bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study populations and casemix: influence on analysis of postoperative outcomes
Authors: Isbister William H. 
Published: March 2003

Background: The importance of patient casemix as a determinant of surgical outcome is now being recognized. The present study was undertaken in order to compare the presentation and outcomes in colorectal patients managed surgically by the same surgeon, in the same way, in different settings. Methods: Colorectal outcome data from the University Department of Surgery in Wellington and the King Faisal Specialist Hospital in Riyadh were analysed in order to determine casemix differences between the two hospitals. Data relating to the type of surgery, the surgeon, the patient’s disease, the operation performed and the postoperative complications were compared. Specific colorectal clinical indicators were compared for two commonly performed operations for rectal cancer: anterior resection and abdomino‐perineal resection of the rectum. Results: Wellington patients were slightly older and there were more females. Emergency surgery was more frequent in Wellington. Left hemicolectomy, sigmoid colectomy, abscess drainage and pilonidal surgery were more common in Wellington whereas abdomino‐perineal resection and anterior resection of the rectum, stoma closure, fistula surgery, seton insertion, restorative proctocolectomy and ileostomy were undertaken more frequently in Riyadh. More complex anal fistulas were managed in Riyadh. Condylomata accuminata, pilonidal abscess, anorectal abscess, rectal prolapse and diverticular disease were rarely seen in Riyadh. There were more postoperative pulmonary and cardiac complications in Wellington. Patients having anterior resection of the rectum were younger in Riyadh and there were proportionally more females. There were some obvious numerical outcome differences in postoperative atelectasis, wound infection, anastomotic leak and deep vein thrombosis rates but none of these reached statistical significance except atelectasis. In Riyadh the usual male‐to‐female ratio of patients undergoing abdomino‐perineal resection was reversed but, again, none of the numerical outcome differences observed reached statistical significance except postoperative atelectasis and intra‐abdominal abscess. Conclusion: Although not statistically significant, the results of the present study suggest that when the same surgeon operates using the same technique in different communities, the outcomes may be different. Care should thus be taken when comparing different populations with different casemixes before definitive conclusions are made in comparative studies.
BLUNT TRAUMA TO THE SPLEEN
Authors: Aseervatham R. , Muller M. 
Published: March 2003

Background: The management of splenic injury resulting from blunt trauma in adults is controversial, with an increasing trend towards non‐operative management and conservation of the spleen. A retrospective review was performed on adult patients treated in a single institution for splenic injury resulting from blunt trauma in an attempt to identify factors important in selecting an appropriate management option and predicting the success of that option. Methods: Associated injuries (standardized using Injury Severity Scores), clinical signs at presentation, computed tomographic grading of splenic injury, and transfusion requirements were documented. Statistical analysis was performed using non‐parametric Mann–Whitney, Chi‐squared, Kolmogorov–Smirnov and multivariate logistic regression tests. Results: Eighty‐five patients were identified. Non‐operative management was used on 39 patients, splenic conservation on 14 patients, and splenectomy on 32 patients. The mean Injury Severity Score was significantly lower in the non‐operative group. Computed tomographic grading of the splenic injury was not found to correlate well with intraoperative findings. Transfusion requirements were lower in the non‐operative group. Non‐operative management failed in four patients; two had continued splenic bleeding, and two required surgery for other intra‐abdominal injuries. Overall mortality was 7%. There was one death in the splenic conservation group, unrelated to the splenic injury, and two patients required a second laparotomy and splenectomy for persistent splenic bleeding. There were five deaths in the splenectomy group, only one of which was related to the splenic surgery. Conclusion: Management of blunt splenic injury remains controversial. The decision to pursue non‐operative management rather than splenic conservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic conservation, particularly in younger, stable patients with single organ injury.
Rectal Cancer: Changing Patterns Of Referral For Radiation Therapy 1982–1997
Authors: Stevens Graham , Firth Ian , Solomon Michael , Saw Robyn , Glenn David , Eyers Anthony , West Richard 
Published: March 2003

Background: The purpose of the present study was to evaluate the changing role of radiation therapy in rectal cancer and to determine the patterns of referral of patients during a 15‐year period.Methods: From 1982 to 1997, 464 patients with carcinoma of the rectum were referred to the Department of Radiation Oncology, Royal Prince Alfred Hospital; 79% of patients had locoregional disease alone and 21% had distant metastasis. Radiation therapy consisted of irradiation (definitive or palliative) alone to the primary tumour in 9.7% of cases; preoperative radiation in 7.3% of cases; preoperative chemoradiation in 7.5% of patients; postoperative radiation in 15.3% of patients; postoperative chemoradiation in 12.3% of patients; treatment of pelvic recurrence in 23.5% of patients and treatment of metastases in 9.1% of patients. The remainder were treated elsewhere (1.9%) or not treated (13.4%).Results: There was an average annual 14% increase in referrals over the accrual period. Recurrent rectal cancer decreased from approximately 30% of referrals during 1982–91 to approximately 10% in 1995–7. The use of postoperative adjuvant radiation reached a peak of 50% in 1993. The use of preoperative radiation increased suddenly in 1994 from < 10% to a sustained rate of approximately 30% of referrals. The use of chemoradiation commenced in 1990 for postoperative adjuvant treatment and in 1994 for preoperative treatment. The median survival time from initial diagnosis was 35 months, with 2‐ and 5‐year survival rates of 62 and 28%, respectively. Survivals at 5 years for patients treated with preoperative and postoperative radiation (with or without chemotherapy) and with recurrent disease were 56, 44 and 21%, respectively.Conclusions: The present study illustrates the changing role of radiation therapy in the management of rectal cancer. The increase in referrals over the observation period was due to increased multidisciplinary input into the initial management of these patients, based on reported clinical trials. The steady increase in the use of adjuvant therapy has paralleled a decrease in referrals for treatment of recurrence and reflects current clinical results. The sequencing of adjuvant therapy is changing currently, with greater emphasis on preoperative adjuvant treatment. Currently most adjuvant therapy includes chemotherapy.
Early Discharge Following Breast Surgery: Assessing Care, Support, And Informational Needs Of Women With Early Breast Cancer In Australia
Authors: Davis Cindy , Williams Philippa , Redman Sally 
Published: March 2003

Background: The overall aims of the present study were to identify differences among women with early breast cancer who were discharged early from the hospital (within 48 h) and those who remained for routine admission in relation to demographic variables, informational needs, supportive needs, complications and satisfaction with care.Methods: A random sample of 544 women diagnosed with early breast cancer was recruited to participate in a telephone survey via State and Territory cancer registries.Results: Findings revealed little significant difference among women participating in early discharge and routine care in relation to demographics variables, informational needs, complication and satisfaction with care. Women participating in early discharge, however, were significantly less likely to be seen by a specialist breast care nurse or a volunteer with breast cancer.Conclusions: Prior to establishing early discharge as routine care, it is essential to establish clear health policy relating to early discharge and adequate follow‐up services for women with breast cancer.
A Randomized Controlled Trial Comparing Cholecystocholangiography With Cystic Duct Cholangiography During Laparoscopic Cholecystectomy
Authors: Wills Vanessa L. , Jorgensen John O. , Hunt David R. 
Published: March 2003

Background: The rate of intraoperative cholangiography fell after the advent of laparoscopic cholecystectomy due to the perceived difficulty of cystic duct cannulation. It is suggested that cholecystocholangiography (CCC) is a valid and easier alternative. The present study compares cystic duct cholangiography (CDC) to CCC with evaluation of procedural time, success rate, image quality, cost and radiation exposure.Methods: Patients undergoing laparoscopic cholecystectomy were randomized to CCC (n = 40) or CDC (n = 36). Details of operative times, radiation exposure, and use of disposable equipment were recorded prospectively. Cholangiograms were performed using image intensification and were scored from 0 to 6 according to adequacy of images. Data were analysed on an intention‐to‐treat basis with the chi‐squared test, t‐test or Fisher’s exact test.Results: The success rate for CDC was 100% and for CCC it was 72% (P = 0.0005). Patients with a failed CCC went on to have CDC for a success rate in the CCC arm of 92.5%. Comparing CDC to CCC, there was no significant difference in cost ($30.16 vs $33.36; P = 0.11), operative time (1 h 13 min vs 1 h 3 min; P = 0.19) or cholangiogram time (8 vs 9 min; P = 0.39). There was a significant difference in screening time (0:41 vs 1:33 min; P < 0.0001), adequate image quality (100 vs 72.5%, P = 0.0005) and procedure‐related complications (0 vs 5; P = 0.03).Conclusions: A significant number of CCC fail. Successful CCC provides inferior image quality and greater radiation exposure. It provides no benefit in time or cost and cannot be recommended for operative cholangiography.
Clinical Review Of The ‘Snodgrass’ Hypospadias Repair
Authors: Holland A. J. A. , Smith G. H. H. , Cass D. T. 
Published: March 2003

Background: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994 based on the concept of hingeing the incised urethral plate. The use of this technique allows a vertically orientated glanular meatus to be produced. A retrospective review of patients who had this procedure for the primary repair of distal hypospadias at New Children’s Hospital was performed to objectively assess the cosmetic and functional outcomes of this technique.Methods: All patients having a TIP urethroplasty for the primary repair of distal hypospadias between 1996 and 1998 were requested to attend for review in an independent clinic. The parents were interviewed and the patient was examined to determine meatal location, meatal size, glanular configuration, urinary stream, straightness of erections, cosmesis, and the presence or absence of cutaneous sinus tracts or a urethral fistula.Results: Sixty patients were identified. Forty‐nine were reviewed in person, 10 were reviewed by telephone and one could not be traced. The median age at surgery was 13 months (range: 6–144 months), with a median follow up of 27 months (range: 2–33 months). A glanular meatus was achieved in 57 patients (97%) and a conical glanular configuration was achieved in 58 patients (98%). The urinary stream and erections were straight in 54 (89%) and 58 patients (98%), respectively. Suture sinus tracts were present in 14 (24%) patients. Six patients (10%) developed a urethral fistula and three (5%) developed meatal stenosis. A good or satisfactory final cosmetic and functional result was achieved in 58 patients (98%).Conclusions: The results of TIP urethroplasty are satisfactory at New Children’s Hospital with the benefit of a cosmetic final outcome similar to a circumcised penis.
Local Recurrence after Mastectomy and Adjuvant CMF: Implications for Adjuvant Radiation Therapy
Authors: Rangan Anna M. , Ahern Verity , Yip Desmond , Boyages John 
Published: March 2003

Background: The purpose of the present study was to evaluate the patterns of failure in a series of patients with node‐positive breast cancer that was treated by total mastectomy and adjuvant chemotherapy. Methods: A retrospective review was undertaken of 217 patients with node‐positive breast cancer who were referred to the oncology departments of Westmead and Nepean Hospitals following total mastectomy between January 1980 and December 1991. The majority of patients (82%) were pre‐ or peri‐menopausal and all underwent chemotherapy with cyclophosphamide, methotrexate and 5‐fluorouracil (CMF) by either an oral or intravenous regimen. No patient received adjuvant radiation therapy. Results: After a median follow up of 8.7 years, 19% of patients had developed a loco‐regional recurrence (LRR). The majority of LRR (79%) occurred within the initial 3 years after mastectomy. The risk of LRR was positively associated with the size of the tumour (11% for T1vs 53% for T3, P < 0.001) and axillary nodal status (16% for three or fewer positive nodes vs 31% for four or more positive nodes, P = 0.017). Patients with T1 or T2 tumours and 1–3 positive nodes had the lowest rate of LRR (11%) while those with T3 tumours or 4–10 positive nodes had the highest rates, ranging from 23 to 75%. Relapse at the chest wall and supraclavicular fossa (SCF) accounted for 46 and 35%, respectively, of all LRR; relapse at the internal mammary chain and axilla was uncommon. Conclusion: The data suggest that patients with T3 tumours (> 5 cm) and any nodal involvement or patients with four or more involved axillary nodes, regardless of T stage, are at a high risk of LRR and will benefit from adjuvant radiation therapy to the chest wall and SCF.
Gastric tube graft interposition as an oesophageal substitute
Authors: Samuel Madan , Burge David M. , Moore Isabelle E. 
Published: March 2003

Background: Use and techniques of oesophageal replacement for long gap oesophageal atresia are still evolving. Gastric tube graft interposition as an oesophageal substitute was evaluated on an animal model. Methods: Twenty‐three postweaned, 28‐day‐old‐piglets were used as the experimental animals. Isoperistaltic gastric tube interposition based on the right gastroepiploic vessels was performed at 28 days of life. Postoperative evaluation included weekly measurement of weight, clinical assessment for gastrointestinal and respiratory complications and deglutition difficulties. Haemoglobin, serum ferritin, albumin, globulins, total proteins and red cell folate were assayed. Pigs were killed and analysed histopathologically following a maximum observation period of 149 days. Results: Growth of the pigs was normal. Deglutition was not impaired in 16 pigs (89%). Minor leak was diagnosed in three pigs (17%), which was successfully managed conservatively. Anastomotic stricture was seen in two pigs (11%). Graft necrosis was not seen. Gross histology showed the absence of hypertrophy, redundancy and kinking of the interposed gastric tube graft. Microscopically non‐erosive oesophagitis was seen in three pigs (17%), ulcerative oesophagitis was seen in two pigs (11%) and submucosal fibrosis was seen in seven pigs (39%). Dysplasia or Barrett’s oesophagitis was not observed at the end of animal growth. Conclusions: Gastric tube graft interposition is an immediate ideal oesophageal substitute due to fewer complications, probable absence of gastro‐oesophageal reflux in the majority by histology, and absence of dilatation and redundancy of the interpose tube. The oesophageal substitute adequately met the nutritional needs for growth and development in the animal model.
Treatment of anal fissure with glyceryl trinitrate in patients referred for surgical management
Authors: Skinner S. A. , Polglase A. L. , Le C. T. , Winnett J. D. 
Published: March 2003

Background: A number of recent studies indicate that anal fissure may be treated by applying glyceryl trinitrate (GTN) ointment. The present study aims to determine the effectiveness and patient acceptability of GTN treatment for patients referred to a consultant surgeon. Methods: A prospective study of 65 consecutive patients referred to one surgeon (ALP) over a 12‐month period was undertaken. All patients were offered 0.2% GTN ointment to be applied intra‐anally four times daily for 4 weeks. Informed consent was obtained and review planned for 4 weeks. Results: Fourteen patients declined treatment and nine of the 14 (64%) subsequently underwent lateral sphincterotomy. Twelve of the 51 patients (18.5%) who accepted treatment could not complete it due to headache or persisting severe anal pain. Thirty‐nine of the 51 patients (77%) were able to complete 4 weeks of treatment. Twenty‐two of the 39 reported an improvement in symptoms. A total of 22 patients (43%) who started GTN treatment subsequently underwent lateral sphincterotomy. Conclusions: Evidence from the present study suggests that GTN ointment has a place in the management of referred patients with severe and/or chronic anal fissure, but sphincterotomy remains an important treatment option for the majority.
Quality assurance in a multidisciplinary symptomatic breast assessment clinic
Authors: Kollias James , Bochner Melissa A. , Gill P. Grantley , Malycha Peter , Coventry Brendon J. 
Published: March 2003

Background: Although quality assurance guidelines for surgeons have been issued and adopted for use in population‐based breast screening programs in Australia, similar guidelines are unavailable for women referred with symptomatic breast problems. Methods: Six hundred and ninety‐six women who attended the Royal Adelaide Hospital Women’s Health Centre between February and November 1998 for investigation and management of a new breast‐related complaint were prospectively evaluated. Investigation strategies and outcomes of the initial consultation were determined and the results compared with the performance quality standards for symptomatic breast disease according to the British Association of Surgical Oncology (BASO) Breast Surgeons’ Group. Results: A breast lump was the presenting symptom in 45%, while breast pain was present in 26%. Ninety per cent of women referred with breast symptoms were given a definitive benign or malignant diagnosis at the initial clinic visit. Although the median time delay between the date of general practitioner referral and breast clinic appointments for all patients was ≤ 7 days, the time delay for ‘urgent’ cases was not met according to BASO performance indicators. All other Royal Adelaide Hospital Breast Clinic audit data were within the range suggested by BASO performance indicators for new consultations in a symptomatic breast assessment clinic. Conclusions: A multidisciplinary breast clinic in a public hospital setting is able to provide clinical services to symptomatic women, with the majority of patients obtaining a confident diagnosis at the first presentation. Performance indicators for symptomatic breast disease are useful in identifying inadequacies at the clerical or clinical level which, following the implementation of subsequent changes, may lead to improvement in patient outcomes.
Patterns of use of Antipsychotic Medication in a Regional Community Mental Health Service
Authors: Callaly Tom , Trauer Tom 
Published: March 2003

Objective: To audit the use of antipsychotic medications in a regional community mental health service. Method: In April 1999 each case manager of the adult and aged care community mental health service documented all medications being prescribed for patients in their care. Results: Out of a total of 792 patients, 572 (72.2%) were prescribed antipsychotic medication. Of those prescribed antipsychotic medication, 67.1% were prescribed atypical or novel antipsychotics, 14.3% were prescribed conventional oral antipsychotics and 23.6% were prescribed a depot antipsychotic preparation. Of the 456 patients prescribed oral antipsychotic medication, 84.2% were prescribed atypical antipsychotics (38.6% were prescribed clozapine, 28.7% olanzapine and 18% risperidone). A total of 100 patients were on a community treatment order (CTO): 40% of patients on a CTO who were prescribed antipsychotics, were prescribed a depot antipsychotic medication compared with 13.7% of patients prescribed antipsychotics who were not on a CTO. Conclusion: The pattern of antipsychotic medication use in this regional community service shows that atypical antipsychotic medication was used more commonly than conventional antipsychotic medication. Over 30% of the use of atypical antipsychotic medication in this service was for conditions other than schizophrenia.
One Hundred Years Ago in New South Wales
Authors: Shea Peter 
Published: March 2003

Objective: To review the way in which psychiatric patients were managed around the turn of the last century, in the context of the institutions, legislation and knowledge and understanding of the nature of psychiatric illness that existed at the time. Conclusions: In 1900 not a great deal was known about the nature of psychiatric illness, treatments were limited, non-specific and, at times, potentially quite dangerous, and most of the care of the psychiatrically ill was provided in overcrowded and underfunded institutions by poorly trained staff, not all of whom were up to the task. In spite of this, there is evidence that in NSW, mainly under the thirty-year influence of Frederick Norton Manning, the care of the psychiatrically ill was passing through a humanitarian phase, characterised by a recognition of the value of the therapeutic milieu, a policy of normalisation, protective legislation and an administrative attitude that reflected a positive concern for the welfare of patients.
Borderline Personality Disorder: Foundation Training for Public Mental Health Clinicians
Authors: Krawitz Roy , Rreal  
Published: March 2003

Objective: To describe the development and delivery of a brief training workshop on borderline personality disorder for public mental health clinicians. Method: During the initial phase the author had contact with key informants, undertook a North American study tour and completed a course in adult teaching. A two-day workshop was developed and delivered to one public mental health service and private workshops were run in three cities. This led to requests to run workshops in other public mental health services. Independent qualitative research of workshop participants provided feedback assisting the evolution of the workshop, as did ongoing participant feedback. Results: One hundred and three workshops were delivered to 2048 participants in Australia and New Zealand between 1997 and 2000. Participants rated the workshop positively with 99.7% stating they would recommend the workshop to others. Conclusions: The numerous workshop requests, good attendance and participant endorsement indicated a desire and readiness of general public mental health clinicians for the training being offered. Substantial training has been available for psychotherapists working in this area but little or nothing for general public mental health clinicians. This workshop provides an addition to training options available in the public sector.