bluuebunny/crossref_metadata_2025_split huggingface dataset:
BARRIERS TO PARTICIPATION IN RANDOMIZED CLINICAL TRIALS FOR EARLY BREAST CANCER AMONG AUSTRALIAN CANCER SPECIALISTS
Authors: Ellis Peter M. , Butow Phyllis N. , John Simes R. , Tattersall Martin H. N. , Dunn Stewart M. 
Published: March 2003

Background: Doctors’ discomfort with the randomized trial process may significantly impact on accrual rates to clinical trials. However, there is little information regarding factors that influence accrual to clinical trials in Australia. The present study examines Australian cancer specialists’ attitudes towards and participation in current breast cancer clinical trials. Methods: All medical and radiation oncologists across Australia and surgeons listed as participants in the Australian and New Zealand Breast Cancer Trials Group were sent questionnaires assessing attitudes towards and participation in current clinical trials for early stage breast cancer. Results: The response rate was 71% (269/381). The mean age of respondents was 45 years and 85% were male. Respondents estimated that a mean of 5.2 (SD = 8.2) of their patients had been enrolled in a breast cancer clinical trial in the previous 12 months. Participation (in any trial) by medical oncologists (60.6%, 95%CI 54.5–66.7%) and surgeons (63.1%, 95%CI 57.1–69.1%) was significantly higher than for radiation oncologists (43.2%, 95%CI 37–49.4%, P = 0.03). The major barriers to participation in current breast cancer trials were lack of resources (44%) or issues related to specific trials (44%; e.g. relevance of the research questions or choice of standard therapies). Conclusions: The results of this study suggest that efforts to improve doctors’ participation in clinical trials need to address a number of issues. More empirical research is needed to evaluate new strategies to raise participation in clinical trials.
SELF‐EXPANDABLE METAL STENTS FOR MALIGNANT DYSPHAGIA
Authors: Lam YUK H. , Chan Angus , Lau James , Lee Danny , Ng Enders , Wong Simon , Chung Sydney 
Published: March 2003

Background: The use of self‐expandable metal stents in relieving dysphagia for patients with incurable malignant oesophageal strictures was retrospectively evaluated. Methods: Between September 1993 and August 1996, 66 male and 16 female patients with a median age of 72 years received self‐expandable metal stents for malignant dysphagia. Six patients had concurrent tracheo‐oesophageal fistulas. All patients were stented under sedation and stent insertion was performed under fluoroscopic guidance. Results: Stent placement was successful in 80 patients (98%). There were seven early complications (inaccurate positioning (n = 3), migration (n = 1), incomplete expansion (n = 1), intractable pain (n = 1), and perforation (n = 1)). Two complications were lethal and three were treated endoscopically. Mean dysphagia grade improved from 3.2 ± 0.7 to 1.8 ± 0.9 (P < 0.05) after implantation. All tracheo‐esophageal fistulas were successfully occluded. Upon a median follow‐up of 8 weeks (range: 2–20 weeks), 30 complications developed in 21 patients (tumour overgrowth (n = 15), food bolus obstruction (n = 7), tumour ingrowth (n = 2), buckling of stent (n = 2), tracheo‐esophageal fistula (n = 2), bleeding (n = 1), and gastric wall herniation through metal coils (n = 1)). Median survival was 13 weeks (range: 1–82 weeks). Conclusion: Self‐expandable metal stents provide useful palliation in patients with incurable malignant dysphagia.
HOW LARGE SHOULD A SKIN TREPHINE BE FOR AN END STOMA?
Authors: Nguyen M. H. , Pittas F. 
Published: March 2003

Background: Although much has been written about techniques for making a good stoma, little has been described regarding how to excise a trephine that will perfectly fit a given end stoma. Methods A reproducible technique for making a stomal trephine to a precise fit for each stoma is described. Results: More than 20 stomas have been made with good results. Conclusion: The skin trephine should have a diameter approximately two‐thirds of the width of the crushed bowel end.
SHOULD NEW SOUTH WALES HOSPITAL DISASTER TEAMS BE SENT TO MAJOR INCIDENT SITES?
Authors: Garner Alan , Nocera Antony 
Published: March 2003

Background: The aim of the present review was to assess the suitability of hospital disaster medical teams’ training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre‐hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed. Methods: A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment. Results: Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied. Conclusion: Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter‐disaster planning as the primary source of on‐site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre‐hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.
LAPAROSCOPIC RADICAL DEROOFING OF HEPATIC CYSTS USING THE ULTRASONIC SCALPEL
Authors: Martin I. , Garden O. J. 
Published: March 2003

Background: There is some debate regarding the role of laparoscopy in deroofing of liver cysts. Methods: Three patients underwent laparoscopic deroofing by means of an ultrasonic scalpel. Results: All three patients underwent treatment successfully with minimal postoperative morbidity and hospital stay. Conclusions: The ultrasonic scalpel has a useful role in the laparoscopic treatment of hepatic cysts.
A PROSPECTIVE SURVEY OF CURRENT METHICILLIN‐RESISTANT STAPHYLOCOCCUS AUREUS CONTROL MEASURES
Authors: Barakate Michael S. , Harris John P. , West Richard H. , Vickery Alison M. , Sharp Catherine A. , Macleod Colin , Benn Richard A. 
Published: March 2003

Background: Methicillin‐resistant Staphylococcus aureus (MRSA) is now endemic in tertiary referral hospitals among the developed world. By prospective survey, the effect of two measures aimed to reduce the spread of MRSA was determined. First, a surgical ward with persistently high levels of MRSA detection was cleaned and renovated. Second, the medical records of all MRSA‐colonized patients were electronically flagged, facilitating immediate application of control measures on readmission. Methods: Data were collected for 995 newly colonized patients admitted between 1 July 1995 and 31 December 1997. Methicillin‐resistant Staphylococcus aureus detection was determined before and after implementation of the interventions, along with the likely place of MRSA acquisition and the monthly incidence of MRSA detection for all inpatients. Chi‐squared testing with odds ratios and 95% confidence intervals determined associations between the effect of control measures studied and MRSA detection rates. Results: New MRSA detection was 21.6 per 1000 admissions before refurbishment compared with 20.4 per 1000 admissions to the surgical ward after refurbishment. New MRSA detection averaged 6.4 per 1000 hospital admissions before the introduction of record flagging and patient cohorting, compared with 6.2 per 1000 admissions after. Conclusion: Neither ward refurbishment, nor introduction of flagging, significantly reduced rates of colonization during the study period. In hospitals that receive MRSA‐colonized patients and provide intensive care facilities, spread of MRSA is a major problem. Effective containment demands separate wards for MRSA‐colonized and non‐colonized patients. The need for such containment should be considered in design of the modern hospital.
BILE DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY: A COLLECTIVE EXPERIENCE OF FOUR TEACHING HOSPITALS AND RESULTS OF REPAIR
Authors: Ooi L. L. P. J. , Goh Y. C. , Chew S. P. , Tay K. H. , Foo E. , Low C. H. , Ch’Ng H. C. , Chan S. T. S. , Soo K. C. 
Published: March 2003

Background: Laparoscopic cholecystectomy has been performed in Singapore since 1990 and, up until the end of 1997, a total of 4445 procedures had been performed in the four major teaching hospitals. Although bile duct injuries were thought to have increased following the introduction of laparoscopic cholecystectomy, there have been no reviews done on the incidence of these injuries in the Singapore context. Methods: The present retrospective review aimed to audit the rate of bile duct injuries in the four major teaching hospitals in Singapore and to document the results of management of these injuries. Results: Of the 4445 procedures performed, there were 19 (0.43%) cases of bile duct injuries. These involved the common hepatic duct (n = 8), common bile duct (n = 10), and the right hepatic duct (n = 1). The underlying gall bladder pathology included non‐inflamed gall bladders (n = 10), acute cholecystitis (n = 4), Mirrizzi’s syndrome (n = 3) and mucocele of the gall bladder (n = 2). Transection of the duct accounted for the majority of the injuries. Eleven bile duct injuries were identified at the time of operation. These were primarily repaired over a T tube (n = 4) or by a bilio‐enteric bypass (n = 7). The remainder were diagnosed at a median of 7 days (range: 1–556 days) after surgery with a presentation of jaundice or pain. These were repaired by bilio‐enteric anastomosis (n = 7) and closure over a T tube (n = 1). Three patients developed strictures subsequently, two following bilio‐enteric repair after delayed diagnosis and one following immediate primary repair over a T tube. One patient developed intrahepatic stones and required a left lateral segmentectomy. Conclusions: The experience of a 0.43% bile duct injury rate is comparable to the best results from most large series in the West. Inflammation at Calot’s triangle is an important associated factor for injury. Early recognition and prompt repair affords good results, and hepaticojejunostomy is recommended as the repair of choice.
VERAPAMIL REDUCES INTIMAL HYPERPLASIA IN A SHEEP CAROTID ARTERY PATCH GRAFT MODEL
Authors: Ao Peng Y. , Hawthorne Wayne J. , Vicaretti Mauro , Fletcher John P. 
Published: March 2003

Background: The current study investigated the effect of verapamil on the development of intimal hyperplasia (IH) using a sheep model. Methods: A gelatin‐sealed Dacron patch graft was implanted into the left common carotid artery in 40 adult Merino sheep. Sheep were then randomly allocated to four groups. Group 1 were controls given no treatment (n = 10). Groups 2–4 were treated with intravenous verapamil 0.5 mg/kg per day in two divided doses for different lengths of time. Group 2 (n = 10) received treatment for 1 week; group 3 (n = 10) received treatment for 2 weeks and group 4 (n = 10) received treatment for 4 weeks. All sheep were killed at 4 weeks and the grafted segments of artery were harvested for IH assessment by an image analysis system. Results: The IH index from the three groups treated with verapamil was significantly less than that of the control (group 1, 0.287 ± 0.077; group 2, 0.205 ± 0.064, P < 0.05; group 3, 0.193 ± 0.059, P < 0.01; group 4, 0.171 ± 0.046, P < 0.01). Conclusion: The present study suggests that verapamil inhibits the development of IH even when treatment is given for only 1 week.
MANDIBULAR RECONSTRUCTION FOLLOWING ABLATIVE TUMOUR SURGERY: AN OVERVIEW OF TREATMENT PLANNING
Authors: Dimitroulis George 
Published: March 2003

Background: In the last half century the evolution of mandibular reconstruction has resulted in a multitude of surgical procedures that have been brought about by advances made in bone science, grafting techniques and materials technology. With the ever increasing number of surgical options currently available it has become essential to take stock of these achievements and reconsider the fundamental principles of reconstructive surgery. Methods: The choice of reconstructive techniques is only part of a wider number of variables that must be considered which will ultimately determine the success or failure of the procedure. Results: Variables likely to influence the outcome of mandibular reconstruction are the site and extent of the defect, the needs and tolerance of the patient, the timing of reconstruction and the surgical skill and techniques available. Conclusion: By careful consideration of these cardinal variables it may be possible to formulate a treatment plan that will not only satisfy the essential needs of the patient but also help increase the likelihood of a successful outcome.
IN‐HOSPITAL MORTALITY AFTER TRANSURETHRAL RESECTION OF THE PROSTATE IN VICTORIAN PUBLIC HOSPITALS
Authors: Ansari M. Z. , Costello A. J. , Ackland M. J. , Carson N. , Mcdonald I. G. 
Published: March 2003

Background: The purpose of the present paper was (i) to identify trends in in‐hospital mortality after transurethral resection of the prostate (TURP) in Victorian public hospitals; and (ii) to explore associations between in‐hospital mortality after TURP and age, adverse events, type of admission (emergency/planned), location of the hospital (metropolitan/rural), teaching status of the hospital and length of stay. Methods: Trends in in‐hospital mortality after TURP and the associations between in‐hospital mortality and the aforementioned variables were studied using International Classification of Diseases, 9th revision, Clinical Modification (ICD‐9‐CM) coded Victorian hospital morbidity data from public hospitals between 1987–88 and 1994–95. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) were based on univariate and multivariate logistic regression, respectively. Results: After adjustment for age, comorbidity, and other confounding variables, the trend in mortality reduction over time was highly significant (P for trend < 0.0001, 95% CI for trend: 0.84–0.95). Highly significant associations with mortality were observed for emergency admissions (OR = 1.99, P < 0.0001), presence of adverse events (OR = 2.69, P < 0.0001), length of hospital stay (P for trend < 0.0001, 95% for trend: 1.88–2.15) and age (P for trend < 0.0001; 95% CI for trend: 1.26–1.48). Conclusions: Routinely collected data from hospitals can provide tentative evidence of improved effectiveness of a surgical treatment, provided analysis takes careful account of potential sources of bias, especially those related to possible changes in case selection over time. These kinds of data should stimulate a joint effort between clinicians, quality assurance experts and epidemiologists to confirm this attribution, and to locate the causative factors.
DEVELOPMENT OF SMALL DIAMETER INTRAMEDULLARY NAILS MADE FROM ISO 5832–9 STAINLESS STEEL
Authors: Ingman A. M. 
Published: March 2003

Background: In order to improve strength in small diameter intramedullary nails, a system was designed in which the implants were manufactured from 30% coldworked ISO 5832–9 stainless steel. Methods: Nail diameters were 9 and 10 mm for the femur, and 8 and 9 mm for the tibia. The nails were solid rods and the screws were partially threaded. Pre‐clinical bending yield tests established that the 8‐, 9‐ and 10‐mm diameter rods had strengths comparable, respectively, with 10‐, 12‐ and 14‐mm diameter Grosse–Kempf nails. Forty‐eight femoral and 98 tibial shaft acute fractures were treated with this system. Postoperatively, patients were allowed to gently bear weight as tolerated. Results: There was one broken nail, occurring 10 months after femoral nailing. There were six broken screws, occurring between 3 and 6 months postoperatively in two patients and after more than 6 months in four patients. The broken screws had no adverse clinical effect. Five patients required late bone grafting or exchange nailing, and 15 patients required dynamization. Conclusion: This design of small diameter locked intramedullary nails was strong enough to allow early weightbearing.
Neck dissection and ipsilateral radiotherapy in the management of cervical metastatic carcinoma from an unknown primary
Authors: Mcmahon J. , Hruby G. , O’Brien C. J. , Mcneil E. B. , Bagia J. S. , Clifford A. R. , Jackson M. A. 
Published: March 2003

Background: In a small proportion of patients presenting with metastases to cervical lymph nodes the primary cancer remains occult despite thorough evaluation. The present report examines patterns of failure and outcome following an initial treatment strategy directed principally at the clinically involved side of the neck. Methods: From a prospectively compiled computerized database 38 patients were identified with metastatic squamous cell carcinoma from an occult primary site. These patients were evaluated with respect to initial treatment, subsequent detection of a primary tumour, neck recurrence and survival characteristics. Results: Thirty‐seven of 38 patients were treated with curative intent and all had neck dissection. Adjuvant radiotherapy was given to 34 of the 37 (90%; 32 postoperatively and two pre‐operatively). Radiotherapy was directed at the ipsilateral neck alone in 24 patients while 10 received comprehensive treatment to both sides of the neck and potential occult primary sites. The rate of control of disease in the ipsilateral neck was 91% while the failure rate in the contralateral neck was 16% (six patients). A primary cancer was ultimately identified in five patients (13%). Disease‐specific survival was 63% at 4 years. Clinical N3 stage, extracapsular tumour extension and involved surgical margins predicted for poorer survival on univariate analysis. Analysis using multiple risk factors found that only involved surgical margins predicted for treatment failure. Conclusions: Despite generally advanced disease at presentation, patients presenting with cervical metastasis from an unknown primary carcinoma have a reasonable survival expectation and aggressive treatment is warranted, but approximately half will develop recurrent disease. Careful follow‐up is required if effective salvage treatment is to be instituted.
Rectal cancer in the kingdom of saudi arabia: the king faisal specialist hospital experience
Authors: Isbister William H. , Murad Mona , Habib Zakaria 
Published: March 2003

Background: No survival data have yet been published from the Kingdom of Saudi Arabia for patients with rectal cancer. The present paper reports experience with these patients over an 8‐year period. Methods: All patients referred to the King Faisal Specialist Hospital (KFSH) between March 1990 and February 1998 for the primary management of rectal cancer were entered into a computerized database. Prior to 1993 patients did not receive adjuvant therapy. Kaplan–Meier survival curves and the log–rank test were used to compare outcome data. Results: There were 70 men (average age: 55.6 years) and 75 women (average age: 52.8 years). Twelve per cent of patients admitted a family history of colorectal carcinoma (CRC). Twenty‐seven per cent of tumours were circumferential. Most tumours were larger than 4 cm and the lowest edge of the majority of tumours was less than 6 cm from the anal verge. Fifty‐four per cent of tumours were fixed; 69% of patients received either pre‐operative or postoperative radiotherapy. A total of 106 patients underwent ‘curative’ surgery. Equal numbers of patients had abdomino‐perineal resection (APR) and anterior resection (AR) of the rectum. Thirty‐five patients received blood peri‐operatively (APR, 34%; AR, 12%). Major anastomotic leakage following AR occurred in two patients. Two patients died within 30 days of surgery. Ten patients were lost to follow‐up. Following curative AR, eight patients had a distal resection margin of < 2 cm and two patients (Dukes’ C) developed local recurrence (25%); 37 patients had a margin > 2 cm and seven developed local recurrence (18.9%). A total of 48 patients underwent curative APR, and four patients developed local recurrence (8.3%). Overall local recurrence was tumour stage‐dependent (Dukes’ B, 8.8%; Dukes’ C, 29.3%). Recurrence was local in 13 patients. Pre‐operative radiotherapy seemed to reduce average tumour size (3.6 vs 4.3 cm). The crude overall 5‐year survival rate was 39%. The 5‐year survival rate for patients with Dukes’ stage C cancers following ‘curative’ surgery was 25%. Conclusion: Curative surgery can be performed with a relatively low requirement for blood transfusion, a low mortality and morbidity, and comparable outcomes to Western studies in spite of the large, low and often advanced stage of the tumours managed. Local recurrence rates following curative resection and re‐anastomosis for low rectal cancers may be reduced by resisting patient pressure to avoid stomata.