number and operative complications was made using Fisher’s exact test or Mann–Whitney U‐test where appropriate.Results: The indication for surgery was as a primary procedure in 20 cases; after failed endoscopic treatment in 48 cases; and after a ‘failed’ fundoplication in two cases. Myotomy was combined with a 360° fundoplication in 57 patients and with an anterior fundoplication in 13 patients. Mucosal perforation occurred intraoperatively in 11 cases. Conversion to an open procedure was required in seven patients. Seven patients required a second operation. At a mean follow up of 2.9 years, symptom scores were significantly improved from preoperative values for dysphagia, regurgitation and chest pain (P < 0.001). There was no increase in the postoperative score for heartburn. The ‘learning curve’ contributed significantly to the length of the procedure, and the need for reoperation.Conclusions: Laparoscopic Heller myotomy is a technically challenging procedure that provides good early palliation of the symptoms associated with achalasia.
Impact of Inadequate Fine‐needle Aspiration Cytology on outcome of Patients with Palpable Breast Lesions
Authors: Lee H. C. , Ooi P. J. L. L. , Poh W. T. , Wong C. Y. 
Published: March 2003

Background: The purpose of the present study was to assess the impact of inadequate fine‐needle aspiration cytology (FNAC) breast specimens on the outcome of patients with a palpable breast lesion. Methods: A retrospective review was carried out of inadequate FNAC specimens from the Department of General Surgery, Singapore General Hospital in 1997. Results: One hundred and thirty‐eight (16.6%) of 831 FNAC specimens were reported inadequate, and these form the study group. Outcome analysis was divided into benign on excision biopsy (n = 38; 29.4%); benign on repeat FNAC or trucut biopsy (n = 6; 4.7%); benign on follow up (n = 46; 35.7%); malignant on histology (n = 11; 8.5%); and lost to follow up (n = 28; 21.7%). The 11 cases with breast cancer were further analysed. The mean time to treatment was 88.3 days for three patients whose tumours were not clinically suspicious of malignancy versus 20 days for six patients who were diagnosed with cancer clinically from the onset. One patient with cancer refused treatment and one absconded from treatment only to return 7 months later. Conclusion: Breast cancer was present in 8.5% of the inadequate FNAC specimens. When clinical suspicion of malignancy is high, an excision biopsy is advised in patients with inadequate FNAC specimens. If properly managed with triple tests and good clinical judgement, the inadequate FNAC specimens do not delay treatment in patients with breast cancer.