bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatrist or Sex Worker? Emotional Awareness in Ethics Education
Authors: Parkinson John 
Published: December 2004

Objective: When too many psychiatrists have been behaving like prostitutes, it is instructive to compare and contrast that ancient profession with our own. The present paper sets out to do that. Methods: Codes of conduct are compared and clinical anecdotes discussed. Results: Both professions give time and services in exchange for money. Guidelines for each highlight limits and boundaries. A danger is ‘falling in love’, a quasi-psychotic experience that facilitates some phases of development but which can be destructive when uncontained. Since the advent of cognitive behavioural therapy (CBT), transference and countertransference are concepts no longer widely used. However, many behaviourists know the importance of a therapeutic alliance and see the therapist as a figure who can invoke idealization and dependence. All psychiatric treatment has a developmental aspect because it seeks to replace primitive feelings and impulsivity with mature behaviour. Adolescence brings not only sexual development but emotional change from the dependent child to the adult capable of care and bonding. Sexual attraction is more mature the more the element of neediness is modified by care and concern. Conclusions: Peer groups are commended for both professions. In psychiatric training, human development should be learnt not just as theoretical background but as lively reality in clinical work, alerting psychiatrists to monitor their own maturity in the doctor-patient setting. The value of personal therapy or analysis is discussed, together with possible adverse sideeffects.
Establishment and Evaluation of a Clinical Pathway for Young Suicide Attempters and Ideators
Authors: Hazell Philip 
Published: December 2004

Objective: To develop, implement and evaluate a pathway to care for young people presenting with suicidal ideation or deliberate self-harm. Methods: A working party consisting of key stakeholders was established to review existing practice, consider recommendations formulated in other centres, formulate a pathway, identify training needs for clinical staff, identify gaps in resources that would hinder the implementation of the pathway, and to evaluate effectiveness. Results: No existing pathways were identified that could be applied to the local context. A pathway was developed by consensus and disseminated to relevant clinical areas. A training strategy involving clinical placements was implemented. Critical gateway points along the pathway were identified and monitored. Compliance with gateway points was satisfactory, with the exception of review by a mental health clinician in the emergency department. More than 75% of young people presenting on the pathway attended community follow up, which is higher than the rate of compliance with follow up reported in most other studies. Conclusions: Establishing a clinical pathway permitted the delineation of roles and responsibilities. Although the pathway was developed for a local context, service planners may find it helpful to follow the steps in the pathway development process that have been outlined.
From the 1870s to the 1970s: the Changing Face of Public Psychiatry in South Australia
Authors: Bell Maureen 
Published: December 2004

Objective: To give an overview of the development of psychiatric services in South Australia from the 1870s to the 1970s, to describe some of the milestones in their progress, and to demonstrate that many of the guiding principles of contemporary services can be found to have their roots in this period. Conclusions: Psychiatric services in South Australia progressed in fits and starts, but not for want of commitment and concern by those responsible for the care of the mentally ill. While in broad outline the development of services followed the course taken in other states, it is clear that the individual efforts of staff of the hospitals and a number of members of the public played an important role in improving the conditions and treatment of those with a mental illness, and laying the foundations for the movement of psychiatric services from their early isolationist position into the general health arena.
‘Auspsyc’: an Email Discussion List for Psychiatrists and Trainees
Authors: Buchanan John 
Published: December 2004

Objective: To describe ‘auspsyc’, an email discussion list for psychiatrists, psychiatry trainees and psychiatry medical officers in Australia and New Zealand. Conclusions: auspsyc provides free, open and timely communication about matters of professional concern. A variety of issues have been covered by members since its inception. Guidelines have been developed to ensure that the email discussion list functions efficiently and that ‘netiquette’ is observed.
Can Psychiatry Reclaim its Soul? Psychiatry's Struggle Against a Dispirited Future
Authors: Halasz George 
Published: December 2004

Objectives: To examine reasons why ‘religion’ and ‘psychiatry’, as systems of belief, have a fraught, mistrustful relationship based on conflict regarding the source of knowledge. The former insists that revelation, not rational empirical evidence, the latter's claim for superiority, is the ultimate source that illuminates the soul, not just the self. This tension is illustrated with the case of ‘facilitated communication’, a method that purportedly improves communication for children with pervasive developmental disorder. The controversy highlights an aspect of the differences between ‘scientific’ and ‘religious’ discourse and offers a further dimension to contemporary psychiatry's crisis: the three-way tension between the brain-less, mind-less and soul-less psychiatry. Conclusion: The suggestion for a possible remedy is to revisit the source of discontent, the Aristotelian doctrine that challenged the ancient wisdom of the immortality of the soul.
Dr Radovan Karadzic: Psychiatrist, Poet, Soccer Coach and Genocidal Leader
Authors: Kaplan Robert M. 
Published: December 2004

Objective: To consider the life of psychiatrist, Dr Radovan Karadzic, and the following questions: (i) whether there was anything in Karadzic's personal life to predict his subsequent career as genocidal leader; (ii) what kind of psychiatrist was Karadzic; and (iii) what comparisons can be made with other genocidal leaders? Conclusions: Karadzic, who, in addition to practising psychiatry, was variously poet, troubadour, soccer coach, chicken farmer, businessman, ecologist and petty criminal, had an astonishing rise to power, becoming president of the Bosnian Serb Republic. As a result of atrocities committed during the Bosnian Civil War 1992-1995, Karadzic stands indicted as a suspected war criminal for crimes against humanity and genocide, the first doctor so indicted since the Nuremberg Doctors' Trial in 1946. Many aspects of Karadzic's personality remain deeply enigmatic. Nevertheless, his grandiose self-image, reckless and profligate nature, boundless opportunism and grotesque capacity for self-deception are his most enduring characteristics.
Clinical Practice Guidelines: A Tool to Measure Variance
Authors: Tobin Margaret , Wilson Andrew , Codyre David , Rosen Alan , Barton David 
Published: December 2004

Objective: To outline plans of the RANZCP Quality Improvement Committee (QIC) for the implementation of the Clinical Practice Guidelines (CPG) into clinical practice in Australia and New Zealand, and provide views of the QIC on the role of CPG as a quality improvement tool. Conclusions: Clinical Practice Guidelines are of limited utility unless there is clinician buy-in and they are used as a tool to measure variance as part of a continuous quality improvement cycle. The QIC actively encourages debate regarding the content and development process of the CPG as well as methods for their use in routine clinical practice.
Summary of Guideline for the Treatment of Panic Disorder and Agoraphobia
Authors: Andrews Gavin , Oakley-Browne Mark , Castle David , Judd Fiona , Baillie Andrew ,   RANZCP Clinical Practice Guideline Team for Panic Disorder
Published: December 2004

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the treatment of panic disorder and agoraphobia Conclusions: Evidence-based treatments for panic disorder and agoraphobia are now clear. These conditions are chronic and disabling in nature, are complicated by delayed treatment and the presence of other psychiatric conditions, and the presence of severe agoraphobia is a negative prognostic indicator. Choice of therapy will depend on the skill of the therapist in applying psychological treatments as well as the preferences of the patient, but there is a role for both psychological and evidence-based pharmacological approaches. The present article is a summary version of the comprehensive Clinical Practice Guideline (Australian and New Zealand Journal of Psychiatry, 2003) which was developed in accordance with National Health and Medical Research Council (NHMRC) criteria. It provides a two-page desk-top summary for use in clinical practice. Economic evaluation of the available evidence-based treatments showed that at 1 year the cost of cognitive behaviour therapy (CBT) is less than the cost of the average drug therapy (CBT becomes cheaper than paroxetine at 8 months, than clomipramine at 11 months and cheaper than imipramine at 13 months). During the second and subsequent years the superiority of CBT increases whether or not the drugs are continued. Evidence levels for specific treatments are provided in the comprehensive guideline and placed in the context of overall principles of thorough assessment and quality clinical management.
Paediatric radiotherapy in Australia and New Zealand: An anachronism in 2003?
Authors: Ahern Verity , Berry Martin 
Published: December 2004

SummaryThis report reviews the activities of the Paediatric Special Interest Group of the Royal Australian and New Zealand College of Radiologists in terms of its involvement with the Australian and New Zealand Children's Cancer Study Group and its research and educational activities. Examples of when and how radiotherapy is currently used in the management of paediatric malignancies are provided. Some thoughts for the future of both paediatric radiotherapy and our subspecialty are also presented.
A 5‐year audit of 778 neonatal renal scans (Part 1): Perplexing pyelectasis and suggested protocol for investigation
Authors: Acton Christine , Pahuja Monica , Opie Gillian , Woodward Alan 
Published: December 2004

SummaryIn this 5‐year review of 778 neonatal renal scans seen in an Obstetric Hospital, most infants were referred because of antenatal ultrasound findings, 92% with fetal pyelectasis. The results were classified according to the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux (VUR) found on a micturating cystourethrogram. Persistant mild to moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). Pyelectasis has proved to be a poor predictor of VUR. A protocol outlining paediatric management for neonates with persisting pyelectasis is included. There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. These infants have been separately reported and illustrated (Part 2). Overall, 13% of infants were found to have significant findings of obstruction, VUR or miscellaneous anomalies affecting management.
A 5‐year audit of 778 neonatal renal scans (Part 2). Miscellaneous anomalies in 59 infants: A pictorial presentation
Authors: Acton Christine , Pahuja Monica , Opie Gillian , Woodward Alan 
Published: December 2004

SummaryIn this 5‐year review of 778 neonatal renal scans seen in an obstetric hospital, Mercy Hospital for Women, Melbourne, most infants were referred because of antenatal ultrasound findings. Ninety‐two percent of these had fetal pyelectasis. The results were classified on the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux found on micturating cystourethrogram. Persisting mild/moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. Review of these 59 infants illustrates the anomalies seen and reports the associated investigations and subsequent outcome in most cases.
Cranial CT interpretation by senior emergency department staff
Authors: Arendts Glenn , Manovel Alvaro , Chai Alan 
Published: December 2004

SummaryThe aims of the present study were to determine the rate of misinterpretation of non‐contrast cranial CT scans by emergency specialists and trainees compared with specialist radiologists, and the proportion of misinterpretations that is consequential. A 12‐month prospective blinded cohort study was performed. One‐hundred and ninety of 1282 scans (14.8%) were misinterpreted, and 78 of these (41.1%) were of potential or actual consequence. We conclude that the performance of senior emergency department staff in non‐contrast cranial CT interpretation is no better than moderately good, and a large proportion of misinterpretations are of potential or actual clinical consequence.
MRI and preoperative embolization of a nasal cavity haemangioma in a child
Authors: Andronikou Savvas , Mandelstam Simone , Fasulakis Stephen 
Published: December 2004

SummaryHaemangiomas are common benign tumours of the head and neck region in children. The nasal cavity, however, is an extremely rare site for such lesions in childhood. We present the typical MRI features of a nasal cavity haemangioma in a 12‐year‐old girl. Biopsy was avoided because of the MRI diagnosis and preoperative embolization of the mass was performed.
Mammographic features of breast cancer in young symptomatic women
Authors: Zadelis Sophia , Houssami Nehmat 
Published: December 2004

SummaryThe present study provides a descriptive analysis of the mammographic appearance of breast cancer in women aged 30−39 years presenting with symptoms, based on 65 cancers confirmed with histology. We correlate the findings with clinical presentation and histological findings. We describe, categorize and illustrate the different lesions seen on mammography. Our study shows that microcalcification, with or without associated masses, is a dominant feature of breast cancer visualized on mammography in women in this age group.
Views of Australian and New Zealand radiation oncologists and registrars about evidence‐based medicine and their access to Internet based sources of evidence
Authors: Veness Michael , Rikard‐Bell Glenys , Ward Jeanette 
Published: December 2004

SummaryIn order to determine the views of Australian and New Zealand (ANZ) radiation oncologists and registrars about evidence‐based medicine (EBM) and their access to, and use of, Internet‐based EBM resources such as MEDLINE and the Cochrane Library, a self‐administered postal survey was sent out in December 2000. A total of 191 of 243 practicing ANZ radiation radiation oncoloists (138) and registrars (53) responded (78.6% response rate). The main outcome measures were: (i) views about EBM and its promotion; (ii) previous EBM training; (iii) extent of Internet access and level of MEDLINE use and access to online medical journals; (iv) awareness of the Cochrane Library and other EBM resources; and (v) self‐assessment of common EBM technical terms. The results of the survey found that most (82.7%) indicated a positive view of themselves towards the current promotion of EBM. However, significantly fewer perceived their colleagues were as positive (χ2 = 35.2, d.f. = 1, P < 0.001). Most (84.8%) considered research findings ‘useful’ in day‐to‐day management of patients. The majority (70.2%) of respondents never had attended an EBM course; however, most indicated interest in such training. The majority (73.8%) reported having accessed MEDLINE or another bibliographic database in the previous month. Seventy‐seven respondents (40.3%) reported that, in the past month, a literature search/article had influenced their practice. Only a minority (28.3%) used the Cochrane Library. Self‐assessment of most of the 12 EBM terms was generally high. For radiation oncologists, past attendance at an EBM course was significantly associated with a better overall self‐assessment of these 12 terms (χ2 = 10.59, d.f. = 1, P = 0.001). These findings reveal strong support for EBM among ANZ radiation oncologists and registrars with most regularly accessing the Internet for evidence. However, lack of awareness of some relevant EBM related resources, particularly the Cochrane Library, remains a challenge. Our findings invite a concerted effort by those promoting EBM to ensure clinicians have both the skills and knowledge to practice EBM.
Subperiosteal aneurysmal bone cyst with associated bone marrow oedema: An unusual appearance
Authors: Slavotinek John P , Wicks Andrew , Spriggins Anthony J 
Published: December 2004

SummaryA case of a subperiosteal aneurysmal bone cyst with adjacent bone marrow oedema is presented. Aneurysmal bone cysts have been well documented in the published literature; however, relatively few have been observed in a subperiosteal location, and associated bone marrow oedema in the absence of a demonstrable pathological fracture is a rare finding. Aneursymal bone cyst should be considered in the differential diagnosis of subperiosteal bone lesions and may be associated with bone marrow oedema.
Retrospective study of the utility of nuclear scintigraphic‐labelled red cell scanning for lower gastrointestinal bleeding
Authors: Levy Richard , Barto Walid , Gani Jon 
Published: December 2004

Background:  The aim of the present study was to evaluate the utility of nuclear scintigraphic‐labelled red cell scanning in the management of bleeding in patients with acute lower gastrointestinal haemorrhage (GIH) who require surgery.Methods:  A prospective database was used to source data on all patients with lower GIH who underwent technetium‐99m (99mTc)‐labelled red cell scanning over a 10‐year period. A subgroup was identified from cross‐reference with the medical records identifying only those patients who continued to bleed and subsequently required laparotomy for further detailed retrospective study. One key question was asked: did the labelled red cell scan influence the type of operation performed by the operating surgeon?Results:  The study identified 249 patients who underwent 287 labelled red cell scans for GIH. Forty patients (16%) underwent laparotomy for ongoing bleeding; 28/40 (70%) of the red cell scans were positive for bleeding. Six patients (15%) died postoperatively, none because of continued bleeding. The 99mTc‐labelled red cell scan was deemed to have been unhelpful in 22 (55%) cases. Twelve of the 22 scans were negative and 10 of the 22 scans were positive but were ignored by the surgeon. The 99mTc‐labelled red cell scan influenced the choice of operation in 18 out of 40 patients (45% of the operated group but only 7.2% of the total scanned group). Of these, 15 patients underwent colonic resection and three patients underwent small bowel resection.Conclusion:  The present study demonstrates that labelled red cell scanning has only a small role to play in managing lower GIH. The 99mTc‐labelled red cell scanning should be used much more selectively. Its use should be limited to patients who continue to bleed after conservative management; it may allow these patients to be effectively treated by segmental bowel resection. Its most critical role, however, is probably to prevent suspected small bowel bleeding from being missed at operation.
Vascular disease risk factor management 4 years after carotid endarterectomy: are opportunities missed?
Authors: Middleton Sandy , Harris John , Lusby Robert , Ward Jeanette 
Published: December 2004

Background:  Because a large percentage of patients surviving carotid endarterectomy (CEA) subsequently die from a vascular cause, the aim of the present paper was to determine risk factor management for a cohort of patients 4 years after their CEA.Methods:  Surviving patients who had a CEA within the region administered by the Central Sydney Area Health Service in 1995 were asked to complete a self‐administered questionnaire to determine vascular risk factors.Results:  Of the 181 patients eligible to participate, 162 returned questionnaires (response rate: 90%). While 106 (65.4%) patients recalled that they had been diagnosed with high blood pressure either before or after their CEA, only 79.2% recalled that their latest blood pressure reading was ‘about right for my age’. Nearly one in five (16.7%) who had had their cholesterol level checked in the last 12 months (n = 120) indicated that the reading was ‘too high’. Only 76.5% reported taking medications to ‘thin the blood’. Almost one‐fifth of patients (17.3%) were current smokers. Only 35.2% of patients participated in a level of physical activity sufficient to confer a health benefit. Further, 30.2% of patients were overweight and 14.8% were obese. The majority of patients (98.1%) reported having a regular general practitioner (GP). Of these, 98.7% had visited their GP at least once within the previous 6 months.Conclusions:  Vascular risk factor management following CEA is suboptimal, inviting the implementation and evaluation of strategies to improve outcomes.
How should gynaecomastia be managed?
Authors: Daniels Ian R. , Layer Graham T. 
Published: December 2004

Background:  The purpose of the present paper was to review the management of men referred to a breast clinic with presumed gynaecomastia.Methods:  A retrospective analysis was carried out of 175 men over the age of 16 years who presented with breast enlargement and/or ‘lumps’, during a 7‐year period to a single‐surgeon. All patients had complete biochemical assessment (liver function tests, γ‐glutamyl transferase, prolactin, α‐fetoprotein, β‐human chorionic gonadotropin), and mammography and/or ultrasound with fine‐needle biopsy if indicated.Results:  One hundred and seventy‐five men, median age 44 years (range: 18−89 years), were assessed. Thirty‐nine had bilateral true gynaecomastia and 88 had unilateral gynaecomastia (53% left). Carcinoma of the breast was diagnosed in eight, pseudo‐­gynaecomastia in 18, 13 had physiological pubertal changes only and nine had other diagnoses. Adverse drug reactions were possibly implicated in the aetiology of 47 patients, alcohol in seven patients, cannabis in one patient, testicular malignancy in four patients and hepatocellular carcinoma in one patient. Five patients were found to have hyperprolactinaemia. Twenty‐four per cent of patients were reassured without intervention; 18% failed to attend follow up. Sixteen per cent were treated with danazol, 15% underwent surgery and 28 were referred for management of their cause. Danazol was effective in 81%, and three patients required surgery when danazol was ineffective. One further patient developed testicular cancer 9 months after presentation.Conclusion:  Men presenting to a breast clinic require clinical assessment to exclude diagnoses other than gynaecomastia. True gynaecomastia can be managed with exclusion of causative factors by non‐invasive investigation and examination. Many patients can be reassured as to the idiopathic nature of the condition and many will fail to attend follow up. Danazol is successful in some patients and surgery should be reserved for resistant cases.