bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatry and the Need for Mental Health Care in Australia: Findings from the National Survey of Mental Health and Wellbeing
Authors: Meadows Graham , Singh Bruce , Burgess Philip , Bobevski Irene 
Published: March 2003

Objective: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists, and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. Method: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. Results: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialities. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. Conclusions: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner, and the inequalities are greater for psychiatric services than for other medical specialities.
RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH–ANAL ANASTOMOSIS IN 203 PATIENTS: THE AUCKLAND EXPERIENCE
Authors: Neilly Paul , Neill Mischel E. , Hill Graham L. 
Published: March 2003

Background: Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become an established operation for patients with ulcerative colitis and familial adenomatous polyposis (FAP). The results of a 15‐year experience with IPAA are reported. Methods: Between September 1982 and June 1997, 203 patients had IPAA surgery. From a review of the charts, data were collected on the surgical procedure, the diagnosis and early and late complications. Pouch function was assessed by means of a postal questionnaire. Results: Of the 201 patients (median age of 32 years; 89 women) with complete records, 122 had J pouches, 65 had W pouches and 14 S pouches were constructed. The pre‐operative diagnosis in 88% was ulcerative colitis and in 10% it was FAP. During a median follow‐up time of 6.1 years the diagnoses were changed for 8% of the patients; in 4% the diagnosis was changed to Crohn’s disease. The overall mortality was 1.5% (early = 2, late = 1) The overall morbidity was 62% (early = 17%, late = 52%). The pouch was removed or was non‐functional in 9%. All patients with a final diagnosis of Crohn’s disease have had their pouch excised. The median stool frequency was 4.0 (range 1.3–8.7) during the day, and 0.7 (range 0–2.1) during the night. The fewer night‐time stools (J = 1.0 ± 0.6; W = 0.4 ± 0.5 P < 0.0001) and the reduced requirement of the W‐pouch patients for anti‐diarrhoeals (P = 0.004) were offset by the need for two W‐pouch patients to pass a catheter to empty their pouches. Conclusions: The type of patients who present for IPAA surgery and the outcomes observed in this series of Auckland patients are similar to those reported from major centres elsewhere.
FIVE MICRO‐CURIE UREA BREATH TEST FOR THE DIAGNOSIS OF HELICOBACTER PYLORI INFECTION: EVALUATION IN A SOUTH‐EAST ASIAN POPULATION
Authors: Yu W. K. , Chow P. K. H. , Y Tan S. , Ng E. H. , Goh A. S. W. , Soo K. C. , Aw S. E. 
Published: March 2003

Background: Helicobacter pylori is an important pathogen responsible for significant morbidity and mortality. Its prevalence varies widely in different geographical locations and is especially high in parts of Asia. Methods: A double‐blind study was carried out to evaluate the use of the 5 μCi (185 KBq) [14C]‐urea breath test ([14C]‐UBT) in a South‐East Asian population by validating its diagnostic accuracy against histology and the CLO test. Results: The sensitivity and specificity of the [14C]‐UBT was 100% when compared against the CLO test. When histology was used as the ‘gold standard’, the sensitivity and specificity were 100% and 97.2%, respectively. There was no overlap or indeterminate values between positive and negative results on the [14C]‐UBT. Conclusions: Among South‐East Asian populations where the prevalence of H. pylori infection is high, the high sensitivity of the 5 μCi [14C]‐UBT makes it a very important test in the detection of H. pylori.
IN VITRO INHIBITION OF TUMOUR GROWTH IN A HELIUM‐RICH ENVIRONMENT: IMPLICATIONS FOR LAPAROSCOPIC SURGERY
Authors: Neuhaus Susan J. , Ellis Tanya S. , Barrett Michael W. , Rofe Allan M. , Watson Glyn G. Jamieson* and David I. 
Published: March 2003

Background: The recent results of several experimental studies have suggested that tumour implantation after laparoscopic surgery for intra‐abdominal malignancy may be partly related to the chemical composition of the insufflation gas used during surgery. These studies have demonstrated that the use of helium as a laparoscopic insufflation agent for cancer surgery results in less tumour implantation and growth at port sites. To further investigate these findings, the present study was performed to compare the growth of cultured tumour cells after exposure to simulated laparoscopic environments, rich in helium, carbon dioxide (CO2), or air. Methods: A rat mammary adenocarcinoma cell suspension was exposed to a simulated laparoscopic environment for 40 min in one of the following groups: (i) control (atmospheric air, equivalent to a ‘gasless’ laparoscopic environment); (ii) a CO2‐rich environment; and (iii) a helium‐rich environment. Cells were then cultured for 18 h and optical density readings were used to assess the number of viable tumour cells at the end of this period. The experiment was performed twice using an identical protocol to ensure consistency in the results. In a further study, pH was continuously measured using an antimony probe during a 40 min insufflation period and for 10 min after insufflation. Results: Cell growth was significantly lower after incubation in the helium‐rich environment compared to both the CO2 and control groups (P < 0.001). There was a significant decrease in pH in the CO2 group which was not observed during exposure to either air or helium. Conclusions: The inhibition of tumour growth in a helium‐rich environment demonstrated by this study, and the reduced incidence of port–site metastases seen in other experimental studies, suggests that the clinical use of helium as an insufflation gas may have important advantages over CO2.
AN EVALUATION OF TRAUMA TEAM LEADER PERFORMANCE BY VIDEO RECORDING
Authors: Ritchie Peter D. , Cameron Peter A. 
Published: March 2003

Background: Team leader performance in trauma resuscitations was assessed using a published system to assess the utility of video recording and to assess the current early management of trauma at The Royal Melbourne Hospital, Melbourne, Australia. Methods: Fifty trauma resuscitations were videotaped over a 21‐month period. Each videotape was assessed by an emergency physician. Results: The team leader was an emergency physician in 37 resuscitations, an emergency medicine registrar in eight and a surgical registrar in five. The mean team leader score was 68.5 ± 8.5 (range 45–78, maximum possible 80). The average time to primary survey completion was 3.3 ± 1.7 min, second phase of resuscitation up to and including chest radiography 14.1 ± 8.5 min, to completion of secondary survey and announcement of overall plan 30 ± 20 min. Frequent deficiencies are documented. Problems with videotaping included forgetting/lack of motivation to start taping, forgetting to turn on the sound, difficulty discerning size of cannulae and logistical problems with only one cubicle outfitted for videotaping. Advantages included lack of intrusion into the resuscitation, increased vigilance by team members aware of the possibility of taping, ability to assess tapes at leisure and team leader performance in after‐hours resuscitations. Conclusions: Video recording is a useful method for the assessment of team member performance in trauma resuscitations. Deficiencies in resuscitation technique can be identified and fed back to those involved. Medico‐legal issues have not proved to be a barrier to the use of the technique. A reliable method of starting taping is needed.
ABDOMINAL SURGERY IN THE OLDER CROHN’S POPULATION
Authors: Norris Benjamin , Solomon Michael J. , Eyers Anthony A. , West Richard H. , Glenn David C. , Morgan Brian P. 
Published: March 2003

Background: The surgical literature perceives that the elderly cohort of Crohn’s patients may have increased risk with surgery. Methods: A retrospective review and prospective database analysis of all patients with histologically proven Crohn’s disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk. Results: A total of 156 patients had 298 laparotomies for histopathologically proven Crohn’s disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut‐off age between younger and older cohorts was 55 years. Thirty‐three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs younger, 25 months), previous number of Crohn’s operations (42.4 vs 39.8%), or duration of known Crohn’s disease. Isolated large bowel disease was more common in the elderly cohort (42.4 vs 18.7%, χ2 = 8.09, P < 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4 vs 51.6%, χ2 = 5.19, P < 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2 vs 0.8%, P < 0.001) and respiratory complications (18.2 vs 2.4%, P = 0.0003) and a longer mean but not median postoperative hospital admission. Conclusions: In conclusion, clinical features and presentation are similar in the older and younger Crohn’s patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.
PYOGENIC LIVER ABSCESS: A REVIEW OF 10 YEARS’ EXPERIENCE IN MANAGEMENT
Authors: Barakate M. S. , Stephen M. S. , Waugh R. C. , Gallagher P. J. , Solomon M. J. , Storey D. W. , Sheldon D. M. 
Published: March 2003

Background: Over the past 15 years, diagnostic and interventional radiology techniques have allowed accurate localization of liver abscesses and image‐guided percutaneous drainage. This review examines whether these technical advances improve clinical results and discusses the selection of treatment for patients with liver abscesses. Methods: Ninety‐eight patients were treated for pyogenic liver abscess (PLA) at the Royal Prince Alfred Hospital, Sydney, between January 1987 and June 1997. The hospital records were examined and clinical presentation, laboratory, radiological and microbiological findings were recorded. Associations between these findings and failure of initial non‐operative management were determined using odds ratios with 95% confidence intervals. Independent predictors were then determined by logistic regression. This analysis was repeated to determine factors associated with mortality. Results: Cholelithiasis and previous hepatobiliary surgery were the most frequently identifiable causes of PLA, each responsible in 15 patients. All 98 patients were treated with intravenous antibiotics and in 13 patients this was the only therapy. Of the remaining 85 patients, six proceeded straight to laparotomy and 79 had percutaneous drainage, of whom 15 required subsequent laparotomy. Factors predicting failure of initial non‐operative management were unresolving jaundice, renal impairment secondary to clinical deterioration, multiloculation of the abscess, rupture on presentation and biliary communication. The overall hospital mortality rate was 8%. Conclusion: Pyogenic liver abscess remains a disease with significant mortality. Image‐guided percutaneous drainage is appropriate treatment for single unilocular PLA. Surgical drainage is more likely to be required in patients who have abscess rupture, incomplete percutaneous drainage or who have uncorrected primary pathology.
EVOLUTION OF THE PELVIC POUCH PROCEDURE AT ONE INSTITUTION: THE FIRST 100 CASES
Authors: Young Christopher J. , Solomon Michael J. , Eyers Anthony A. , West Richard H. , Martin Hugh C. , Glenn David C. , Morgan Brian P. , Roberts Rachael 
Published: March 2003

Background: Total extirpation of the colon with pelvic pouch formation, and the avoidance of a permanent stoma, continues to pose a challenge for better results, both technically and functionally. The aims of this study were to investigate the first 100 pelvic ileal‐pouch procedures, assessing changes in surgical technique, their relationship to morbidity and long‐term outcome, and compare this to the few large international series. Methods: Between 1984 and 1997, 100 patients had a pelvic J‐shaped ileal‐pouch formed, 58 two‐stage and 42 three‐stage procedures. Fifty had a hand‐sewn pouch‐anal anastomosis and 50 a double‐stapled anastomosis. Seventy‐three were for ulcerative colitis, five for indeterminate colitis, 20 for familial adenomatous polyposis (FAP), one for multiple primary colorectal cancers, and one for constipation. Results: After a median follow‐up of 68 months, 97% of patients still have a functioning pouch. There were two postoperative deaths (one after‐pouch formation and one after‐stoma closure). Morbidity occurred in 52 patients, including three patients with pouch leaks and three pouch‐anal anastomosis leaks (6% leak rate), 27% with a small bowel obstruction (2% early, 20% late, 5% both), a 19% anal stricture rate, and a 9% pouchitis rate. Three pouches have been removed (all for Crohn’s disease). Median number of bowel movements per day was six, with 85% of patients reporting a good quality of life. Patients following a double‐stapled procedure have less anal seepage and improved continence over those with a hand‐sewn ileal pouch‐anal anastomosis. Conclusions: Despite high morbidity rates, pelvic pouch formation provides satisfactory long‐term results for patients requiring total proctocolectomy, with functional results and morbidity rates comparable to larger overseas series.
PERCUTANEOUS TRANSCHOLECYSTIC CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Richardson Nigel G. B. , Mcintosh Neil A. , Sarre Richard G. 
Published: March 2003

Background: Controversy still exists regarding the role of routine cholangiography in laparoscopic cholecystectomy. Although the need to identify common bile duct stones is perhaps less critical than it was in the past, confirmation of anatomy by peroperative cholangiography is important for both clinical and medico‐legal purposes. Conventionally, contrast has been introduced into the biliary tree via the cystic duct after dissection of Calot’s triangle. Methods: A simple technique of cholangiography by direct gall‐bladder puncture is described, which can be done quickly and easily at the beginning of the operation. Results: The retrospective analysis of 250 consecutive cases shows the technique to be safe, accurate and to provide useful cholangiograms in 85% of cases. Conclusions: Percutaneous transcholecystic cholangiography can be performed readily without special equipment. It provides valuable anatomical information in 85% of cases before commencing dissection of the cystic duct.
UNILATERAL VOCAL FOLD PARALYSIS: CAUSES, OPTIONS AND OUTCOMES
Authors: Havas Thomas , Lowinger David , Priestley Jocelyn 
Published: March 2003

Background: This study presents the current aetiology of and management options for vocal fold paralysis. Methods: One hundred and eight patients with unilateral vocal fold paralysis, managed by The Sydney Voice Clinic from 1989 to 1996, are reviewed. Aetiology of the palsy was classified as iatrogenic (45 of 108), idiopathic (36 of 108) and other defined causes (27 of 108). Nineteen patients were observed with the rest being managed with speech therapy alone (38 of 108), surgery (24 of 108) or surgery with adjuvant speech therapy (27 of 108). Surgical techniques included vocal fold augmentation (n = 43), thyroplasty (n = 20) and laryngeal re‐innervation (n = 12). Results: Overall 78 of 108 patients had restoration of near normal to normal voice with an additional 14 attaining a very good voice or better (voice outcome < 2). Conclusions: Early intervention for symptomatic patients was found to be rewarding and safe. Vocal fold augmentation with autologous fat was particularly successful in achieving sustained improvement of voice.
RING AVULSION INJURIES
Authors: Mcdonald A. H. N. , Cleland H. J. , Leung M. , Slattery P. G. 
Published: March 2003

Background: Ring avulsion injuries can vary in severity from mere breach of the skin through to complete amputation or degloving. Management of the more severe injuries remains controversial in deciding whether to salvage or amputate. Method: Six cases managed between 1991 and 1997 are presented. Results: Results were comparable to the larger series published. Conclusion: Referral to a microsurgical unit and attempted repair where possible are recommended.
CYSTOSARCOMA PHYLLODES: THE WESTERN AUSTRALIAN EXPERIENCE
Authors: Holthouse DAVID J. , Smith PETER A. , Naunton‐Morgan Richard , Minchin David 
Published: March 2003

Background: Cystosarcoma phyllodes is a rare breast tumour whose behaviour is not well understood by many clinicians. Methods: In 1998 a retrospective study was undertaken of women diagnosed with phyllodes tumour of the breast who had their initial surgery between 1983 and 1994 in Western Australian public hospitals. Results: Forty women were diagnosed and treated over this period; however, only 28 received ongoing follow‐up (70%). Follow‐up was obtained on 26 of these. The median age at diagnosis in this group was 46 years. Cases were predominantly Caucasian (85.5%). Postmenopausal women were affected in 26.9% of cases. Four patients had recurrences after surgery (one malignant and three benign). No patient had a recurrence with primary tumours with a diameter of ≤ 2 cm. Mean time to recurrence was 35.8 months. Conclusions: Breast‐conserving surgery was used in almost all cases (96.2% of first operations).
COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF EQUIVOCAL APPENDICITIS
Authors: Cho CAROLYN S. , Buckingham JOHN M. , Pierce Mark , Hardman DAVID T. 
Published: March 2003

Background: The clinically obscure right iliac fossa (RIF) pain remains a diagnostic problem. The present study examines the use of computed tomography (CT) in improving the accuracy of clinical assessment in these difficult surgical cases. Methods: The trial design was a retrospective review of all patients admitted under one surgeon with suspected acute appendicitis, between 1 January 1995 and 30 June 1997. The study setting was a district hospital (Calvary Hospital) that received patients from both an urban and rural environment. The patient cohort was identified from the Unit Registry and an International Classification of Diseases‐based review of medical records. Twenty‐one prospective data points were obtained from patient records. Those patients admitted with RIF pain and equivocal symptoms and signs subsequently underwent a CT and/or ultrasound (US) examination, conducted by the attending radiologist. For those patients who proceeded to appendicectomy, the histopathological findings were correlated with the imaging report. Those patients who were discharged after imaging without proceeding to operation were not readmitted to any regional hospital during the course of the study. Results: A total of 84 patients were identified. Thirty‐three patients (39%) underwent appendicectomy without imaging and were excluded from further analysis. A total of 51 patients (61%) underwent 61 imaging procedures. The CT scan was correct in 35/36 patients (97%), while US was correct in 17/25 patients (68%). Conclusions: The present study suggests that CT can be used to improve the accuracy of diagnosis of obscure RIF pain. As a pilot study, it supports the development of a randomized controlled trial in a multicentre regional study.
ADDITION OF PHYSICIANS TO PARAMEDIC HELICOPTER SERVICES DECREASES BLUNT TRAUMA MORTALITY
Authors: Garner Alan , Rashford Stephen , Lee Anna , Bartolacci Robert 
Published: March 2003

Background: The authors hypothesized that the addition of critical care physicians to the flight crew of paramedic helicopter services would decrease mortality in blunt trauma, and that this would be due to the greater procedural capability and clinical judgement of the physician. Methods: Retrospective comparison was undertaken of patients flown directly from the accident scene over a 28‐month period by the paramedic‐staffed Westpac Hunter region helicopter to John Hunter Hospital, and the physician‐staffed NRMA CareFlight helicopter to Westmead or Nepean Hospitals. Inclusion criteria were blunt trauma and an Injury Severity Score of ≥ 10. Mortality was compared by trauma score–injury severity score (TRISS) methodology. Results: There were 140 patients in the paramedic treatment group and 67 in the physician group. There were no significant differences between the groups in age, mechanism of injury, distance transported, response, scene or transport times. Physicians intubated a greater proportion of patients (51 vs 10%; P < 0.001) including all patients with a Glasgow Coma Score of < 9. Physicians gave significantly greater volumes of fluids to hypotensive patients (median: 5035 vs 1475 mL; P < 0.001) and performed thoracic decompressions on a larger proportion of patients (12 vs 1%; P < 0.01). The Z statistic for the physician treatment group was 2.72 (P < 0.01) compared with –1.16 (P = 0.25) in the paramedic group. The adjusted W statistic was 13.44 (95% CI: 7.80–19.08) suggesting that there would be between eight and 19 extra survivors per 100 patients treated in the physician group compared with the paramedic group. Conclusions: Physicians perform a greater number of procedures at accident scenes without increasing scene time. This results in significantly lower mortality. Critical care physicians should be added to paramedic helicopter services for scene response to blunt trauma.