bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deliberate self‐harm in rural Western Australia: Results of an intervention study
Authors: Aoun Samar 
Published: March 2003

ABSTRACTThis study evaluates an intervention program in its first 2 years of operation in rural Western Australia. The program was effective in producing a systems change within the hospital by implementing a protocol of best practice and in improving the inter‐sectoral liaison between community‐based referrals and treatment agencies through professional and community education. The early indications suggest a reduction in the rate of hospital admissions for repeated suicide attempts for cases who were managed by the suicide intervention counsellor through a high‐intervention approach.
The relationship between community psychiatric nurses and clients with severe and persistent mental illness: The client’s experience
Authors: O'Brien Louise 
Published: March 2003

ABSTRACT The aim of this phenomenological study was to construct an interpretation of the experience of nurse–patient relationships, in the context of community psychiatric nursing. The purpose of this paper is to focus on the experience of the relationship from the perspective of the clients. Themes of ‘having someone looking out for me’, ‘working in collaboration’, and ‘being understood and gaining understanding’ were identified. This thematic structure was used to understand the meaning of the relationship for the clients. Implications for practice, education, clinical supervision and mental health services are discussed.
OLDER PATIENTS IN THE ACUTE CARE SETTING: RURAL AND METROPOLITAN NURSES’ KNOWLEDGE, ATTITUDES AND PRACTICES
Authors: Courtney Mary , Tong Shilu , Walsh Anne 
Published: March 2003

ABSTRACTMany studies reporting nurses’ knowledge of and attitudes toward older patients in long‐term care settings have used instruments designed for older people. However, nurses’ attitudes toward older patients are not as positive as their attitudes toward older people. Few studies investigate acute care nurses’ knowledge of and attitudes toward older patients. In order to address these shortcomings, a self‐report questionnaire was developed to determine nurses’ knowledge of, and attitudes and practices toward, older patients in both rural and metropolitan acute care settings. Rural nurses were more knowledgeable about older patients’ activities during hospitalisation, the likelihood of them developing postoperative complications and the improbability of their reporting incontinence. Rural nurses also reported more positive practices regarding pain management and restraint usage. However, metropolitan nurses reported more positive attitudes toward sleeping medications, decision making, discharge planning and the benefits of acute gerontological units, and were more knowledgeable about older patients’ bowel changes in the acute care setting.
Late infection of hydroxyapatite orbital implants
Authors: Sloan Brian H , McNab Alan A , McKelvie Penny 
Published: March 2003

Background: Exposure and minor complications of hydroxyapatite orbital implants are common. Infection appears to be rare and fibrovascular ingrowth into hydroxyapatite implants may make infection and extrusion less likely than with other types of orbital implant. Methods: We describe three cases of chronic low‐grade infection of hydroxyapatite implants, occurring late after apparently uncomplicated surgery, with tiny or inapparent areas of conjunctival loss or exposure. Results: Two of the three cases grew Staphylococcus aureus on culture. All three implants ultimately needed to be removed. A characteristic histological pattern was seen, with abrupt transition between vascularized and abscessed implant. Conclusions: Chronic infection of hydroxyapatite implants can occur late, in the absence of large conjunctival defects, or other obvious risk factors. While exposure of the implant to pathogens through a breach in the conjunctiva may have been a factor, it appeared that the infection may have arisen in an avascular portion of the implant prior to the conjunctival breakdown in one or more of these cases.
Postoperative deposits on the Acrysof intraocular lens
Authors: House P , Barry C , Morgan W , Sumner C 
Published: March 2003

Purpose: To report a commonly occurring change on the anterior surface of the Acrysof intraocular lens which is presumed to be due to the proliferation of lens epithelial cells from the capsulo‐rhexis margin. Method: Forty‐one consecutive cases (31 patients) of Acrysof intraocular lens implantation were followed prospectively. Clinical charts were reviewed for changes on or within the lens and visual acuity and refractive changes recorded. All cases were dilated at 3–5 weeks postoperatively to facilitate observation of changes. Representative slit lamp photos were taken. Results: Deposits on the intraocular lens surface were noted on 18 of 41 lenses at 3–5 weeks post surgery. Deposits were not found on examinations conducted during the first postoperative week. All changes had fully resolved by 3 months. Conclusions: The changes recorded had no impact on visual acuity. The deposits noted do not represent clinically important pathology. They may be an unusual marker of biocompatibility with this lens. Surgeons using this lens should be aware of these changes.
Verbal Fluency in Schizophrenia: Reduction in Semantic Store
Authors: Chen Ronald Y.L. , Chen Eric Y.H. , Chan Charlotte K.Y. , Lam Linda C.W. , Lieh-Mak Felice 
Published: March 2003

Objective: This is a study of the word production of patients with schizophrenia using a semantic verbal fluency task to address the unresolved issue of retrieval or storage impairment. Method: Twenty-one patients with schizophrenia and 11 matched healthy subjects performed a semantic verbal fluency task on ‘food’, ‘animal’ and ‘transport’ categories in Cantonese for 3 minutes each on five separate trials. Results: Patients generated significantly fewer numbers of words compared with control on each trial. The estimated lexicon size of the patients was significantly smaller than that of the equivalent group. The amount of shared words and variable words generated in all five trials were reduced in the patient group. Conclusions: Our results suggest that poor verbal fluency in patients with schizophrenia may partly be attributable to reduction in semantic store. The importance of temporal lobe involvement on verbal fluency deficits needs to be emphasised as an integral part of the neurobiological basis of schizophrenia research.
Psychiatric Training in New Zealand
Authors: Moloney Janet , MacDonald Joanna 
Published: March 2003

Objective: The aims of this study were to develop a profile of current psychiatric trainees in New Zealand, to identify factors important in their recruitment to and retention in psychiatric training and to identify factors that predict failure to complete training. Method: A survey was sent to all current psychiatric trainees in New Zealand and to all trainees who could be traced who had left psychiatric training in New Zealand in the last 5 years without completing the Fellowship of the Royal Australian and New Zealand College of Psychiatrists. Results: General characteristics of the two groups are presented, as well as information about recruitment, burnout, general health and experiences of work and training. The only significant difference in general characteristics between the two groups was that more of those who had left training prematurely had been born overseas. The levels of family and personal mental illness were high, but there was no difference in these rates between those who had stayed in training and those who had left prematurely. Most trainees had decided to pursue a psychiatric career during their house-officer years. The most important factors determining the choice of a career in psychiatry were philosophical interest and house-officer experience in psychiatry. With respect to retention, despite high rates of burnout and psychological morbidity, and dissatisfaction with various aspects of the work setting, 94% of current trainees indicated satisfaction with their decision to train in psychiatry and over 90% intended to practise in New Zealand in the future. Most trainees who left training prematurely did so during the first 2 years of training. Dissatisfaction with work conditions, and stress or burnout were the main reasons for leaving. Conclusions: This study provides information on some of the complex determinants of psychiatric recruitment and retention in the New Zealand setting. Areas that could be addressed in order to improve recruitment, work satisfaction and retention in training are considered.
EMST IN PAPUA NEW GUINEA: MORE THAN JUST A COURSE
Authors: Graham JOHN C. 
Published: March 2003

Background: Trauma in Papua New Guinea (PNG) is a major reason for acute hospital admission. The Early Management of Severe Trauma Course (EMST) of the Royal Australasian College of Surgeons was introduced to PNG in 1993 to help in trauma education. Methods: Four EMST courses have been held in Port Moresby since 1993 with the support of the Department of Surgery of the University of PNG. Results: Sixty‐two doctors have attended a course and three PNG doctors have been trained as course instructors. Trauma workshops were held in other provincial hospitals extending the course principles to nurses and health professionals in these areas. Conclusion: The introduction of EMST to PNG has proven to be a worthwhile endeavour and the program is now firmly established in PNG.
A PROSPECTIVE RANDOMIZED TRIAL OF DAY‐STAY ONLY VERSUS OVERNIGHT‐STAY LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Hollington P. , Toogood G. J. , Padbury R. T. A. 
Published: March 2003

Background: Although the feasibility of laparoscopic cholecystectomy performed as day surgery has been established, cost and recovery time have not previously been evaluated in a prospective comparative fashion. Methods: Patients were randomized to day stay only or overnight stay, and a nurse assessed the former postoperatively at home. All patients were reviewed weekly or as required if problems occurred. Costing comparisons were made between the two groups using Trendstar software. Results: A total of 131 patients were evaluated after randomization (60 day‐stay only patients and 71 overnight‐stay patients). A total of 18.3% of the day‐stay patients required in‐hospital admission for nausea, vomiting, or pain, or after conversion to open operation; 18.3% of the overnight group required an extended length of stay for similar reasons. After discharge, two day‐stay and three overnight‐stay patients required readmission, only one had a significant complication. The mean times to return to normal activity averaged 1.8 weeks (SE: 0.1 weeks) and 1.9 weeks (SE: 0.1 weeks) for day‐stay and overnight‐stay groups, respectively (P = 0.63), and costs of $2732 (SE: $76) compared to $2835 (SE $110), respectively (P = 0.94). Conclusions: In the present randomized controlled study, day‐stay management did not compromise postoperative patient outcome. In the setting of a major teaching hospital there was no cost advantage when compared to overnight‐stay management.
FACTORS THAT INFLUENCE LENGTH OF STAY AFTER APPENDICECTOMY IN CHILDREN
Authors: Foulds Katherine A. , Beasley Spencer W. , Maoate Kiki 
Published: March 2003

Background: The length of hospital stay following appendicectomy in children at Christchurch Hospital has decreased in recent years. The aim of the present study was to identify those factors that contributed to this change. Methods: A retrospective review of children admitted to Christchurch Hospital between 1994 and 1998 inclusive who underwent appendicectomy for suspected appendicitis was conducted. Data recorded included standard demographic information, symptom duration, operative details, analgesia, antibiotics, pathology, complications and postoperative length of stay (LOS). Results: Postoperative LOS decreased significantly during the period reviewed across all degrees of appendiceal inflammation, from a mean of 70.5 to 50.1 h. The main determinant of postoperative hospital stay was the severity of the appendiceal inflammatory process. Other factors that influenced LOS included surgical approach (open vs laparoscopic), use of intra‐operative local anaesthesia, type and mode of postoperative analgesia, and age of the child. Longer duration of antibiotic use and symptom duration of greater than 24 h were associated with a longer LOS, primarily as a reflection of the severity of inflammation of the appendix. Factors that appeared to have little or no influence included gender and the experience of the surgeon. Conclusion: The severity of the inflammatory process appeared to be the main determinant of postoperative hospital LOS; advanced appendicitis with abscess formation or peritonitis was associated with the longest LOS, irrespective of the surgical approach, although the LOS after appendicectomy was reduced by a laparoscopic approach. Intra‐operative local anaesthesia during open appendicectomy reduced hospital stay, probably because it reduced the need for postoperative narcotics. Early diagnosis (< 24 h) was associated with a shorter postoperative LOS for acutely inflamed appendices.
PILONIDAL DISEASE IN SINGAPORE: CLINICAL FEATURES AND MANAGEMENT
Authors: Lee H. C. , Ho Y‐H. , Seow C. F. , Eu K‐W. , Nyam D. 
Published: March 2003

Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9‐year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. Results: There were 38 men and 23 women with a mean age of 27 ± 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 ± 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence.
DID REMBRANDT’S BATHSHEBA REALLY HAVE BREAST CANCER?
Authors: Bourne R. G. 
Published: March 2003

Background: Rembrandt’s Bathsheba (Louvre, Paris) reveals an abnormality of the left breast and axilla. Previously breast cancer has been suggested as the probable diagnosis. Methods: The present paper reviews the clinical history as well as the clinical findings. Results: Inconsistencies, pitfalls in the diagnosis and the consequences of the possibility of a different model for the body of the figure are discussed. Conclusion: An alternative diagnosis of an infective process such as tuberculous mastitis or, less likely, chronic lactational breast abscess is suggested.
Zuckerkandl’s tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence?
Authors: Hisham A. N. , Aina E. N. 
Published: March 2003

Background: The Zuckerkandl’s tubercle (ZT) of the thyroid gland is a well‐described anatomical landmark, but few studies have clearly defined its association with pressure symptoms. Methods: Sixty‐six consecutive patients who had primary thyroid surgery were prospectively included in the present study between late January and early August 1998. Results: A total of 96 capsular dissections were performed at thyroid surgery. Grades two and three ZT were recognized in 77 (80.2%) dissections. In general 49 (63.6%) of them were associated with significant pressure symptoms. In 43 (87.8%) of the dissections with pressure symptoms, grade 3 ZT was observed (mean weight of goitre: 154.8 g). Interestingly in this group, 16 (37.2%) patients with pressure symptoms had a goitre that was < 100 g and in one patient it was only 21 g. Conclusions: The pressure symptom of the thyroid gland does not always appear to be due to the large size of the goitre. In a relatively small‐size goitre the ZT may cause significant pressure symptoms. Observations in the present study supported a strong association of enlarged ZT with pressure symptoms. We believe this is unlikely to be simply a coincidence but rather a consequence of the enlarged tubercle. Nonetheless a prospective randomized study is called for to allow meaningful and objective evidence to be drawn.
THYROID SURGERY AND ANAESTHESIA FOLLOWING HEAD AND NECK IRRADIATION FOR CHILDHOOD MALIGNANCY
Authors: Delbridge Leigh , Sutherland Joanna , Somerville Helen , Steinbeck Kate , Stevens Graham 
Published: March 2003

Background: Increasing numbers of adolescents and young adults are undergoing thyroid surgery because of the risk of malignancy following previous irradiation for childhood malignancy. Irradiation to the head and/or neck regions may induce changes in the soft tissues and larynx that are far from normal with respect to both size and mobility. The aim of the present study was to evaluate the possible impact of such changes on both surgical and anaesthetic technique during thyroidectomy. Methods: This was a retrospective case study. Thirty consecutive patients undergoing total thyroidectomy following previous irradiation for childhood malignancy formed the study group. Results: There were no permanent surgical or anaesthetic complications in the group. In particular there were no cases of either permanent recurrent laryngeal nerve palsy or permanent hypoparathyroidism. Twenty‐eight patients had an uneventful intubation and two were unable to be intubated directly, one requiring fibre‐optic bronchoscopic intubation and the other having surgery performed with a laryngeal mask following failed bronchoscopy. Both of these patients had received high‐dose direct irradiation to the larynx for solid tumours. Conclusions: Despite potential difficulties associated with the heavily irradiated larynx, thyroid surgery and anaesthesia can be performed safely with minimal complications in experienced hands.
Microsatellite Instability And Allelic Imbalance In Primary And Secondary Colorectal Cancer
Authors: Schneider Anne , Rohr Serge , Kelly Michael D. , Mitry Ragai , Pignatelli Massimo , Doré Caroline J. , Gaub Marie‐Pierre , Jaeck Daniel , Meyer Christian , Oudet Pierre , Habib Nagy A. 
Published: March 2003

Background: Several studies of colorectal cancer have shown an association between the number and type of genomic defects and the stage of disease. A subset of colorectal tumours are due to inactivation of DNA mismatch repair genes and these tumours exhibit microsatellite instability. The aim of the present study was to compare and contrast the genomic defects present in both the primary and metastatic stages of the disease using microsatellite probes.Methods: Modifications of the allelic profiles of 25 microsatellite regions were studied in a total of 85 colorectal tumours using fluorescent polymerase chain reaction (PCR) technology and subsequent direct analysis on an automatic sequencer. This approach was used because it allows the study of microsatellite instability and allelic imbalance. Stepwise logistic regression analysis was used to develop a model to predict whether the tumour was primary or secondary from the percentage of allelic imbalance. Subsequently, a group of 17 patients with primary colorectal tumours was analysed prospectively to test the proposed model.Results: Six of 39 primary tumours showed microsatellite instability compared to 0 of 29 liver metastases (P = 0.03). Primary tumours showed significantly less allelic imbalance than liver metastases (P < 0.001). Three probes (d18s53, d9s158 and d10s191) were selected for use in a model to classify a tumour as primary or secondary on the basis of the degree of allelic imbalance. When tested prospectively this model had a specificity of 82%.Conclusions: The present study demonstrates the potential importance of using microsatellite probes both as a diagnostic tool and as a research technique to investigate the mechanisms of tumour progression. An important clinical finding is that none of the colorectal liver metastases showed microsatellite instability (0 of 29). This analysis also confirmed other work that has shown a direct relationship between the degree of allelic imbalance and the stage of disease.
Significance of a Positive Oesophageal Margin in Stomach Cancer
Authors: Chan W. H. , Wong W. K. , Khin L. W. , Chan H. S. , Soo K. C. 
Published: March 2003

Background: A positive oesophageal margin is frequently encountered in total and proximal gastrectomies. It is controversial as to whether a positive oesophageal margin in gastrectomy predisposes to anastomotic dehiscence and loco‐regional recurrence. Its independent impact on survival has not been fully addressed. Methods: A retrospective review of 137 total and proximal gastrectomies for adenocarcinoma was undertaken. Independent prognostic factors were identified in a bivariate and Cox proportional hazards regression model. Results: The prevalence of positive oesophageal margin was 18.2%. A positive oesophageal margin was not associated with increased anastomotic leak (8.0 vs 10.7%; P = 0.51), operative morbidity (32.0 vs 27.7%; P = 0.85) or 30‐day mortality (8.0 vs 5.4%; P = 0.48) rates when compared with a negative margin. In addition, it did not predispose to anastomotic (13.0 vs 10.4%; P = 0.47) or regional (22.7 vs 24.5%; P = 0.51) recurrences. In the multivariate analysis the TNM stage and status of the oesophageal margin were the only independent prognostic factors for survival. Conclusions: A positive oesophageal margin is an independent poor prognostic factor for long‐term survival in stomach cancer. All efforts should therefore be made to clear the oesophageal margin in total and proximal gastrectomies.
Anaesthetic Simulators: Training for the Broader Health‐Care Profession
Authors: Watterson Leonie , Flanagan Brendan , Donovan Brent , Robinson Brian 
Published: March 2003

Background: The use of high‐fidelity patient simulators for training health‐care professionals has increased rapidly in recent years. Approximately 150 simulation training centres operate internationally. Australasia has acquired four centres since 1997. A large component of simulator‐based training is experiential. Methods: Participants manage clinical scenarios on lifelike computer‐controlled mannikins within realistic clinical environments. Afterwards they actively reflect upon the experience, an exercise that is facilitated by observation of a video replay of the event. Results: This approach to training promotes a consideration of broader issues which can influence clinical practice and patient outcomes. This has particular relevance to emergencies. Here, events that are by nature infrequent and unscheduled can be addressed in a controlled fashion, in an environment that is supportive and separated from actual patients. Conclusions: A broad range of skills can be addressed with this resource. Of key importance are situational management and team effectiveness skills. Deficiencies with respect to these ‘non‐clinical’ skills are being increasingly identified for their contribution to preventable adverse events within the health‐care environment. Multidisciplinary operation‐room team training has the potential to address these issues as they relate to the perioperative environment.