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Background: Family (whanau) and other carers can play a central part in the natural history of psychiatric service users. Diagnoses or the classification of mental disorders play a significant role in communications between clinicians, psychiatric service users, and family. Despite that centrality, the views and experiences of family on the utility of the present classification systems have been little studied. Aims: This study aimed to document the understanding and opinions of families/ whanau on the utility of diagnostic labels as they observed them being applied to their family members. Method: This is a qualitative study. The families of two cultural groups (New Zealand Maori and non-Maori) of psychiatric service users were interviewed using a structured approach. Results: A number of themes on the utility of the diagnostic systems emerged. The single most powerful message being that how the diagnostic labels were communicated, and how they were utilized in the patient management planning, were of paramount importance. There were some cross-cultural differences. From Maori, there was a particular plea for a greater incorporation of culturally syntonic concepts. Conclusion: Family/ whanau had positive views of the contributions current diagnostic practices make to patient care. The study elicited the view that more contextual issues, and not just phenomenology, should be taken into account in the development of diagnostic systems.

The article presents a longitudinal study on job satisfaction and burnout in a cohort group of psychiatrists from New Zealand. The study administered thre questionnaires including a socio-demographic one, the Job Diagnostic Survey (JDS), and the Maslach Burnout Inventory (MBI). It concludes that it is important to consider the aspects of job satisfaction in the development of treatments for psychiatrists who score high on burnout.

In this prospective, multicenter, non-randomized study for patients with stage I--II Hodgkin lymphoma, group 1 (without risk-factors [[RF]]) had three cycles of ABVD chemotherapy (adriamycin, bleomycin, vinblastine, and dacarbazine) and group 2 (any of bulk, extranodal site, >3 regions, raised erythrocyte sedimentation rate [[ESR]]) and group 3 (B-symptoms) received four cycles. Involved field radiotherapy (IFRT) 30 Gy was given after adequate chemotherapy response. Five-year overall survival and freedom from progression (FFP) were 96%% (95%% confidence interval [[CI]] 91--98%%) and 90%% (84--94%%), respectively. Five-year FFP was 97%% (90--99%%), 89%% (75--95%%), and 73%% (52--86%%) for groups 1, 2, and 3, respectively. In patients with RF, chemotherapy responses of complete response unconfirmed (CRu), partial response (PR), and stable disease (SD) were associated with FFP of 90%%, 86%%, and 62%% ( p==0.17), and CR/no CR on functional imaging with FFP of 90%%/67%%, respectively ( p==0.05). The 97%% FFP in group 1 compares favorably with previously reported results from cooperative trial groups. Intensification of therapy warrants study in patients with RF and a poor chemotherapy response. [ABSTRACT FROM AUTHOR]

Background: Many studies have looked at sources of stress in psychiatrists, yet the role played by different factors in the causation of burnout in psychiatrists remains unclear. We had two aims, first, to develop a predictive model for the onset of burnout. Second, we aimed to study the differences in the perception of what caused stress between psychiatrists who rated themselves high on Emotional Exhaustion compared to those who rated themselves as low on Emotional Exhaustion.Methods: A previously described questionnaire that identified stressors relevant to consultant psychiatrists was mailed out to 426 psychiatrists, with 240 replies. Scores on the Emotional Exhaustion dimension of the Maslach Burnout Inventory were available for 131 respondents.Results: Based on an earlier literature review, the Sources of Stress Questionnaire (SOS-Q) used in the study had 45 factors, categorized into predisposing, precipitating, perpetuating and protective factors for burnout in psychiatrists. Of these, factor analysis identified 11 non-correlated factors which were used in the final analysis of this study. Four factors emerged as associated with burnout in psychiatrists in New Zealand: too much work; working long hours; an aggressive administrative environment; and lacking support from management. Two factors negatively correlated with Emotional Exhaustion were a high level of job satisfaction and/or enjoyment, and low pay compared to other countries.Conclusions: Most factors associated with burnout are preventable and can be managed jointly between psychiatrists and administrators. Service providers need to address burnout seriously. [ABSTRACT FROM PUBLISHER]

Objectives: The aim of this study was to ascertain the workload for rural general practitioners providing palliative care and to identify barriers to care for patients living in rural areas of New Zealand. Design and methods: This was a cross-sectional survey of rural general practitioners using a postal questionnaire. Results: One hundred eighty-six questionnaires were returned. Of respondents, 98% provided palliative care. The estimated mean number of patients cared for in the previous 12 months was 7.3. Specialist medical advice from a hospice or palliative care consultant was accessed by 77% of respondents. District and community nursing was available to over 90% of respondents but this was not universally available 24 hours a day in all areas. Forty-seven percent of rural palliative care patients died at home. Conclusions: Commitment of general practitioners to palliative care appeared high although the workload was a relatively small part of their activity. There seems to be a need for wider availability of specialist advice, 24-hour nursing cover, and some support services. A commitment to supporting domiciliary services is needed if large increases in institutional care are to be avoided in the future. [ABSTRACT FROM AUTHOR]

Mobile phone images might be useful in after-hours triage of primary care. We conducted a study to identify population access to mobile phone cameras and to assess the clinical usefulness of mobile phone cameras. The survey was conducted among 480 patients attending two rural New Zealand practices. There were significantly more Maori owners compared to non-Maori (P =0.002). Age was a significant factor influencing the ownership of mobile phones. We also conducted a clinical quiz among health professionals to assess how the provision of images on a mobile phone and on CD-ROM (to simulate the image that would be seen if email was used to transmit the images) influenced diagnostic confidence. Ten photographable clinical conditions were used to quiz 30 health professionals who were randomized into three groups of 10 each on diagnostic confidence. Images were found to significantly increase diagnostic confidence in all cases except one. It appears that mobile phone cameras are generally acceptable to patients and likely to be of practical use to rural practitioners in a range of clinical scenarios. [ABSTRACT FROM AUTHOR]

Objective: To examine whether data on the clinical profiles of psychiatric service users can inform the claim that Maori in the New Zealand community have an increased rate of bipolar disorder. Method: The standardized recordings of a variety of clinical phenomena previously collected in a New Zealand study of psychiatric service users was extracted for those persons who were diagnosed with a bipolar mental disorder. The individual clinical phenomena were then compared by ethnicity. Results: The most dramatic result was the increased recording of high levels of overactivity or disruptive aggressive behaviour in Maori compared with European in psychiatric service users, despite which, the rates of the disorder did not significantly differ by ethnicity. Conclusion: In the community survey lay raters were deciding on the presence or absence of phenomena including hyperactivity without the contextual knowledge that clinicians use. It is possible that the Composite International Diagnostic Interview decision tree was being fed an excessive amount of that criterion. [ABSTRACT FROM AUTHOR]

Objective: The present accepted classificatory systems (ICD-10 and DSM-IV) represent the culmination of 100 years of post-Kraepelinian evolution. The present paper reports on a study to ascertain the views of New Zealand psychiatrists on their requirements of a classificatory system, and their opinions on those currently in use. Method: An anonymous postal survey of 542 psychiatrists and trainees was undertaken in New Zealand. Results: A total of 235 questionnaires were returned, completed. New Zealand psychiatrists primarily use DSM-IV and do so because that is what they were taught on. They make relatively limited use of the multiaxiality. The purposes of classificatory systems that they value most highly are reliable interclinician communication, and to inform patient management planning. The two purposes they valued least were usefulness for a national statistical base, or to indicate prognosis. Conclusions: New Zealand psychiatrists' views are consistent with some of the stated objectives of ICD-10 and DSM-IV, but there is significant diversity in the former and over-ambition in the latter, with much to be resolved. [ABSTRACT FROM AUTHOR]

Background: The incremental value of 18FDG PET/CT in patients with breast cancer (BC) compared to conventional imaging (CI) in clinical practice is unclear. The aim of this study was to evaluate the management impact and prognostic value of 18 F-FDG PET/CT in this setting., Methods: Sixty-three patients who were referred to our institution for suspicion of BC relapse were retrospectively enrolled. All patients had been evaluated with CI and underwent PET/CT. At a median follow-up of 61 months, serial clinical, imaging and pathologic results were obtained to validate diagnostic findings. Overall Survival (OS) was estimated using Kaplan Meier methods and analyzed using the Cox proportional hazards regression models., Results: Forty-two patients had a confirmed relapse with 37 (88%) positive on CI and 40 (95%) positive on PET/CT. When compared with CI, PET/CT had a higher negative predictive value (86% versus 54%) and positive predictive value (95% versus 70%). The management impact of PET/CT was high (change of treatment modality or intent) in 30 patients (48%) and medium (change in radiation treatment volume or dose fractionation) in 6 patients (9%). Thirty-nine patients (62%) died during follow-up. The PET/CT result was a highly significant predictor of OS (Hazard Ratio [95% Confidence Interval] =4.7 [2.0-10.9] for PET positive versus PET negative for a systemic recurrence; p = 0.0003). In a Cox multivariate analysis including other prognosis factors, PET/CT findings predicted survival (p = 0.005). In contrast, restaging by CI was not significant predictor of survival., Conclusion: Our study support the value of 18 F-FDG PET/CT in providing incremental information that influence patient management and refine prognostic stratification in the setting of suspected recurrent breast cancer.

Evidence and argument for the allocation of funds to forensic psychiatric services to take account of the ethnic disparities in the use of the Justice System is presented. This would reflect the reality of the distribution of Service demand.