e20731 Background: The diagnosis of cancer represents a major physical and psychological challenge for patients and their families. Psycho-oncology services are limited throughout the country. We assess the service profile of patients assessed between 1/2003 and 6/2008 to determine how the needs of patients have changed. Methods: Case notes from all patients referred by medical oncologists, clinical nurse specialists and/or social workers to the psycho-oncology service were reviewed for the period 7/07 to 6/08. Demographic details, cancer diagnosis and stage, time since diagnosis, psychiatric diagnosis (past/current), and need for psychiatric intervention were collected. This data was compared to a similar review performed from 1/03 to 12/03. Results: 106 patients were psychiatrically assessed during the period 07/08 compared with 63 from 2003, representing a 68% increase in activity. All major cancers were represented. There was a 30% increase in patients assessed with lung cancer (14% in 07/08 vs. 11% in 2003). More patients were referred with localised disease in 07/08 than in 2003 (37.5% vs .19%, p=0.012).Patients with a past history of psychiatric disorder were more likely to be referred in 07/08 compared to 2003 (54% vs. 32% p=0.005). There was a significant decrease in the numbers diagnosed with depression in 07/08 (29% vs. 51%, p= 0.004) with a corresponding increase in the diagnosis of adjustment disorder (26% vs. 6%). Conclusions: Psycho-oncology services remain an important component of care for patients with cancer. The increased rate of referrals may reflect an increased awareness amongst oncology staff of psychological distress in this vulnerable population. No significant financial relationships to disclose.

Background and Aims:Patients with SMI receive long term intervention with psychotropic agents often associated with weight gain. Weight and lifestyle management programmes may prevent, reduce or reverse weight gain, however most data is short-term. Categorical data is not often reportedMethods:A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors commenced 2002 in Ireland. Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes. Groups were led by trained healthcare professionals.Results:Data is reported up to 24 months from 55 patients (27 male; 28 female) from 6 centres. Mean age 49.4 years (range 21-74). Schizophrenia 63%, Affective disorders 26%, other 11%. Patients completing 1 year - 55% and 2 years 22%. Baseline mean weight 98.6 kg (SD 19.2) decreased to final visit weight 96.9kg (SD 18.4).Paired t –test, p = 0.0030; CI Mean 2.53 (0.9-4.159). Weight increased in 11/55, maintained 7/55 and decreased 37/55.Conclusions:Weight gain in SMI patients is not inevitable and was found in only 20% of patients attending weight clinics in Ireland. Patients may benefit if similar interventions were widely available.

Results: One hundred seventeen procedures were performed. The outcome at 5 to 11 years’ (mean, 6.4 years’) follow-up was determined for 113 patients (97%). Twelve patients (11%) died of unrelated causes during follow-up, and 1 patient underwent esophagectomy. Further surgery was undertaken in 12 patients (11%): 8 for recurrent reflux, 3 for a symptomatic hiatal hernia, and 1 for dysphagia. For 100 patients with clinical outcome data at late follow-up, gastroesophageal reflux symptoms were significantly improved following surgery and were well controlled in 80 patients. The incidence and severity of dysphagia were reduced after surgery. Normal belching was preserved in 91 patients, and almost all patients were able to eat normally. The overall outcome of surgery was rated as satisfactory, with 95 patients reporting that they considered their original decision to undergo surgery correct.

The aim of this study was to evaluate the place of computer‐aided learning in a basic science course in the undergraduate medical curriculum at the University of Adelaide.

BACKGROUND:Opportunities for interactive learning in electrocardiography are limited--particularly at postgraduate level. In medical education, increasing use is being made of the electronic medium and various materials have been developed to improve clinicians' skills.AIMS:To test and evaluate the learning of electrocardiography among health professionals.METHODS:A software package, containing a tutorial on electrocardiography and a self-assessment programme of 140 electrocardiograms (ECGs) was constructed. Seventy-two health professionals were recruited into the study and tested before and after the study period. Participants were randomly allocated to one of three groups: control (no study material), tutorial or computer. The tutorial group participated in a series of tutorials and the computer group were provided with a CD-ROM containing study material for them to use in their own time. The results were assessed for statistical significance between all groups using analysis of variance techniques.RESULTS:Sixty-one individuals completed the study. Each of the three groups was pre and post tested on their knowledge of electrocardiography and their ability to interpret ECGs. The computer group was the only group to achieve a significant increase in performance in their knowledge on electrocardiography and in their ability to interpret ECGs.CONCLUSIONS:Suitably structured computer programmes are effective in helping clinicians understand electrocardiography and interpret ECGs.

BACKGROUND:Student teaching of surgery has been devolved from the university in an effort to increase and broaden undergraduate clinical experience. In order to ensure uniformity of learning we have defined learning objectives and provided a computer-based package to supplement clinical teaching. A study was undertaken to evaluate the place of computer-based learning in a clinical environment.METHODS:Twelve modules were provided for study during a 6-week attachment. These covered clinical problems related to cardiology, neurosurgery and gastrointestinal haemorrhage. Eighty-four fourth-year students undertook a pre- and post-test assessment on these three topics as well as acute abdominal pain. No extra learning material on the latter topic was provided during the attachment.RESULTS:While all students showed significant improvement in performance in the post-test assessment, those who had access to the computer material performed significantly better than did the controls. Within the topics, students in both groups performed equally well on the post-test assessment of acute abdominal pain but the control group's performance was significantly lacking on the topic of gastrointestinal haemorrhage, suggesting that the bulk of learning on this subject came from the computer material and little from the clinical attachment.CONCLUSIONS:This type of learning resource can be used to supplement the student's clinical experience and at the same time monitor what they learn during clinical clerkships and identify areas of weakness.

BACKGROUND:Computers and other forms of information technology are increasingly used in medical education. We undertook a study to evaluate the place of the computer in the assessment of clinical skills of junior medical students.METHODS:The history taking and physical examination skills of 136 third-year students were assessed in a series of structured and observed clinical stations and compared to their performance in similar computer-based problems.RESULTS:Students scored equally on the computer-based tasks and in the observed stations, but the weaker students who failed one or another component of the examination were more likely to pass at a clinical station and fail the computer task.CONCLUSIONS:This study has shown that computer-based clinical simulations can be constructed to supplement conventional assessment processes in clinical medicine and may have a role in increasing their reliability.

We report here a precise, in situ 31P{1H}-NMR method of assaying enantiopurity of α-hydroxyphosphonate esters, the products of the carbonyl hydrophosphonylation (Pudovik) reaction. This method is based upon a diazaphospholidine chiral derivatising agent (CDA) which satisfies all of the criteria for a precise assay; (i) derivatisation of α-hydroxyphosphonate esters is both rapid and clean, (ii) kinetic resolution is absent and (iii) 31P{1H} chemical shift dispersions are excellent (>5ppm). Calibration of this assay has been achieved by cross-referencing the 31P{1H}-NMR signals obtained for the CDA-derivatised ester of (MeO)2P(O)CHPh(OH) to optical rotation measurements from scalemic material obtained upon lipase catalysed hydrolysis (F–AP 15, Rhizopus oryzae) of (MeO)2P(O)CHPh(OAc). Analysis of NMR chemical shift and coupling parameters for a closely related series of derivatised α-hydroxyphosphonate esters support further configuration assignments on the basis of inference. We report also on the configurational stability of α-hydroxyphosphonate esters in the presence of acids, organonitrogen bases and metal salts. 2H-labelling and carbonyl crossover experiments reveal that low levels of epimerisation (<2%) at the alpha-carbon atom (Cα) of α-hydroxyphosphonate esters is possible under certain conditions of catalysis and within certain limits. A design strategy for the construction of catalyst systems in the Pudovik reaction is outlined based upon a combination of Lewis acidic (E) and Lewis basic (N) sites. Four types of catalyst are outlined, members of two distinct Classes I and II according to the nature of the acid and base sites, along with our investigations of representative examples of each Class. A variety of Class I.1 systems based on β-amino alcohols (one hydrogen bonding E site and one organonitrogen N site), have been assayed in the model reaction between (MeO)2P(O)H and PhCHO. Results suggest that catalysis of the Pudovik reaction is clean and efficient in certain cases but that catalytic activity is strongly dependent upon the nature of the basic (N) nitrogen centre. Moreover, only low levels (<10%) of enantioselectivity are afforded by all amino alcohols assayed. Achiral variants of Class I.2 catalysts (multiple hydrogen bonding E and/or N sites) have been examined to model carbonyl and H-phosphonate binding; an amphoteric receptor based on a pyridine dicarboxamide scaffold has been synthesised and shown to bind benzaldehyde >50% more strongly (K11 0.53 mol−1 dm3) than dimethyl-H-phosphonate (K11 0.34 mol−1 dm3, 298 K) and to catalyse the hydrophosphonylation reaction between these two substrates with a second order rate constant comparable to that of triethylamine (both k2 5.9×10−2 mol−1 dm3 h−1, 293 K). However, one of the major limitations of this model is that competitive product inhibition dominates after some 15 turnovers (75% completion). Model studies reveal that hydrophosphonylation catalysis via a nitrogen Lewis base is accelerated up to 10-fold upon the introduction of [Zn(OSO2CF3)2] as co-catalyst. Consequently, Class II.1 systems employ metal salts [Zn(OSO2CF3)2] as Lewis acidic E sites and chiral co-catalysts capable of binding to the metal and also acting as Lewis basic N sites. Such systems catalyse the addition of (MeO)2P(O)H to PhCHO cleanly with modest turnover numbers (<10 turnovers; 50% completion) but with enhanced enantioselectivity over Class I catalysts (<40% e.e.). However, competitive product inhibition is still problematic. Class II.2 systems are related to Class II.1 but possess directly coordinated E and N sites with more basic N functions and consequently are far more active as catalysts than the other classes. This increased catalytic activity is exemplified by one of the simplest achiral members, diethylzinc which catalyses the 100% chemo- and regioselective addition of (MeO)2P(O)H to PhCHO to afford (MeO)2P(O)CHPh(OH) with an average turnover rate (over a 1 h reaction time at 298 K) of 115 h−1 compared to ca. 1 h−1 for NEt3 under analogous conditions. Chiral variants are proposed.

Background: A computer-based learning package has been developed, aimed at expanding students' knowledge base, as well as improving data-handling abilities and clinical problem-solving skills. The program was evaluated by monitoring its use by students, canvassing users' opinions and measuring its effectiveness as a learning tool compared to tutorials on the same material.Methods: Evaluation was undertaken using three methods: initially, by a questionnaire on computers as a learning tool and the applicability of the content; second, through monitoring by the computer of student use, decisions and performance; finally, through pre-and post-test assessment of fifth-year students who either used a computer package or attended a tutorial on equivalent material.Results: Most students provided positive comments on the learning material and expressed a willingness to see computer-aided learning (CAL) introduced into the curriculum. Over a 3-month period, 26 modules in the program were used on 1246 occasions. Objective measurement showed a significant gain in knowledge, data handling and problem-solving skills.Conclusions: Computer-aided learning is a valuable learning resource that deserves better attention in medical education. When used appropriately, the computer can be an effective learning resource, not only for the delivery of knowledge, but also to help students develop their problem-solving skills.

Stereocontrol in the asymmetric phosphonylation of aldehydes via organophosphorus esters is a function of the topology of the chiral reagents employed. We report here on the diastereoselective phosphonylation of selected unsaturated organic substrates using diazaphospholidine reagents based on the N,N′-bis[1-(S)-phenylethyl]-1,2-ethylenediamine auxiliary which affords a different profile of selectivities to those reported previously using diazaphospholidine reagents containing the N.N′-(dineopentyl)-trans-1,2-diaminocyclohexane auxiliary.

Philip C. Mitchell; David I. Watson, P.G. Devitt, R. Britten-Jones, S. MacDonald, MD; J.C. Myers, Glyn G. Jamieson