Application of amendments to the Privacy Act (Cth) 1988 as they affect private clinical practice

INTRODUCTION: The amendments to the Privacy Act (Cth) 1988 came into force on 21st December 2001. These changes expand the impact of the Act to include the private sector and will have considerable consequences upon healthcare delivery in Australia. This paper reports the findings of a survey, which examined the implications of the Act for doctors in private practice. METHOD: Both Government and private agencies were canvassed to seek clarification of various aspects of the Act. Responses were analysed to determine what needed to be done to ensure compliance with the Act and were reviewed in the light of published material provided by commentators. RESULTS: Of twenty-one contacts, only ten responded of which five were Government agencies. Government agencies chose to deflect commentary and did not respond to specific questions. The Medical Defence Organisations (MDOs) provided the most useful commentary, highlighting various 'grey areas' of concern. DISCUSSION: Government agencies tasked with the enforcement of the Act were unhelpful in providing useful guidelines to specific questions. MDOs offered by guidelines to risk management obviate litigation. This survey emphasised the concept that legislation developed for general purposes required redefinition to be applicable to the medical profession and had the capacity to negatively impact upon patient well-being.     

An alternative approach to the preparation of (188)Re radiopharmaceuticals from generator-produced [(188)ReO(4)](-): efficient synthesis of (188)Re(V)-meso-2,3-dimercaptosuccinic acid

A new efficient approach for the preparation of (188)Re radiopharmaceuticals starting from [(188)ReO(4)](-), produced at a carrier-free level through the (188)W/(188)Re generator system, is described. The reaction procedure was based on the combined action of different reagents and has been applied in detail to the preparation of the therapeutic agent (188)Re(V)-DMSA (H(2)DMSA [meso-2,3-dimercaptosuccinic acid]). The most efficient combination required the use of SnCl(2), oxalate ions, and gamma-cyclodextrin. These were reacted with [(188)ReO(4)](-) and H(2)DMSA to afford the final radiopharmaceutical in high radiochemical purity, at room temperature, and in weakly acidic solution. The role played by the various reagents in the reaction was investigated. It was found that SnCl(2) behaved as the actual reducing agent, whereas oxalate and gamma-cyclodextrin greatly enhanced the ease of reduction of [(188)ReO(4)](-) through the action of two hypothetical mechanisms. In the first step of the reaction, oxalate ions gave rise to the formation of Re(VII) complexes with the concomitant expansion of the coordination sphere of the metal. This process strongly favored the electron transfer between Sn(2+) and Re(+7) centers, giving rise to intermediate reduced rhenium complexes. These species were further stabilized by the formation of transient host-guest aggregates with gamma-cyclodextrin and finally converted into (188)Re(V)-DMSA through simple replacement of the coordinated ligands by H(2)DMSA.     

Section 5(2) of the Mental Health Act: local and national use over a twelve-year period

The pattern of use of Section 5(2) of the Mental Health Act 1983 was examined over a 12-year period at one psychiatric hospital. Although there was a national trend for Section 5(2) to be used more frequently, the local pattern was of a fluctuating number of patients being placed on this Section, but without there being any upward trend towards its increased use. As has been seen in other studies, Section 5(2), however, tended to be used for a younger group of patient who had often only been admitted within the previous 24 hours.     

Section 5(2) of the Mental Health Act 1983 in practice: an audit and a review

All applications of s.5(2) of the Mental Health Act 1983 (MHA) between January 1997 and December 1998 were examined to assess variables likely to affect outcome and to compare these findings to other similar published studies. Of the 154 applications (7% of all admissions), 56 were converted to s.3 and 39 to s.2 of the MHA. We found that the time of application, grade of doctor making the application and the day of application were the best predictors of outcome of s.5(2). Apart from a few exceptions, our findings were generally in keeping with previous published results. These findings suggest a national trend in the clinical use of s.5(2) and may provide a useful guide for those considering reform of this part of the MHA.