Regional Specialist Research Articles

Overcoming the distance barrier in relation to treatment for haematology patients: Queensland findings.

The aim of the present study was to document the financial and psychosocial impact of relocation for specialist haematology treatment in Queensland. This study was a qualitative exploratory study comprising 45 in-depth interviews with haematology patients supported by the Leukaemia Foundation of Queensland. The findings indicate that decentralisation of treatment is assisting haematology patients to overcome the profound difficulties associated with travelling to the metropolitan area for treatment. Fostering specialist outreach and building capacity in regional cancer centres are service delivery strategies that are greatly appreciated by regional, rural and remote haematology patients who are stressed by the many challenges associated with leaving home to travel distances for specialist treatment. It is the hope and expectation that these findings will make a contribution to informing future health policy and service delivery planning.

Measuring the Pain of Mucositis using Oucher and DEGR

Aim: To measure pain in mucositis using two pain scales of contrasting design (DEGR and Oucher), and to compare the two scores. Patients and methods: Children receiving treatment for pain related to cancer therapy on a regional specialist oncology ward were eligible for the study. Children’s pain was scored in parallel using DEGR administered by the ward nurses and Oucher administered by a research nurse. Results: Thirty families participated in the study. Pain score data were incomplete for nine. 143 DEGR scores and 92 Oucher scores were obtained. Scores from either scale were discarded if too remote (i.e. >4 hours apart) from their paired score from the other. Forty-six complete sets of paired data were obtained from 21 subjects. Mucositis pain persisted for several days. Oucher scores were significantly and inversely influenced by time while DEGR scores were not, such that scores diverged after three days. Conclusions: Pain persisted despite intensive treatment. Behaviour patterns associated with persistent pain seemed to become apparent during acute episodes of mucositis. Our data suggest DEGR was more sensitive to persistent pain than the Oucher but patient numbers were small.

Patient with ST-elevation myocardial infarction, coronary artery embolism and no signs of coronary atherosclerosis in angiography

1Faculty of Medical Sciences, University of Varmia and Masuria, Olsztyn, Poland 2Cardiac Catheterization Laboratory, Regional Specialist Hospital, Olsztyn, Poland 3Invasive Cardiology Department, Central Clinical Hospital of the Internal Affairs and Administration Ministry, Warsaw, Poland 4Institute of Experimental and Clinical Medicine, Polish Academy of Sciences, Warsaw, Poland 5Department of Cardiology, Regional Specialist Hospital, Olsztyn, Poland 6Department of Radiology and Medical Imaging, Regional Specialist Hospital, Olsztyn, Poland

Quality of life of patients with irritable bowel syndrome before and after education.

The aim of the present study was to analyse the impact of education of patients with irritable bowel syndrome (IBS) on their quality of life. The study was carried out at the Gastroenterology Outpatient Clinic of the Independent Public Clinical Hospital No. 4 in Lublin and Gastroenterology Outpatient Clinic of the Cardinal Stefan Wyszyński Regional Specialist Hospital in Lublin in the years 2010-2011. The quality of life was analysed using the Quality of Life Questionnaire (QOL-Q R. Schalock, K. Keith). The group of 83 patients with the diagnosis of irritable bowel syndrome, who gave their consent for inclusion in the study, was provided with information about the essence of the disease, disease-related diet and lifestyle, course of the disease, medications, and check-ups. Our patients educated by the physician, nurse and those provided with written information had substantially higher scores in multi-dimensional aspects of the quality of life after education. Six months after education patients with IBS showed a significantly higher quality of life in all aspects, i.e. Satisfaction, Competence/productivity, Empowerment/independence and Social inclusion/community integration. The understanding of the essence of their disease contributed to a decrease in anxiety associated with the neoplastic disease and worrying symptoms, which significantly reduced the incidence of complaints. 1. Quality of life of patients with irritable bowel syndrome is substantially reduced in all the examined spheres. 2. Education of patients with IBS resulted in enhanced quality of life and reduced disease-related complaints. 3. Education of patients with IBS plays a significant role in the entire therapeutic process.

Overcoming challenges of implementation of FBT at the Regional Eating Disorders Service (REDS) in Auckland, New Zealand

In 2010 the New Zealand Ministry of Health made a decision to roll out training in FBT across New Zealand for clinicians working with eating disorders. The expectation was that the three regional specialist services in New Zealand would subsequently provide a lead to ensure implementation of FBT across their Region. This presentation will describe the process of change to achieve uptake of FBT as a new treatment model by the existing adolescent team of the Regional Eating Disorder Service in Auckland (REDS). The steps taken to overcome the significant initial challenges and the strategies and the resources required to achieve a sustainable model of provision of FBT at REDS will be discussed as well as its implications for regional training and supervision of CAMHS clinicians across the Northern and Midland Regions of New Zealand. The positive impact of these changes on outcome data is described in more detail in the presentation What difference does FBT make? Results of a service audit following the implementation of FBT. This abstract was presented in the Service Initiatives: Child and Adolescent Refeeding and FBT stream of the 2014 ANZAED Conference.

Whither Southeast Asia in the Anthropocene?

For the authors of these papers, as is true for many of us, there is a special urgency associated with the acceleration of environmental degradation and its negative impact on individual human lives to which we bear witness in Asia and elsewhere. While truly “natural” disasters like earthquakes and tsunamis are strikingly devastating, it is the destruction of environments from anthropogenic sources that are often the most frustrating. That is, we believe that because human beings caused the problems, we should be able to fix them, and, indeed, as humanists it is axiomatic that we are committed to improving the human condition. Over the past few decades, however, there has been a growing awareness that human interaction with the natural environment may be creating a world, for the most part, unfit for human habitation. It is out of this awareness that the term “Anthropocene” has emerged, describing that epoch during which human activity has reached such a level of intensity that it has had a discernable impact on the earth itself. Thus, as these writers suggest, it is imperative for us as regional specialists to engage in conversations across disciplines and geographic areas that provide opportunities to increase our understanding of the Anthropocene in Asia in all of its local and global dimensions.

European Studies

The study of Western countries and teaching courses on the related subjects have longstanding and established tradition at MGIMO-University. The basis of this brilliant research and teaching tradition was laid down by such academicians as E.V. Tarle and V.G. Trukhanovsky, Professor L.I. Clove, Y. Borisov, F.I. Notovitch, G.L. Rozanov. Their work in 1940-1960's at the Department of World History at MGIMO-University progressed in following directions: France studies, German studies, American studies. The work resulted in a number of monographs and textbooks on modern history and foreign policy of the studied countries and regions. The aim of the publications was dictated by the goal of the Institute - to prepare the specialists in international affairs primarily for practical work. A close relationship with the Foreign Ministry was "binding advantage" sometimes limiting researchers in choosing periods and subjects for the study. At the same time the undisputed advantage and quality of regional studies at MGIMO were strengthened by the practical relevance of research, making it a vital and interesting not only for specialists but also for students and researchers from other research centers. Another characteristic of the tradition is the analysis of foreign policy and diplomacy in a close relationship with the socio-economic and political processes. Such an integrated approach to regional geography also formed largely under the influence of institutional profile designed to train highly skilled and versatile specialists in specific countries and regions with a good knowledge of their languages, history, economics, politics, law and culture. Therefore, scientific and educational-methodical work at MGIMO-University has always relied on a wealth of empirical data and has been focused on the analysis of real-world phenomena and processes, acute problems of foreign countries. Scientific research at MGIMO-University traditionally intertwined with pedagogical objectives.

Epidemiology, clinical history and microbiology of peritonsillar abscess.

The purpose of this investigation was to explore the epidemiology, clinical history and microbiology of peritonsillar abscess (PTA). A retrospective review of PTA cases treated at the Department of Otolaryngology, Regional Specialist Hospital in Radom, Poland between 1st October 2003 and 30th September 2013 was undertaken. A total of 111 PTA patients were admitted. The study population consisted of 57.7 % males and 42.3 % females, with an average age of 31.0 (range 5–78) years. Smokers comprised 22.0 % of the study group. The seasonal variation of PTA was statistically insignificant (p = 0.45). Recurrent tonsillitis occurred in 35.5 % of patients. In comparison with the rest of the study population, patients with a history of recurrent pharyngotonsillitis had higher incidence of previous PTA episodes [odds ratio (OR) 17.8, 95 % confidence interval (CI) 2.1–148.7, p = 0.001]. Also, they were more frequently treated with antibiotics prior to hospitalisation (OR 4.6, 95 % CI 2.0–10.9, p = 0.0005) and had significantly longer hospital stay (p = 0.03). Bacterial cultures of abscess aspirates were performed in 40.5 % of patients. Monomicrobial growth was detected in 77.8 % of aerobic cultures. Streptococcus pyogenes, growing most frequently in monoculture, was found in 28.9 % of aerobic cultures. PTA patients with and without recurrent pharyngotonsillitis differed with regard to clinical history and course of disease. The percentage of smokers among PTA patients was lower than that described in the literature. Monomicrobial growth predominated in PTA aspirate cultures. S. pyogenes proved to be the most frequent pathogen.

Shorter intervals at peak SV vs.V̇O2max may yield high SV with less physiological stress

The purpose of this study was to evaluate whether greater and sustainable stroke volume (SV) responses may be obtained by exercise intensities corresponding to peak SV (SVpeak) vs. maximal O2 consumption (), and short vs. long intervals (SI vs. LI). Nine moderate- to well-trained male athletes competing at regional level specialists of cyclist, track and field volunteered to take part in the study (: 59.7 ± 7.4 mL·min−1·kg−1). Following familiarisation sessions, was determined, and then SVpeak was evaluated using exercise intensities at 40%–100% of by nitrous-oxide rebreathing (N2ORB) method. Then each separate participant exercised wattages corresponding to individual and SVpeak during both SI (SI and SISVpeak) and LI (LI and LISVpeak) workouts on a cycle ergometer. Main results showed that both SI and SISVpeak yielded greater SV responses than LI and LISVpeak (p ≤ 0.05). Mean SV responses were greater in LISVpeak than in LI (p ≤ 0.05), but there was no statistical difference between SISVpeak and SI. However, there was significantly less physiological stress based on VO2, respiratory exchange ratio, heart rate and rate of perceived exhaustion in SVpeak than in intensities (p ≤ 0.05). Moreover, SV responses at exercise phases increased in the early stages and remain stable until the end of SI and SISVpeak workouts (p > 0.05), while they were gradually decreasing in LI and LISVpeak sessions (p ≤ 0.05). In conclusion, if the aim of a training session is to improve SVpeak with less physiological stress, SISVpeak seems a better alternative than other modalities tested in the present study.

Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution.

BackgroundOutreach has been endorsed as an important global strategy to promote universal access to health care but it depends on health workers who are willing to travel. In Australia, rural outreach is commonly provided by specialist doctors who periodically visit the same community over time. However information about the level of participation and the distribution of these services nationally is limited. This paper outlines the proportion of Australian specialist doctors who participate in rural outreach, describes their characteristics and assesses how these characteristics influence remote outreach provision.MethodsWe used data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, collected between June and November 2008. Weighted logistic regression analyses examined the effect of covariates: sex, age, specialist residential location, rural background, practice arrangements and specialist group on rural outreach. A separate logistic regression analysis studied the effect of covariates on remote outreach compared with other rural outreach.ResultsOf 4,596 specialist doctors, 19% (n = 909) provided outreach; of which, 16% (n = 149) provided remote outreach. Most (75%) outreach providers were metropolitan specialists. In multivariate analysis, outreach was associated with being male (OR 1.38, 1.12 to 1.69), having a rural residence (both inner regional: OR 2.07, 1.68 to 2.54; and outer regional/remote: OR 3.40, 2.38 to 4.87) and working in private consulting rooms (OR 1.24, 1.01 to 1.53). Remote outreach was associated with increasing 5-year age (OR1.17, 1.05 to 1.31) and residing in an outer regional/remote location (OR 10.84, 5.82 to 20.19). Specialists based in inner regional areas were less likely than metropolitan-based specialists to provide remote outreach (OR 0.35, 0.17 to 0.70).ConclusionThere is a healthy level of interest in rural outreach work, but remote outreach is less common. Whilst most providers are metropolitan-based, rural doctors are more likely to provide outreach services. Remote distribution is influenced differently: inner regional specialists are less likely to provide remote services compared with metropolitan specialists. To benefit from outreach services and ensure adequate remote distribution, we need to promote coordinated delivery of services arising from metropolitan and rural locations according to rural and remote health need.

No. 58 Inappropriately Delayed Discharges From a Regional Specialist Inpatient Neurological Rehabilitation Unit: Prospective Study

No. 58 Inappropriately Delayed Discharges From a Regional Specialist Inpatient Neurological Rehabilitation Unit: Prospective Study

Generalist birds govern the seed dispersal of a parasitic plant with strong recruitment constraints.

Mistletoes constitute instructive study cases with which to address the role of generalist consumers in the study of plant-animal interactions. Their ranges of safe sites for recruitment are among the most restricted of any plant; therefore, frugivores specializing in mistletoe have been considered almost indispensable for the seed dispersal of these parasitic plants. However, the absence of such specialists in numerous regions inhabited by many mistletoe species raises the question of whether unspecialized vectors may successfully disperse mistletoe seeds to narrowly defined safe sites. Using the European mistletoe Viscum album subsp. austriacum as a study case, we recorded a broad range of 11 bird species that disperse mistletoe seeds. For these species, we studied the mistletoe-visitation rate and feeding behavior to estimate the quantity component of dispersal effectiveness, and the post-foraging microhabitat use, seed handling, and recruitment probabilities of different microhabitats as a measure of the quality component of effectiveness. Both endozoochory and ectozoochory are valid dispersal mechanisms, as the seeds do not need to be ingested to germinate, increasing seed-dispersal versatility. Thrushes were the most effective dispersers, although they were rather inefficient, whereas small birds (both frugivores and non-frugivores) offered low-quantity but high-quality services for depositing seeds directly upon safe sites. As birds behave similarly on parasitized and non-parasitized hosts, and vectors have broad home ranges, reinfection within patches and the colonization of new patches are ensured by an ample assemblage of generalist birds. Thus, a parasitic plant requiring precision in seed dispersal can rely on unspecialized dispersers.

Audit of Clinical Outcomes following Definitive Chemoradiotherapy for Oesophageal Cancer following the Introduction of a Regional Specialist Multidisciplinary Team Meeting.

Audit of Clinical Outcomes following Definitive Chemoradiotherapy for Oesophageal Cancer following the Introduction of a Regional Specialist Multidisciplinary Team Meeting.

Pre-operative departmental ultrasound of the rotator cuff: sensitivity and specificity in a regional specialist orthopaedic centre.

The present study aimed to assess the accuracy of radiology department ultrasound scans in identifying rotator cuff tears at our institution, a regional specialist orthopaedic centre. Pre-operative ultrasound scan reports were obtained from 64 consecutive patients who subsequently underwent arthroscopic subacromial decompression and/or rotator cuff repair. The ultrasound reports were compared with the arthroscopic findings as a reference standard. If both full- and partial-thickness tears are counted as true positives, ultrasound has a sensitivity of 70%, a specificity of 67% and a positive predictive value of 81%. If only partial tears are counted as true positives, sensitivity decreases to 8% and positive predictive value to 10%. The mean time lag from scan to surgery was 44 weeks. A positive pre-operative ultrasound scan at our institution predicts an actual rotator cuff tear in 70% of cases. However, it is not accurate with respect to identifying partial-thickness tears or distinguishing them from full-thickness defects. Ultrasound scanning is highly operator dependent and, in addition, its accuracy may be affected by the lengthy time period from scanning to surgery. Clinicians should be cautious in proceeding to surgery based on the ultrasound findings.

Cardboard characters, vague concerns and an old debate: Some Reflections about the Meaning of Regional Specialisation and Area Studies in Geography

German geography currently appears to be dominated by a continuing critique of essentialist concepts of regions and an equalisation of Areas Studies with a rather naive study of world regions. This is astonishing since the idea that regions do not simply exist by themselves has long been widely acknowledged. However, this does not imply that regions do not matter anymore. Any research topic is embedded in a certain regional context the knowledge of which is crucial in order to gain a more thorough understanding of the subject. In this article, we therefore want to show that the persistent dissociation of “predefined world regions” which has become a veritable credo targets at a cardboard character. We argue that the common accusation of “regional specialists” to essentialise regions, is rather contributing to an obscure othering of Area Studies than to an active understanding of the construction of spaces. Thus, against the background of our experiences as geographers in the field of African Studies, we call for a reengagement with the central idea of regional specialisation in geography to be further enriched by recent geographical discussions on different conceptualisations of space, instead leaving the on-going revitalisation of Area Studies to other disciplines.

What are the socio-economic impacts of genetically modified crops worldwide? A systematic map protocol

Genetically modified (GM) crops have generated a great deal of controversy. Since commercially introduced to farmers in 1996, the global area cultivated with GM crops has increased 94-fold. The rapid adoption of GM technology has had substantial socio-economic impacts which a vast amount of technical and non-technical literature has addressed in the last two decades. However, contradictory results between individual studies abound. Extensive and transparent reviews concerning this contentious and complex issue could help promote evidence-based dialogue among the diverse parties involved. This protocol specifies the methodology for identifying, evaluating, and mapping evidence related to the main review question: what are the socio-economic impacts of genetically modified crops worldwide? This question has been subdivided into the following topics: (a) farm-level impacts; (b) impacts of coexistence regulations; (c) impacts along the supply chain; (d) consumer-level impacts; (e) impacts on food security; and (f) environmental economic impacts. The search strategy includes the identification of primary studies from general scientific databases; global, regional, and national specialist databases; an on-line search engine; institutional websites; journal websites; subject experts/researchers; and serendipity. Searches will be conducted in six languages (Chinese, English, French, German, Portuguese, and Spanish). Identified studies will be screened for inclusion/exclusion criteria by a group of multi-language reviewers. Finally, pre-defined data from the studies will be extracted, mapped, and presented in a report. Potential research gaps will be identified and discussed, and the review process will be documented in an open-access database (i.e. CADIMA, http://www.cadima.info/ ).

Editorial

Over the course of our careers we will see many thousands of patients, but there are one or two who we remember vividly; it is often these patients who shape and change our practice most. The problem-based review written by Kevin Jones’ team in Bolton in this edition reminded me of one of the first patients I clerked as a medical Senior House Off icer, while working in a District General Hospital back in the early 1990s. I was revising for the written part of the MRCP Part 2 examination at the time, so when the general practitioner described the young man’s fatigue, low grade fever and rash as ‘probable viraema’, my thoughts immediately turned to far more esoteric diagnoses. For once my suspicions were confirmed. The ‘fatigue’ was clearly proximal myopathy with marked tenderness suggesting a myositis; his rash had the typical ‘heliotrope’ distribution accompanied by nail-fold oedema; the diagnosis of dermatomyositis was sealed long before the consultant ward round when the laboratory phoned through his Creatinine Kinase result of over 15,000. I remember the feeling of elation at having made the diagnosis, the metaphorical pat on the back from my consultant and the look of relief in the eyes of the patient and his mother when I told them that we had the answer. I had no doubt in my mind that the hydrocortisone I had prescribed would rapidly improve his symptoms allowing him to resume his usual activity within a few weeks – I had read all about it in Kumar and Clark or some other erudite medical text book. For a few hours medicine was wonderful – until my cardiac arrest bleep went off. CPR was already in progress when I arrived on the ward; I had attended resuscitation calls before, but never for an 18 year old. A nurse reported that he had complained of dyspnoea and became drowsy shortly before he stopped breathing. There was a cardiac output, but no respiratory effort – he was intubated, ventilated, transferred to intensive care and then to a regional specialist unit, but sadly never regained consciousness before he died 2 weeks later. This was a tragic story which affected many people, but which taught me a really important lesson: making a diagnosis is where our job starts – not where it ends. We will never know whether we could have made any difference to this poor young man by anticipating a different outcome, closer monitoring of his respiratory function or earlier involvement of our critical care team. The speed of his deterioration was such that even today’s focus on early warning scoring and prompt recognition of changes in physiology, which has developed over the past 2 decades, would probably not have changed his outcome. However the key is to expect the unexpected; there are formes frustes of many conditions which behave differently to those which appear in the text books. Making a diagnosis should never be a cause for celebration.

ISCB: past–present perspective for the International Society for Computational Biology

Since its establishment in 1997, International Society for Computational Biology (ISCB) has contributed importantly toward advancing the understanding of living systems through computation. The ISCB represents nearly 3000 members working in >70 countries. It has doubled the number of members since 2007. At the same time, the number of meetings organized by the ISCB has increased from two in 2007 to eight in 2013, and the society has cemented many lasting alliances with regional societies and specialist groups. ISCB is ready to grow into a challenging and promising future. The progress over the past 7 years has resulted from the vision, and possibly more importantly, the passion and hard working dedication of many individuals.

지역방송의 뉴미디어 유통전략 분석 :MBCNET 사례를 중심으로

방송시장의 급격한 환경변화는 지역방송의 사회적 입지를 위축시키고 재정적 기반을 위협하고 있지만, 동시에 인터넷과 모바일 기반의 플랫폼과 스마트 미디어는 새로운 콘텐츠 유통의 활로로서 가능성을 부여하고 있다. 본 연구는 지역 지상파방송의 수퍼스테이션 사례 및 전문가 인터뷰를 통해 변화하는 방송환경에 적합한 지역방송의 유통모델을 살펴보고, 새로운 유통모델 확립을 위해 지역방송의 역할과 추진해야 할 전략을 논의하였다. MBCNET의 재무성과 및 시청률, 뉴미디어 유통에 대한 분석결과, MBCNET은 콘텐츠 라이브러리와 MBC 지역방송사의 영향력에 힘입어 성공적인 성과를 내고 있는 것으로 나타났다. 그러나 지속적인 경쟁력 강화를 위해 콘텐츠와 플랫폼의 마케팅역량의 향상이 필요하며, 시청자들의 이용행태에 기반한 경쟁력 있는 콘텐츠의 제작역량 강화 및 N스크린 환경에 대응할 수 있는 조직의 정비가 필요한 것으로 분석되었다. The current media and content situation is increasingly more competitive and under the radical environment changes, the social & financial position of regional broadcasting companies has been threatened. The internet & mobile based platforms and smart media, however, bring a new opportunity of content distribution. This study analyzes the current status of MBCNET which is the superstation of regional MBC stations and specialists interviews to develop the content distribution strategies of regional broadcasting companies. According to the following: finance, ratings, and new media distribution analysis, the MBCNET outcome is deemed successful based on the content library and regional power. MBCNET utilized opportunity to develop strong content resources and distribution power. In order to maintain its competitive edge, MBCNET needs to adopt the following strategies: content and platform marketing power, research & development of competitive content based on user behavior analysis, and reorganization that is able to counteract N-screen circumstances.

ISCB: past–present perspective for the International Society for Computational Biology

Since its establishment in 1997, International Society for Computational Biology (ISCB) has contributed importantly toward advancing the understanding of living systems through computation. The ISCB represents nearly 3000 members working in >70 countries. It has doubled the number of members since 2007. At the same time, the number of meetings organized by the ISCB has increased from two in 2007 to eight in 2013, and the society has cemented many lasting alliances with regional societies and specialist groups. ISCB is ready to grow into a challenging and promising future. The progress over the past 7 years has resulted from the vision, and possibly more importantly, the passion and hard working dedication of many individuals.