Access to primary health care for Australian young people: service provider perspectives.

BACKGROUND: To adequately address the complex health needs of young people, their access to services, and the quality of services received, must be improved. AIMS: To explore the barriers to service provision for young people and to identify the training needs of primary healthcare service providers in New South Wales (NSW), Australia. DESIGN OF STUDY: A cross-sectional, qualitative study of the perspectives of a range of health service providers. SETTING: A range of primary healthcare organisations across NSW. METHODS: Samples of general practitioners (GPs), youth health workers, youth health coordinators, and community health centre staff were drawn from urban and rural clusters across NSW. Focus groups and interviews were used to identify barriers to service provision and the training needs of service providers. Data were tape recorded, transcribed, and analysed. RESULTS: Barriers to service provision among GPs and community health centre staff included inadequate time, flexibility, skills, and confidence in working with young people, and poor linkages with other relevant services. Training needs included better knowledge of and skills in adolescent health requirements, working with adolescents, and working with other services. Barriers to service provision for youth health workers and coordinators included lack of financial resources and infrastructure. There were few linkages between groups of service providers. CONCLUSION: Models of service provision that allow stronger linkages between service providers, sufficient time for consultation with young people, adequate training and support of health professionals, and flexibility of service provision, including outreach, should be explored and evaluated.     

Chemosurgical debridement of osteomyelitic bone by zinc chloride fixative

Zinc chloride fixative (as described in fixed-tissue Mohs surgery) is useful as a chemical debridement method for osteomyelitic bone. We describe a case of an 86-year-old female with a 67-year history of an osteomyelitic ulcer of the anterior tibia. Previous attempts at surgical extirpation of the bone followed by immediate or delayed repair by orthopedic and plastic surgery services had eventuated in recurrence of the basic osteomyelitic process. Below-the-knee amputation was recommended as the only alternative to treatment. However, we chose to apply zinc chloride fixative which penetrated the full thickness of cortical bone and revealed a wider and deeper extent of the infectious process than previously recognized. Following removal of the fixed bone, a muscle flap repair followed by split-thickness skin grafting was done by plastic surgery. The patient remains ulcer and symptom free 31 months postoperatively. We feel zinc chloride fixative is useful as an adjunct to other surgical means of extirpation of bone as it is tissue sparing and more accurately determines the extent of involved bone when infected.     

Powered wheelchair bucking

Using a dummy test driver with a simulated flaccid forearm capable of representing either a large or zero friction condition, six powered wheelchairs were examined for bucking tendencies. In the zero friction condition, bucking was easily induced in 5 of 6 tested wheelchairs. Adding friction to the simulated forearm prevented bucking in all tested wheelchairs but one. Bucking is not simply related to wheelchair performance measures such as speed or acceleration. Sustained bucking corresponds to neutral stability in a speed regulated machine. Changes in natural frequency and damping characteristics are predicted as useful in reducing powered wheelchair bucking.     

Dopamine denervation does not alter in vivo 3H-spiperone binding in rat striatum: implications for external imaging of dopamine receptors in Parkinson's disease

Striatal particulate preparations, both from rats with lesion-induced striatal dopamine (DA) loss and from some striatal dopamine (DA) loss and from some patients with Parkinson's disease, exhibit increased 3H-neuroleptic binding, which is interpreted to be the mechanism of denervation-induced behavioral supersensitivity to dopaminergic compounds. After intravenous 3H-spiperone (3H-SP) administration to rats with unilateral nigral lesions, we found no differences in accumulation of total or particulate-bound 3H-SP in dopamine-denervated compared with intact striata. 3H-SP in vivo binds to less than 10% of striatal sites labeled by 3H-SP incubated with striatal particulate preparations in vitro. Quantitative autoradiography of 3H-SP binding to striatal sections in vitro also failed to reveal any effects of dopamine denervation. 3H-SP bound to striatal sites in vivo dissociates more slowly than that bound to striatal particulate preparations labeled in vitro. Striatal binding properties of 3H-SP administered in vivo are quite different from the same kinetic binding parameters estimated in vitro using crude membrane preparations of striatum. In addition, striatal binding of in vivo-administered 3H-SP is not affected by prior lesion of the substantia nigra, which results in profound ipsilateral striatal dopamine depletion. Thus, behavioral supersensitivity to dopaminergic compounds may not be associated with altered striatal binding properties for dopamine receptor ligands in vivo.     

Nitrates do not affect prostacyclin formation by rat arteries: this is unrelated to increased vascular prostacyclin formation with age

The question of whether vasodilator nitrates act by releasing prostacyclin is controversial. Since the ability of blood vessels to form prostacyclin changes with age, we have investigated whether this may explain the discrepancies in the literature. It does not, since isosorbide dinitrate or glyceryl trinitrate incubated with rat aorta or vena cava from male Wistar rats had little or no effect on the release of prostacyclin, measured as 6-keto-PGF1 alpha. We confirm that the aorta produces substantially more prostacyclin than the vena cava. The arterial production of prostacyclin was greater in rats weighing 350-400 g than in those weighing 116-152 g, but the production by the veins was similar in both groups.     

Mohs micrographic surgery for skin cancers of the neck

The neck is not a common area for a skin cancer to occur. However, when it does occur and extends deeply, careful extirpation is necessary so that vital structures will be identified and, if possible, preserved. The Mohs surgeon can most accurately determine the true extent of malignancies in this area; the head and neck surgeon can best identify and protect important anatomic structures. Together both physicians can achieve the best chance of cure and lessen the complication rate for patients with selected invasive cutaneous tumors of the neck. Future collaborative efforts will undoubtedly be directed toward complete extirpation of deeper tumors of the neck, especially those of the pharynx, hypopharynx, and trachea.     

Group excellence: A model for the application of Japanese Management to Mental Health Centers

Mental health centers and other government sponsored service organizations need highly effective management techniques. In this era of tightening budgets, the Japanese Management System may be a way of increasing both excellence and employee satisfaction. Managers who choose to explore this system may need a concise, written model as a guide to the ingenious, extensive, and paradoxical Japanese Management System. The System centers around quality control circles—autonomous problem-solving groups that strive for excellence. Composed of hierarchically interlocking groups, it uses a wide selection of group cohesion techniques to inspire esprit de corps, and an interlocking set of rewards governs behavior at every level. Decision making is collective (although supervisors retain veto power), and execution of ideas, once agreed upon, is quick and consistent. The System operates holistically, enthusiastically, with a high degree of excellence and mutual concern.     

Melbourne trial of adjuvant immunotherapy in operable large bowel cancer

A controlled randomized clinical trial was undertaken to assess the ability of combined non-specific and specific immunotherapy to alter the disease-free interval and overall survival of patients with Stage B or C large bowel cancer. The immunotherapy consisted of a 2 year programme of vaccinations with BCG and neuraminidase-treated autologous tumour cells. Three hundred and one patients entered the trial. At 5 years of follow-up there is no evidence that this form of immunotherapy can alter either the disease-free interval or survival in this group of patients.