bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Drug Promotion Adversely Influence Doctors' Abilities to Make the Best Decisions for Patients?
Authors: Jureidini Jon , Mansfield Peter 
Published: March 2003

Aim: To increase awareness amongst psychiatrists and trainees of the effects of pharmaceutical promotion and to stimulate careful evaluation of the relationships between psychiatry and the pharmaceutical industry. Method: Key findings from the literature and from 20 years experience with the Medical Lobby for Appropriate Marketing are summarised. Results: The relationship between doctors and pharmaceutical companies is shown to be problematic in a way that might negatively impact on patient care. Conclusions: Patients may benefit if individual psychiatrists, and the profession as a whole, develop more healthy scepticism about the harm to benefit ratios of relationships with the pharmaceutical industry.
Mental Illness is not a Crime: The Impact of the Adversarial Judicial System
Authors: Manovel William 
Published: March 2003

Objective: This paper challenges the adversarial judicial model of the Mental Health Review Tribunal. Following a brief history of the adversarial legal system, it questions the impact of imposing a legal environment on the mentally ill and on the traditional doctor/patient relationship. It also examines issues of poor communication and excessive bureaucracy. Conclusions: The current legal process is inhumane, outdated, and inefficient. There is room for lateral thinking into developing a more appropriate and contemporary model to address issues of civil liberties and medical treatment for the mentally ill. One possible model could be made up of a non-judicial and independent team with appropriately trained staff, recruited from more ‘caring’ professions, with well-defined, but discretionary legal powers. Editor's note: The continuum of training in psychiatry commences at university. Sydney University's new postgraduate medical program has adopted a different model to train students in aspects of psychological medicine. During their placement, students are being asked to think critically about, and if necessary challenge, current orthodoxies. The following essay, by a final year medical student, was written during a placement at Rozelle Hospital. The essay examines the impact of legal intervention on mental health. The author is currently an Intern at Nepean Hospital in Sydney. He has worked previously as a commercial and naval lawyer.
A Contemporary View of Psychiatry Services in a General Medical Hospital
Authors: Holmes Alex , Judd Fiona , Lloyd John , Dakis Jennifer , Cairns Fiona , Kerr Louise , Kiang Maria , McKinnon Jonathan 
Published: March 2003

Objective: To describe the nature of psychiatry work within a general medical hospital and to compare and contrast the nature of that work between emergency department and inpatient settings. Method: The data from the Royal Melbourne Hospital (RMH) consultationliaison service database relating to referral, patient demographics, psychiatric diagnosis service use, management and discharge arrangements was recorded for all referrals to the RMH C-L service in 1999. The inpatient and emergency department arms of the service were compared. Results: The referral rate for inpatients and the emergency department was 2.9% and 2.1% respectively. The reasons for referral and frequency of psychiatric diagnosis differed significantly between the two settings. Conclusions: The provision of C-L services to inpatients and the emergency department needs to be tailored to the different patient populations.
The Case for Mandatory MOPS
Authors: Mayne Keith 
Published: March 2003

Objective: To provide background information and a rationale regarding the mandatory Maintenance of Professional Standards (MOPS) Program of the RANZCP. Conclusions: MOPS has evolved over ten years and will continue to develop and change. MOPS programs have been viewed by Medical Colleges as a major force in unifying the profession against destructive outside influences. MOPS is not an assessment of competence or performance, and not equivalent to “recertification”. Rather, MOPS reflects the belief that participation in continuing medical education and quality improvement processes will maintain and improve standards of practice. There is every reason to be confident that, with ongoing adjustment, MOPS will continue to meet the professional development needs of all RANZCP Fellows.
Beyond Interdisciplinary Boundaries: Views of Consumers, Carers and Non-Government Organizations on Teamwork
Authors: MacDonald Elspeth , Herrman Helen , Hinds Pauline , Crowe Jim , McDonald Paul 
Published: March 2003

Objective: To present the views of consumers, carers, and non-government organizations (NGOs) on interdisciplinary teamwork. The transcript from a symposium organized by the RANZCP Professional Liaison Committee at TheMHS conference of Australia and New Zealand is reviewed and analyzed. Results: Consumer and carer participation in interdisciplinary teams is important. Consumers, carers and NGOs have useful perspectives on threats to interdisciplinary practice, and their views can assist teams to develop principles that promote positive interdisciplinary partnerships. Conclusions: Effective and responsive partnerships with consumers and carers require interdisciplinary team members to commit to listening to and responding to the viewpoints of the users of their services. Resourcing and structuring teamwork around the viewpoint of users of mental health services can fundamentally change interdisciplinary teamwork. Furthermore, the commitment to consumer and carer participation has implications for how teams conduct their clinical practice and practice research.
Collaboration to Innovation: Facilitating the Introduction of Intensive Child and Adolescent Psychiatry Treatment Teams
Authors: Nicholls Denise , McDermott Brett 
Published: March 2003

Objectives: To describe from an academic and practical perspective the process of organisational change associated with the introduction of an innovative child and adolescent mental health service. Method: The project consultation process is described. Process redesign literature is reviewed and the application of the principles to the project process is discussed. Results: The project successfully produced a unified, inter-sector recommendation for a new service which had achieved wide endorsement. Understanding and utilising process redesign principles was confirmed to be advantageous. Further, an evidence based approach was found to be helpful in uniting the sectors and in accelerating change. Obstacles to innovation were identified and specifically addressed by the planning process. Conclusions: Restructuring of services or the introduction of new services in response to policy changes or to changes in available resources is commonplace. Often it is assumed that the benefits expected from proposed changes will automatically flow and little effort is made to employ current knowledge from the literature regarding the successful implementation of organisational change. A rigorous planning process is required for service change, particularly when innovative treatments are being considered.
A ‘Fair Play’? Comparison of an Objective Structured Clinical Examination of Final Year Medical Students Training in Psychiatry and their Supervisors' Appraisals
Authors: Melding Pamela , Coverdale John , Robinson Elizabeth 
Published: March 2003

Objective: Expected standards for student performance in psychiatry can vary between supervisors and institutions. Recently, the University of Auckland required its academic departments to have an objective standard assessment or test for each student on a clinical attachment. We aimed to compare an objective structured clinical examination of final year medical students training in psychiatry and their supervisors' appraisals. Method: Assessment in psychiatry initially consisted of a two-hour written test. Subsequently, the test in psychiatry changed to a standardised, modified, objective, structured, clinical examination (OSCE) using simulated patients. The clinical supervisor rated each student on a set of clinical parameters using a scale of 1-6. In addition, members of the academic department of psychiatry separately tested the students with a modified OSCE on the last day of their clinical attachment. The results of the OSCE are compared with clinical attachment assessments and the previous method of evaluation, the written test. Results: There was no correlation between the written test and the supervisor's assessment for the clinical attachment indicating that the written test was not a good method of evaluating student performance. The correlation between the clinical attachment grading and the OSCE for year 1 was 0.4 (p=0.002) and for year 2 was 0.5 (p=0.001). However, marks for the OSCE were consistently lower than those given for the clinical attachment. Conclusions: The introduction of the modified OSCE had the desired outcome of changing students' focus from the pursuit of theoretical knowledge to the attainment of practical skills.
Interagency Training in Dual Disability
Authors: Mohr Caroline , Phillips Alex , Curran Jenny , Rymill Ann 
Published: March 2003

Objective: Mental health care professionals are poorly trained in intellectual disability, and workers in intellectual disability (ID) services are similarly unskilled in mental health care principles. Consequently, the mental health needs of adults with intellectual disabilities and psychiatric disorders are not being adequately met. Method: A three day training programme was designed to redress this situation and encourage these separate services to work collaboratively. The programme was evaluated with 30 participants drawn from MH and ID services. Results: Evaluations conducted pre- and post-training indicated increases in participants' confidence in working in and knowledge of DD, and ability to complete study assessments. Post training letters written by participants to their managers indicated their commitment to educate their co-workers in DD, learn more about DD, change their clinical practices, and collaborate with staff from the other service. Conclusions: This preliminary evaluation suggested the promise of positive outcomes for people with DD following joint training of staff from ID and MH services.
Improved Functioning in a Woman with Schizophrenia on Exclusive Therapy with Oestrogen Pills
Authors: Tunde-Ayinmode Mosunmola , Singh Ashok , Marsden Karen 
Published: March 2003

Objective: To highlight the therapeutic potential of oestrogen in schizophrenia and raise awareness about the need for more clinical trials. Method: Case Report. Results: The case concerns a woman suffering from chronic paranoid schizophrenia, who complied poorly with antipsychotic medication and had severely impaired psychological and social functioning. Oestrogen therapy in the form of an oral contraceptive pill (brevinor- norethisterone/ ethinyloestradiol) was used with effect. Conclusions: Oestrogen therapy shows promise in select cases in the treatment of schizophrenia and warrants further study.
Ultrasound of soft‐tissue masses: Pitfalls in interpretation
Authors: Doyle Anthony James , Miller Mary V , French J Gary 
Published: March 2003

SUMMARYA review of 43 patients with soft‐tissue tumours identified from a tumour registry showed a 23% rate of incorrect initial diagnosis by ultrasound imaging. Seven patients, five with malignant tumours, suffered a delay in diagnosis (ranging up to 6 months) as a result. The most common error was to mistake a solid tumour for a haematoma. Caution is recommended in the interpretation of ultrasound of soft‐tissue masses, particularly with regard to the erroneous diagnosis of haematoma.
Radiological–pathological correlation: Alveolar pattern
Authors: Stahl Jürgen , Sage Michael R 
Published: March 2003

SUMMARYThis review summarizes important pathological lesions of the lung that typically present radiographically with an ‘alveolar pattern’. For each entity, the latest findings as to its pathogenesis, aetiology and pathology are reviewed in the introductory remarks. We then present the typical radiological appearances alongside macroscopic and microscopic pathological photographs. It is hoped that the parallel presentation of radiological image with the pathology will enhance the understanding of the diverse range of diseases the aevolar pattern comprises.
Odontoid fracture following an epileptic seizure
Authors: Torreggiani William C , Lyburn Iain D , Harris Alison C , Nicolaou Savvas 
Published: March 2003

SUMMARYFractures of the thoracic and lumber spine are well recognized following an epileptic seizure. Fractures of the cervical spine are not. The rare occurrence of a displaced odontoid fracture type 2, secondary to a grand mal seizure is presented. To our knowledge, this association has not been described previously in the English literature.
Use of endoscopic mucosal clips in radiotherapy planning for oesophageal carcinoma: A series of three cases
Authors: Hui Andrew , Abi‐Hanna David , Rae Robert , Delaney Geoff 
Published: March 2003

SUMMARYThis paper describes the technique of placing endoscopic mucosal clips to localize oesophageal carcinoma and hence facilitate radiotherapy planning. This technique has been used on three patients in our centre. One was treated radically with external beam radiotherapy and two were treated palliatively (retreatment) with intraluminal brachytherapy. Mucosal hemoclips were placed at the time of endoscopy to indicate the superior and inferior extent of the tumour. The clips provided a radiologically‐recognisable marker of the tumour extent and were visible on simulation films or planning CT scans. The radiation portal included the tumour as demarcated by the clips with an adequate margin. There were no complications related to the placement of the clips. All patients completed the radiotherapy course as planned.
Lumbar artery pseudoaneurysm following renal biopsy: Treatment with ultrasound‐guided thrombin injection
Authors: Ramsay Duncan W , Marshall Martin 
Published: March 2003

SUMMARYlatrogenic pseudoaneurysms are usually seen following arterial catheterization. However, we describe a case of a 23‐year‐old woman who developed a pseudoaneurysm of a lumbar artery following renal biopsy. In view of her progressing renal failure, arterial embolization was felt to be inappropriate, and although the pseudoaneurysm could be seen ultrasonically, guided compression could not be applied because of the location of the aneurysm deep to the lumbar musculature. Hence, the pseudoaneurysm was thrombosed by percutaneous ultrasound‐guided injection of thrombin directly into the pseudoaneurysm sac. This resulted in immediate thrombosis of the aneurysm and no recurrence on follow‐up imaging. Thrombin injection for femoral artery pseudoaneurysms following catheterization is becoming more widely accepted, and our case demonstrates that this technique might be applied to pseudoaneurysms elsewhere in the body.
Murray Valley encephalitis: Case report and review of neuroradiological features
Authors: Kienzle N , Boyes L 
Published: March 2003

SUMMARYWe report on a child with diffuse symmetrical thalamic enlargement and signal increase on MRI, representing changes caused by Murray Valley encephalitis (MVE). Very little has previously been reported on the neuroradiological findings of MVE, also known as Australian encephalitis. It is endemic to tropical North Australia, particularly Western Aus­tralia and the Northern Territory, but can occur in other parts of Australia. The last epidemic was in south‐eastern Australia in 1974. Australian encephalitis is the second most serious acute viral encephalitis to be encountered in Australia. Clinicians need to be aware of MVE in this era of ever‐increasing travel. Our aim is to highlight these finding and further define the neuroradiological features.
SIGNALLING AND GENE REGULATION BY UREA AND NaCl IN THE RENAL MEDULLA
Authors: Cohen David M 
Published: March 2003

1. Cells of the mammalian renal medulla are routinely subjected to an enormously elevated and labile ambient osmolality as a consequence of the renal concentrating mechanism. The present review focuses on the most recent advances in hyperosmotic solute‐mediated signal transduction and regulation of gene transcription in cells of the kidney medulla.2. On the basis of osmolality alone, NaCl and urea are the principal renal medullary solutes.3. Urea, which is membrane permeant, activates transcription of immediate‐early genes via an extracellular signal‐ regulated kinase (ERK)/Elk‐1‐dependent pathway. Urea also activates multiple effectors characteristic of a receptor tyrosine kinase‐like signalling cascade.4. In contrast, the functionally impermeant solute NaCl activates transcription of tonicity responsive genes (principally genes encoding proteins essential for osmolyte uptake or synthesis) via a unique consensus element contained within their 5′ flanking sequences.5. An activity exhibiting tonicity inducible sequence‐specific interaction with this DNA element has been identified.6. Hypertonicity, like thermal stress, activates transcription of genes encoding heat shock proteins. The relationship between signalling events leading to tonicity mediated and heat shock‐mediated gene transcription remains to be established.
ENDOTHELIN‐1 AS A MEDIATOR IN CARDIOVASCULAR DISEASE
Authors: Kelly John J , Whitworth Judith A 
Published: March 2003

1. Brachial artery infusion of endothelin (ET)‐1 causes transient vasodilatation followed by sustained vasoconstriction of the forearm vascular bed, whereas ET‐1 antagonists cause sustained vasodilatation. These data suggest that ET‐1 contributes to basal vascular tone.2. Systemic infusion of ET‐1 increases blood pressure and total peripheral vascular resistance and reduces heart rate and cardiac output. The renal and pulmonary circulations are particularly sensitive to the vasoconstrictor effects of ET‐1. Systemic infusion of the ETA/B receptor antagonist TAK‐044 reduces mean arterial pressure and peripheral vascular resistance.3. Plasma ET‐1 concentrations are not elevated in essential hypertension; however, insulin resistance may be a major determinant of plasma ET‐1 concentrations. Vascular sensitivity to ET‐1 is normal or may be increased in essential hypertension.4. Plasma ET‐1 concentrations are increased in moderate and severe heart failure and are correlated with clinical and haemodynamic measures of severity. Endothelin‐1 contributes to increased vascular tone in cardiac failure.5. Plasma ET‐1 concentrations increase following myocardial infarction and persistent elevation predicts an increased mortality within the subsequent 12 months.6. Preliminary data suggest that interventions that reduce the activity of the endothelin system may have a beneficial effect in heart failure and myocardial infarction.
REDUCTION OF HUMAN RECOMBINANT TYPE II PHOSPHOLIPASE A2 AND PROSTAGLANDIN F2α RELEASE BY MICROTUBULE DEPOLYMERIZING AGENTS
Authors: Munns Mj , King Rg , Rice Ge 
Published: March 2003

1. The present study examines the effects of the microtubule depolarizing agent colchicine on secretory type II phospholipase A2 (PLA2) function in Chinese hamster ovary (CHO) cells that specifically overexpress human type II PLA2 and the effect of both colchicine and tubulazole on the release of type II PLA2 and prostaglandin (PG) F2α from human placental explants.2. Significant suppression by colchicine (0.01–10 μmol/L) of PLA2 activity (P < 0.00001), immunoreactive type II PLA2 (irPLA2; P < 0.00001) and PGF2α release (P < 0.01) was observed in medium from overexpressing CHO cells. These effects were significantly reduced (P < 0.0001) in the presence of 10 μmol/L taxol, an agent that prevents depolymerization of microtubules. The addition of 30 μmol/L arachidonic acid significantly reduced (P < 0.0001) the inhibition of PGF2α production in CHO cell lines.3. The addition of 1 μmol/L colchicine to human placental explants for 24 h significantly reduced irPLA2 (P < 0.00001) and PGF2α production (P < 0.00001). Similarly, 1 μmol/L tubulazole significantly blocked irPLA2 (P < 0.001) and PGF2α (P < 0.0001).4. At 10 μmol/L, taxol significantly reduced irPLA2 inhibition by colchicine (n = 8; P < 0.05) and tubulazole (n = 8; P < 0.05). Similarly, taxol significantly reduced the reduction in PGF2α production caused by colchicine (P < 0.001) and by tubulazole (P < 0.001).5. These results suggest that integrity of the microtubule system is required for PLA2 function and the subsequent production of pro‐inflammatory mediators.
REGULATION OF CASPASE ACTIVATION IN APOPTOSIS: IMPLICATIONS IN PATHOGENESIS AND TREATMENT OF DISEASE
Authors: Kumar Sharad 
Published: March 2003

1. Apoptosis is an essential process to remove excess, unwanted and harmful cells and maintain homeostasis. One of the key steps in apoptosis is activation of a group of proteases termed caspases.2. Caspases are cysteine proteases that cleave their substrates after an aspartate residue. Approximately one dozen such proteases have been cloned during the past few years. While some caspases are largely responsible for the proteolytic processing of proinflammatory cytokines, such as interleukin (IL)‐1β, others are directly involved in the execution of apoptosis.3. Once apoptotic upstream caspases are activated in response to specific apoptotic stimuli, they can activate the downstream or effector class of caspases. Most proteins that are cleaved during apoptosis leading to the characteristic apoptotic morphology are targeted by the downstream caspases. The cleavage of these proteins by caspases can be either an activating or inactivating event for the function of a protein; however, in most cases, it contributes to the apoptotic phenotype of the cell.4. Because caspase cleavage is the initiating event in most forms of apoptosis, it is a tightly controlled process with many checks and balances. An understanding of the regulation of caspases is providing novel ways for therapeutic intervention to modulate apoptotic behaviour of cells in many diseases that arise due to inappropriate apoptosis.5. The present article will endeavour to discuss recent advances in our understanding of caspase regulation and will elaborate on how this knowledge is being used in the development of new classes of therapeutic molecules that can be used for the treatment of human ailments.
EFFECTS OF HEPARIN ON VASCULAR DYSFUNCTION IN DIABETIC RATS
Authors: Oturai Peter S 
Published: March 2003

1. Treatment with heparin has beneficial effects in diabetic nephropathy. The occurrence of increased urinary albumin excretion in diabetic patients reflects general vascular dysfunction, including increased transcapillary permeability of macromolecules. The aim of the present study was to evaluate the effects of heparin on vascular dysfunction in diabetic rats.2. Male Sprague‐Dawley rats were used in two studies. Diabetes was induced by 65 mg/kg, i.v., streptozotocin. In one study, diabetic rats were dosed subcutaneously with different heparin fractions for 8 months and the transcapillary escape rate of albumin (TERalb) was measured in anaesthetized animals. In the other study, heparin was given for 6 weeks, followed by tissue albumin clearance measurements in awake rats. Normal and diabetic rats receiving saline served as controls.3. Blood glucose did not differ among the diabetic groups and ranged from 22 to 26 mmol/L. The mean (±SD) TERalb was increased by diabetes compared with values in normal rats (17.5±3 vs 14.1±3.3%/h, respectively). Neither unfractionated nor low molecular weight heparin significantly affected this increase. [131I]‐Albumin clearance was significantly increased in diabetic rats in the eye, skin and skeletal muscle tissues compared with normal rats (0.17–0.40 vs 0.1–0.23 μL plasma/g per min). Low molecular weight heparin treatment did not affect the increased organ albumin clearance.4. In conclusion, heparin treatment does not affect diabetes‐induced vascular dysfunction as expressed by increased TERalb and clearance of albumin in rats.