Victoria Medical Research Articles

Understanding influences on psychiatry specialty selection in Victoria's Medical workforce.

Australia faces a psychiatrist shortage, making it crucial to understand factors influencing specialty choice and workforce retention. An online cross-sectional survey was conducted among medical doctors in their prevocational and vocational stages working in Victoria, Australia. Participants were asked about various factors that influenced their choice of specialty. This study focused on those interested in or currently training in psychiatry. To explore differences in factors influencing specialty choice, prevocational doctors interested in psychiatry were compared to those undecided about their specialty. Of the 107 respondents, 56 expressed interest in or were training in psychiatry. The top five factors influencing psychiatry specialty choice were perceived ability, specialty culture, prior experience, work-life balance, and patient interactions. Both prevocational and vocational doctors shared similar views on these factors. Factors such as the cost of training, influence of family and friends, prestige, length of the training program, and salary were reported as less influential. This study identified several factors that were important to junior doctors when selecting psychiatry as a specialty. Active consideration of these factors within service and training frameworks may facilitate improved junior doctor wellbeing and greater workforce retention.

Relationship between two-year behaviour and neurodevelopmental outcome at five years of very low-birthweight survivors.

A prospective five-year follow-up of survivors of very low birthweight (less than or equal to 1500 g) born in 1979 was carried out at the Queen Victoria Medical Centre, Melbourne, between 1980 and 1985. Of the 57 children reported here, 23 had been identified during psychological testing at two years as having an attention deficit disorder (ADD). Although the number with ADD at five years had decreased to 18, the two-year diagnosis was retained to test its predictive value for outcome at school-age. Children with ADD at two years differed significantly from their peers at five years in verbal, performance and full-scale IQ and had significantly more minor physical disabilities. They also had poorer visual acuity, more tremor, poorer balance, and more deviations with arms extended in pronation. The ADD children had more minor, though chronic, physical illnesses such as tonsillitis and serous otitis media. Their mothers expressed greater concern than the other mothers about hearing and behaviour. The ADD children were rated as significantly more aggressive, difficult to manage and less able to cope with frustration. As a predictor of five-year IQ, behaviour at two years was more powerful than social class. ADD discriminated a subgroup of very low-birthweight children whose lower IQ and multiple physical, neurological and behavioural difficulties place them at very high risk of learning disabilities.

Antenatal Nonstress Cardiotocography

EDITORIAL COMMENT: There are problems with the interpretation of the value of antenatal cardiotocography in current obstetric practice. For example, a recent review by Thacker and Berkelman concluded that although nonstress and contraction stress cardiotocographs are used extensively in the United States of America, ‘neither have been demonstrated to be useful diagnostic tests’ (1). These authors stated that antepartum fetal surveillance techniques are potentially useful screening tests but still ‘require critical evaluation, with large randomized, controlled trials, to determine their efficiency and safety before their further diffusion into obstetrical practice’ (1).This issue of the journal contains audits of the indications and results of antenatal cardiotocography (using nonstress testing) performed in the Fetal Monitoring Departments of 2 of the University Teaching Hospitals in Melbourne. It is evident that antepartum cardiotocography has become popular with clinicians; 42% of patients at the Queen Victoria Medical Centre were tested and 32% at the Mercy Maternity Hospital, although the tests were ordered on clinical indications and not as a routine. The results showed that when there was evidence of satisfactory fetal reserve the perinatal mortality rate was less than 0.3% after malformations incompatible with life were excluded. Both studies showed a highly significant increase in the incidence of fetal growth retardation and low Apgar scores in infants born from pregnancies with abnormal cardiotocography. The Mercy Maternity Hospital data also showed that the perinatal mortality rate was increased from less than 1% to nearly 4% when fetal reserve was reduced, and to almost 20% when there was evidence of critical reserve (presence of late decelerations plus loss of beat to beat variation). These papers do not consider the management of patients who have evidence of critical fetal reserve. Since the perinatal mortality rate in these cases is approximately 20%, such a finding warrants immediate delivery, usually by Caesarean section.The clinician's problem is what to do with the patient who has evidence of reduced fetal reserve on cardiotocography. This is an important consideration since this group constitutes about 8% of the patients tested by antenatal cardiotocography — the critical reserve group comprising only 1–2% of those tested. Oats and colleagues from the Mercy Maternity Hospital give clinical details of all the perinatal deaths that occurred in their patients with normal antenatal cardiotocography or with evidence of reduced fetal reserve. These authors have designated those cases in which they regard, in retrospect, the perinatal death as being possibly avoidable, and the reader can also see the number of unexplained deaths that occurred within a week of the test being performed.The great advantage of antenatal cardiotocography is that it allows the clinician to defer delivery when there is evidence of satisfactory fetal reserve and so avoid the problems of prematurity when there is no absolute maternal indication for delivery. The reader can also see from the cases quoted that the clinician should not defer delivery when there is evidence of reduced reserve when the pregnancy has reached practical viability — 37 weeks' gestation. It is possible that recognition of reduced reserve with appropriate clinical action accounts for the varying incidence of critical reserve reported from different centres.

Fine needle aspiration cytology in breast disease management--a 4 year experience.

At the Queen Victoria Medical Centre between 1981 and 1984, 2920 fine needle aspirates of the breast were examined with an overall diagnostic accuracy of 97% and a sensitivity of 80%. This high diagnostic accuracy combined with the ease and complication-free nature of the procedure has meant that fine needle aspiration (FNA) has become an important part of the investigation and management of breast disease within the breast service of the Queen Victoria Medical Centre.

An analysis of factors associated with ectopic pregnancy in a human in vitro fertilization program : Martinez F; Trounson A Department of Obstetrics and Gynaecology, Queen Victoria Medical Centre, Melbourne, Vic. 3000, Australia Fertil. Steril.; 45/1 (79–87) 1986

International Journal of Gynecology & ObstetricsVolume 25, Issue 2 p. 174-175 Citations from the literature in vitro fertilization An analysis of factors associated with ectopic pregnancy in a human in vitro fertilization program Martinez F; Trounson A Department of Obstetrics and Gynaecology, Queen Victoria Medical Centre, Melbourne, Vic. 3000, Australia Fertil. Steril.; 45/1 (79–87) 1986 First published: April 1987 https://doi.org/10.1016/0020-7292(87)90039-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume25, Issue2April 1987Pages 174-175 RelatedInformation

Summary of labour and obstetric audit by microcomputer.

A microcomputer is used directly by the clinician, immediately after delivering a baby, to produce a summary letter to the referring physician and for the case notes. The programme is easy to use, and accepted by a wide range of medical users. In addition to producing a summary, the information is added to the obstetric data base, which may be interrogated by a computer novice. The system is now used to produce yearly obstetric audits of the Queen Victoria Medical Centre.

The Surviving Monozygotic Twin

Department of Paediatrics and Pathology, Queen Victoria Medical Centre, Melbourne, Australia Arch. Dis. Child. 61: 454, 1986

The effect of progesterone supplementation around the time of oocyte recovery in patients superovulated for in vitro fertilization : Trounson A; Howlet D; Rogers P; Hoppen H-O Centre for Early Human Development, Monash University, Queen Victoria Medical Centre, Melbourne, Vic. 3000, Australia FERTIL. STERIL.; 45/4 (532–535) 1986

The effect of progesterone supplementation around the time of oocyte recovery in patients superovulated for in vitro fertilization : Trounson A; Howlet D; Rogers P; Hoppen H-O Centre for Early Human Development, Monash University, Queen Victoria Medical Centre, Melbourne, Vic. 3000, Australia FERTIL. STERIL.; 45/4 (532–535) 1986

Birth centre confinement at the Queen Victoria Medical Centre: four years' experience.

A review of the first four years of the functioning of the birth centre at the Queen Victoria Medical Centre is presented. In that time, 1040 pregnant women were accepted for confinement there. Of these, 52 withdrew for non-obstetric reasons, while 470 were transferred to alternative obstetrical care--274 because of antepartum complications and 196 because of intrapartum problems. Therefore, 518 women were delivered in the birth centre. The care of the women is entrusted almost entirely to a team of midwives and this review demonstrates an enviable safety record.

Freeze/thawing of embryos and donor oocyte IVF embryos : C. Wood. Department of Obstetrics and Gynaecology, Monash University, Queen Victoria Medical Centre Melbourne, Australia, 3000

Freeze/thawing of embryos and donor oocyte IVF embryos : C. Wood. Department of Obstetrics and Gynaecology, Monash University, Queen Victoria Medical Centre Melbourne, Australia, 3000

Infertile Couples Entering an In Vitro Fertilisation Programme: A Preliminary Survey

This paper presents the findings of a pilot survey of 30 infertile couples who presented for in vitro fertilisation treatment at the Monash—Epworth—Queen Victoria Medical Centre. Wives of the couples underwent an extensive pre-treatment interview for demographic information and psychiatric evaluation. In addition, psychometric testing was carried out to provide psychological profiles. Husbands were interviewed separately and completed self-report questionnaires on marital adjustment. Two sub-groups were identified where the diagnosis of infertility was regarded as of organic or ‘idiopathic’ aetiology. Differences between the two sub-groups were found on neuroticism, anxiety, locus of control and dyadic adjustment. At 2 months after treatment great difficulty was experienced in obtaining follow-up responses. Reasons for this are suggested and recommendations for further investigations and supportive therapy are presented.

Clinical In Vitro Fertilization

This book on in vitro fertilization is edited by two of the most prominent people in the field. Both carry responsibility for one of the most successful in vitro fertilization programs in the world—the Queen Victoria Medical Centre in Melbourne, Australia. However, contrary to some other books on the topic, this monograph does not restrict itself to the experience of one large center. With many contributors from some of the other highly successful Australian in vitro programs, this book, in fact, summarizes the Australian experience. And this is one of the major reasons why this monograph is a must for everybody interested in the subject of in vitro fertilization. In the preface, the editors correctly remind us that Edwards and Steptoe first described the technique of in vitro fertilization and, in Cambridge, later achieved the birth of the first two normal neonates. From very early on, the collaboration between Cambridge

Erratum: External Human Fertilization: An Evaluation of Policy

In table 1 on p. 128 in the article "External human fertilization: an evaluation of policy" by C. Grobstein et al. (14 Oct., p. 127), the number of embryo transfers for Queen Victoria Medical Centre (218) resulted from the 364 laparoscopies of the first two clinical series. The first figure for the percentage of pregnancies per embryo transfer for that center also represents the combined result from the first two clinical series, and the percentage is 20(43/218), not 12.

Bigger role for bioethics centres

Medical Journal of AustraliaVolume 1, Issue 4 p. 182-182 Article Bigger role for bioethics centres First published: 01 February 1983 https://doi.org/10.5694/j.1326-5377.1983.tb104356.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Bioethics centres are extremely helpful as information and discussion centres for the community, according to Dr Alan Trounson, Senior Lecturer in Obstetrics and Gynaecology at the Queen Victoria Medical Centre in Melbourne. Dr Trounson has been closely associated with the development of techniques in embryo freezing and in-vitro fertilization (IVF) at the renowned hospital (Alan Trounson, Carl Wood, John Leeton. The freezing of embryos — an ethical obligation. Volume1, Issue4February 1983Pages 182-182 RelatedInformation

Early neurodevelopmental outcome of very low birthweight infants.

. In the 18 months, January 1979 to July 1980, 149 infants who weighed ≤1500g at birth were cared for in the neonatal intensive care unit at Queen Victoria Medical Centre, Melbourne. During this period the neonatal survival rate for infants weighing 501–1000g was 57% and for those weighing 1001–1500g was 91%. Of the 123 neonatal survivors, four died within the first year after birth. One hundred and seventeen (98%) of 119 surviving infants have been assessed at follow-up. At a mean age of 12.3 months (corrected for prematurity), 11 (9%) survivors had physical handicaps only and four (3%) had developmental delay, including one child who was also physically handicapped. Nine of the 14 children with a defined handicap were considered to have significant functional handicap. Therefore 108 (92%) survivors are able to function within the normal range. These results suggest that the chance of survival for infants of very low birthweight has continued to increase whereas their handicap-rate has remained stable and relatively low.

Results of intensive care for 375 very low birthweight infants.

ABSTRACT. In the 4 years 1977 to 1980, 375 infants weighing 501–1500g were admitted to the neonatal unit of the Queen Victoria Medical Centre. Overall neonatal survival was 79%; 56% of infants weighing 501–1000g and 89% of infants weighing 1001–1500g survived. Four post neonatal deaths occurred in hospital. Perinatal factors associated with decreased survival were indicators of perinatal asphyxia, thus demonstrating the imortance of the prevention of this condition in the management of early preterm labour. The survival rate for infants born after Caesarean section was significantly higher than those born after vaginal delivery for the whole study group but not among the smallest infants weighing ≤ 1000g. The two most common causes of respiratory failure were hyaline membrane disease and recurrent apnoea of prematurity. Two hundred and forty-seven (68%) infants required assisted ventilation, of whom 116 (67%) survived. Although the majority of infants could be ventilated successfully with low peak airway and positive and expiratory pressures, the prevention of air leak and bronchopulmonary dysplasia remain a therapeutic challenge. As we now expect the majority of very low birthweight infants to survive, documentation of short and long term morbidities are essential in order to determine how much greater an improvement can be expected by the use of new innovations in perinatal care.

Drug use in pregnancy: how to avoid problems.

The Obstetric Drug Information Service at the Queen Victoria Medical Center in Melbourne Australia aims to provide relevant information relating to drug use in pregnancy. A preliminary study conducted by the Center revealed that 62.5% of pregnant women consumed drugs during their pregnancies (excluding iron and vitamins) with an average of 3 drugs per woman. Certain drugs are relatively safer than others and the selection of the appropriate drug for a pregnant patient is very important to the future health and well-being of the child. At least 5% of all birth defects are drug induced. The drugs that produce fetal abnormalities are called "dysmorphogens" or "teratogens". General principles of drug use in pregnancy are outlined. These include the following: 1) no drug should be considered 100% safe to the developing fetus including topical preparations; 2) a true indication must be present for the administration of any drug; 3) the potential benefits should always be weighed against the possible hazards of that drug to the mother and the fetus; and 4) the effect of a drug on the fetus may not necessarily be the same as the intended pharmacological effect on the mother. The following specific drug induced embryopathies are reviewed: fetal alcohol syndrome; Warfarin syndrome; fetal hydantoin syndrome; stilbestrol (diethylstilbestrol DES) syndrome VACTERL syndrome and thalidomide embryopathy. Drugs which are safe for use in pregnancy are analgesics hypnosedatives antibiotics antiemetics and antihistamines psychotherapeutic drugs antihypertensive drugs antituberculous drugs antimalarial drugs antithyroid drugs and antidiabetic drugs.

Birth centre confinement at the Queen Victoria Medical Centre. I. Obstetric and neonatal outcome.

A review of hte first 175 confinements at the Queen Victoria Medical Centre Birth Centre is presented. The design, structure and function of hte Birth Centre is described and the safety of the programme demonstrated. Seventy-four pregnancies (42%) accepted for Birth Centre confinement required transfer because of antepartum or intrapartum complications. There were satisfactory obstetric and neonatal outcomes in all pregnancies. The first year's experience has allowed a reassessment of the risk factors, which will permit greater use of the Birth Centre without any increases risk to mothers or babies.

A controlled trial of fetal heart rate monitoring in a low-risk obstetric population

A controlled of fetal rate (FHR) monitoring. in a low-risk obetetric was carried out in 989 patients at the Maternity Hospital and Victoria Medical Centre. The use of monitoring failed demonstrate any improvement perinatal outcome. Monitoring was associated with an increased intervintion small increase in the number of babies who remained in the isollete beyond 3 days. This study does not support the view that FHR monitoring should be used in all labors. Further study in a larger sample is recommended. (Am. J. Obstet. Gynecol 141: 527, 1981 .)

Improving prognosis for infants weighing 1000 g or less at birth.

In the two years 1977 and 1978, 55 infants weighing less than or equal to 1000 g were admitted to the neonatal unit of the Queen Victoria Medical Centre. Overall neonatal survival was 60%; 44% of infants weighing 501-750 g and 67% of infants weighing 751-1000 g survived. One postneonatal death occurred at 51 days. Maternal risk factors were present in 80% of infants, although none had an effect on survival. Perinatal asphyxia, as indicated by an Apgar score less than or equal to 3 at five minutes, and base deficit greater than 10 mmol/l on admission, were associated with decreased survival. Mortality data with increasing postnatal age were used to produce a chart for sequential predication of neonatal survival. Intraventricular haemorrhage remained the most common necropsy finding. Follow-up of 32 survivors to date has shown no abnormalities, with the exception of one retrolental fibroplasia, and one porencephaly of unknown aetiology. We conclude that the prognosis for infants weighing less than or equal to 1000 g has continued to improve. From a review of the clinical and pathological characteristics in these infants however, it is obvious that this outcome requires complex organisation and costly resources in perinatal centres to which high-risk pregnancies must be transferred for optimal management both before and after birth.