Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008)

PubMed Central

Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

2011-01-01

The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies. PMID:22105401

Quantifying the proportion of general practice and low-acuity patients in the emergency department.

PubMed

Nagree, Yusuf; Camarda, Vanessa J; Fatovich, Daniel M; Cameron, Peter A; Dey, Ian; Gosbell, Andrew D; McCarthy, Sally M; Mountain, David

2013-06-17

To accurately estimate the proportion of patients presenting to the emergency department (ED) who may have been suitable to be seen in general practice. Using data sourced from the Emergency Department Information Systems for the calendar 2013s 2009 to 2011 at three major tertiary hospitals in Perth, Western Australia, we compared four methods for calculating general practice-type patients. These were the validated Sprivulis method, the widely used Australasian College for Emergency Medicine method, a discharge diagnosis method developed by the Tasmanian Department of Human and Health Services, and the Australian Institute of Health and Welfare (AIHW) method. General practice-type patient attendances to EDs, estimated using the four methods. All methods except the AIHW method showed that 10%-12% of patients attending tertiary EDs in Perth may have been suitable for general practice. These attendances comprised 3%-5% of total ED length of stay. The AIHW method produced different results (general practice-type patients accounted for about 25% of attendances, comprising 10%-11% of total ED length of stay). General practice-type patient attendances were not evenly distributed across the week, with proportionally more patients presenting during weekday daytime (08:00-17:00) and proportionally fewer overnight (00:00-08:00). This suggests that it is not a lack of general practitioners that drives patients to the ED, as weekday working hours are the time of greatest GP availability. The estimated proportion of general practice-type patients attending the EDs of Perth's major hospitals is 10%-12%, and this accounts for < 5% of the total ED length of stay. The AIHW methodology overestimates the actual proportion of general practice-type patient attendances.

Royal london hospital set P28 plans 30th anniversary reunion.

PubMed

Sibthorpe, Fran

2013-04-03

Members of Set P28 at the Royal London Hospital who began their training in February 1980 are planning a reunion on July 27 in London. The venue will be announced later. Email fran-joy@hotmail.com for details.

Roles of infection control nurses in Royal Thai Army hospitals.

PubMed

Chaisombat, Yawares; Moongtui, Wanchai; Soparat, Poonsap; Buppanharan, Wanchai; Danchaivijitr, Somwang

2005-12-01

To study the performance according to the assigned roles of infection control nurses (ICNs) in Royal Thai Army hospitals. Interviewing ICNs in 6 hospitals. During April and May 2002, 11 ICNs in 6 hospitals were interviewed. Two hospitals had been accredited and 4 were applying for hospital accreditation. Full-time ICNs were identified in 5 and part-time in 6. The ICNs were graduated with bachelor and master degrees in 5 and 6 respectively. Two ICNs graduated with master degree in IC. All could perform their roles in administration, education, surveillance, personnel health, consultation and quality improvement. Only 7 ICNs had experience in outbreak investigation. None were principle investigators in research except for their master degrees. The main problem was the absence of ICNs posts in all except 1 hospital. Infection control nurses in Royal Thai Army hospitals in the present study could perform their roles according to assignment except involvement in outbreak investigation in some and in research as the principle investigators in all.

Enrolled nurse medication administration.

PubMed

Kimberley, Anne; Myers, Helen; Davis, Sue; Keogh, Penny; Twigg, Di

2004-01-01

This paper describes an initiative undertaken at Sir Charles Gairdner Hospital in Perth, Western Australia to enhance the professional development of enrolled nurses to allow them to administer medications without the direct supervision of a registered nurse. This practice change proved to be a positive step for the hospital and for enrolled nurses. Benefits for patients were identified as greater continuity of care and increased timeliness of medication admiuistrqtion. The benefits for enrolled nurses were increased job satisfaction, improved morale and self esteem while the main benefit for registered nurses was decreased stres and workload.

Development of a clinical practice guideline for testing nasogastric tube placement.

PubMed

Peter, Sue; Gill, Fenella

2009-01-01

A Perth metropolitan hospital group standardized changes to nasogastric tube placement, including removal of the "whoosh test" and litmus paper, and introduction of pH testing. Two audits were conducted: bedside data collection at a pediatric hospital and a point-prevalence audit across seven hospitals. Aspirate was obtained for 97% of all tests and pH was < or = 5.5 for 84%, validating the practice changes. However, patients on continuous feeds and/or receiving acid-inhibiting medications had multiple pH testing fails. Nasogastric tube placement continues to present a challenge for those high-risk patients on continuous feeds and/or receiving acid-inhibiting medications.

Designing new collaborative learning spaces in clinical environments: experiences from a children's hospital in Australia.

PubMed

Bines, Julie E; Jamieson, Peter

2013-09-01

Hospitals are complex places that provide a rich learning environment for students, staff, patients and their families, professional groups and the community. The "new" Royal Children's Hospital opened in late 2011. Its mission is focused on improving health and well-being of children and adolescents through leadership in healthcare, research and education. Addressing the need to create "responsive learning environments" aligned with the shift to student-centred pedagogy, two distinct learning environments were developed within the new Royal Children's Hospital; (i) a dedicated education precinct providing a suite of physical environments to promote a more active, collaborative and social learning experience for education and training programs conducted on the Royal Children's Hospital campus and (ii) a suite of learning spaces embedded within clinical areas so that learning becomes an integral part of the daily activities of this busy Hospital environment. The aim of this article is to present the overarching educational principles that lead the design of these learning spaces and describe the opportunities and obstacles encountered in the development of collaborative learning spaces within a large hospital development.

Genetics Home Reference: Legg-Calvé-Perthes disease

MedlinePlus

... link) LEGG-CALVE-PERTHES DISEASE MedGen (1 link) Avascular necrosis of the capital femoral epiphysis Sources for This ... at onset-dependent presentations of premature hip osteoarthritis, avascular necrosis of the femoral head, or Legg-Calvé-Perthes ...

Two Years on: Koha 3.0 in Use at the CAMLIS Library, Royal London Homoeopathic Hospital

ERIC Educational Resources Information Center

Bissels, Gerhard; Chandler, Andrea

2010-01-01

Purpose: The purpose of this paper is to describe the further development of the Koha 3.0 library management system (LMS) and the involvement of external software consultants at the Complementary and Alternative Medicine Library and Information Service (CAMLIS), Royal London Homoeopathic Hospital. Design/methodology/approach: The paper takes the…

A portrait of prefrontal lobotomy performed at the Royal Prince Alfred Hospital in Sydney by Dr Rex Money.

PubMed

White, Richard T; McGee-Collett, Martin

2016-10-01

The objective of this article is to provide a portrait of prefrontal lobotomy performed at the Royal Prince Alfred Hospital, Sydney by the Head of Neurosurgery Dr Rex Money and to describe Dr Money's role in the promotion of psychosurgery in Sydney. We draw attention to an oral presentation by Dr Rex Money in 1951, a journal article written by Money, archival information held at the Royal Prince Alfred Hospital, including Dr Money's accounts of his travels and his reports regarding neurosurgery - both internationally and in Australia. Dr Rex Money performed a series of 13 prefrontal lobotomies between 1945 and 1951, and presented the theoretical basis for his series, his operative procedures and the outcomes at the annual meeting of its medical officers' association. Notwithstanding various deficiencies in his clinical research, Money's descriptions give a relatively comprehensive account of one of the first series of prefrontal lobotomies performed in Australia. The current article also describes Dr Money's contributions to the promotion of psychosurgery in Sydney, and illustrates the participation of a senior neurosurgeon and of a major Sydney teaching hospital during the psychosurgery saga. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Lateral and posterior pillar grade changes during the treatment of Perthes disease in older patients using skin traction and range of motion exercises.

PubMed

Sugimoto, Yoshihisa; Akazawa, Hirofumi; Mitani, Shigeru; Tanaka, Masato; Nakagomi, Tadashi; Asaumi, Koji; Ozaki, Toshifumi

2006-03-01

The lateral pillar (LP) grade changes detected during treatment periods have received a lot of attention recently. Lappin et al. reported LP collapses in 92 of 275 (33%) patients during the treatment, but did not provide information for comparing treatment methods and age of onset of the disease. The purpose of this study was to review radiological changes in LP grade in older patients with Perthes disease during 20 months of treatment with skin traction and ROM exercises. We have also reported any grade changes in the posterior pillar (PP) classification. Twenty-one patients with unilateral disease who were 9 years or older at the onset of symptoms had been followed until skeletal maturity. Out of 21 older patients with Perthes disease, our study had two (9.5%) who experienced LP collapse and two (9.5%) who experienced PP collapse during the first 20 months of treatment. The average time from onset to hospitalization in hips, initially classified as LP group C and PP group C, was significantly longer than in LP and PP groups A and B. The LP collapse in two hips and PP collapse in two hips occurred during months 4-8 of treatment. On the other hand, of the patients allowed to ambulate with the Pogo stick orthosis from months 8 to 12 and without a brace from months 10 to 15, none had a collapse of their LPs or PPs during these periods. Lappin et al. reported that 92 of 275 patients (33%) who were managed conservatively in several hospitals experienced LP collapse during their treatment periods. Our results suggest that older patients with this disease treated with skin traction and ROM exercises rarely suffer a LP collapse, as compared with the Lappin et al. report.

Different methods of treatment related to the bilateral occurrence of Perthes' disease.

PubMed

Futami, T; Suzuki, S

1997-11-01

We treated 98 consecutive patients with Perthes' disease by a unilateral brace in external rotation, flexion and abduction and a further consecutive 110 by a bilateral cast with the hips in internal rotation and abduction. During treatment in the unilateral brace, six (6.1%) hips on the opposite side developed evidence of Perthes' disease and one developed this after the brace had been removed. In children managed in bilateral casts, no contralateral Perthes' disease was seen. Adequate containment of the femoral head may prevent subsequent changes in the opposite hip.

Initial statistics from the Perth Automated Supernova Search

NASA Astrophysics Data System (ADS)

Williams, A. J.

1997-08-01

The Perth Automated Supernova Search uses the 61-cm PLAT (Perth Lowell Automated Telescope) at Perth Observatory, Western Australia. Since 1993 January 1, five confirmed supernovae have been found by the search. The analysis of the first three years of data is discussed, and preliminary results presented. We find a Type Ib/c rate of 0.43 +/- 0.43 SNu, and a Type IIP rate of 0.86 +/- 0.49 SNu, where SNu are 'supernova units'. These values are for a Hubble constant of 75 km per sec per Mpc.

Implementation of an Open Source Library Management System: Experiences with Koha 3.0 at the Royal London Homoeopathic Hospital

ERIC Educational Resources Information Center

Bissels, Gerhard

2008-01-01

Purpose: The purpose of this paper is to describe the selection process and criteria that led to the implementation of the Koha 3.0 library management system (LMS) at the Complementary and Alternative Medicine Library and Information Service (CAMLIS), Royal London Homoeopathic Hospital. Design/methodology/approach: The paper is a report based on…

A method to investigate the biomechanical alterations in Perthes' disease by hip joint contact modeling.

PubMed

Salmingo, Remel Alingalan; Skytte, Tina Lercke; Traberg, Marie Sand; Mikkelsen, Lars Pilgaard; Henneberg, Kaj-Åge; Wong, Christian

2017-01-01

Perthes' disease is a destructive hip joint disorder characterized by malformation of the femoral head in young children. While the morphological changes have been widely studied, the biomechanical effects of these changes still need to be further elucidated. The objective of this study was to develop a method to investigate the biomechanical alterations in Perthes' disease by finite element (FE) contact modeling using MRI. The MRI data of a unilateral Perthes' case was obtained to develop the three-dimensional FE model of the hip joint. The stress and contact pressure patterns in the unaffected hip were well distributed. Elevated concentrations of stress and contact pressure were found in the Perthes' hip. The highest femoral cartilage von Mises stress 3.9 MPa and contact pressure 5.3 MPa were found in the Perthes' hip, whereas 2.4 MPa and 4.9 MPa in the healthy hip, respectively. The healthy bone in the femoral head of the Perthes' hip carries additional loads as indicated by the increase of stress levels around the necrotic-healthy bone interface. Identifying the biomechanical changes, such as the location of stress and contact pressure concentrations, is a prerequisite for the preoperative planning to obtain stress relief for the highly stressed areas in the malformed hip. This single-patient study demonstrated that the biomechanical alterations in Perthes' disease can be evaluated individually by patient-specific finite element contact modeling using MRI. A multi-patient study is required to test the strength of the proposed method as a pre-surgery planning tool.

Evaluation of gait performance of a participant with Perthes disease while walking with and without a Scottish-Rite orthosis.

PubMed

Karimi, Mohammad; Sedigh, Jafar; Fatoye, Francis

2013-06-01

Scottish-Rite orthosis is one of the conservative methods used to treat Legg-Calvé-Perthes disease. As there was not enough evidence to show the effects of using this orthosis on reducing the loads applied on the limb, this research aimed to find the influence of this orthosis. A participant with Perthes disease on the left hip joint was recruited into this study to walk with and without the orthosis. The kinetic and kinematic parameters were collected by a motion analysis system and a Kistler force platform. No significant differences were noted between the hip joint flexion/extension range of motion and the moments between the sound side and the side affected by Legg-Calvé-Perthes disease. It may be concluded that use of orthosis may not have any positive effects to decrease the loads or to improve the alignment of the hip joint in participants with Perthes disease, as expected. The use of Scottish-Rite orthosis not only does not improve the containment of the hip joint, but also does not have any significant influence on loads applied on the joint during walking of the subject with Perthes disease. The results of this research can be used by clinicians involved in treatment of patients with Legg-Calvé-Perthes disease.

The first lady almoner: the appointment, position, and findings of Miss Mary Stewart at the Royal Free Hospital, 1895-99.

PubMed

Cullen, Lynsey T

2013-10-01

This article examines the professional roots of the hospital almoner, a position which has been widely neglected in medical history. The first almoner was Miss Mary Stewart, a former Charity Organization Society employee, appointed at the Royal Free Hospital of central London in 1895. The Royal Free was a charitable hospital which offered free medical treatment to patients considered morally deserving but unable to afford medical care elsewhere. The role expected of Stewart was to means test patients in order to ensure that only those deemed "appropriate" received free medical treatment, and to establish the extent to which the hospital was being abused by those who could afford to contribute toward their medical care. While in office, Stewart continually reshaped the role of almoner. She fashioned the position into that of a medical social worker and undertook such duties as referring patients to other means of medical and charitable assistance, visiting patients' homes, and training almoners for positions at other voluntary hospitals. Through the examination of Mary Stewart's Almoners Report Book, this article considers the circumstances of her appointment, the role she performed, and the findings of her investigations.

The First Lady Almoner: The Appointment, Position, and Findings of Miss Mary Stewart at the Royal Free Hospital, 1895–99

PubMed Central

Cullen, Lynsey T.

2013-01-01

This article examines the professional roots of the hospital almoner, a position which has been widely neglected in medical history. The first almoner was Miss Mary Stewart, a former Charity Organization Society employee, appointed at the Royal Free Hospital of central London in 1895. The Royal Free was a charitable hospital which offered free medical treatment to patients considered morally deserving but unable to afford medical care elsewhere. The role expected of Stewart was to means test patients in order to ensure that only those deemed “appropriate” received free medical treatment, and to establish the extent to which the hospital was being abused by those who could afford to contribute toward their medical care. While in office, Stewart continually reshaped the role of almoner. She fashioned the position into that of a medical social worker and undertook such duties as referring patients to other means of medical and charitable assistance, visiting patients' homes, and training almoners for positions at other voluntary hospitals. Through the examination of Mary Stewart's Almoners Report Book, this article considers the circumstances of her appointment, the role she performed, and the findings of her investigations. PMID:22474098

Enhancing the clinical utility of the burn specific health scale-brief: not just for major burns.

PubMed

Finlay, V; Phillips, M; Wood, F; Hendrie, D; Allison, G T; Edgar, D

2014-03-01

Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice. This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients. BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzed Cronbach's alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B. Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach's alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p<0.001, p<0.001, p=0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p<0.001). The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns. The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

In the media: Burns as a method of assault.

PubMed

O'Halloran, E; Duke, J; Rea, S; Wood, F

2013-09-01

The aims of this study were to determine whether a change occurred in the pattern of assault burn injury cases hospitalised to the adult state burns unit, Western Australia, from 2004 to mid-year of 2012, and to compare patient and burn characteristics of adult assault burns with those admitted for unintentional burns. Study data were obtained from the Royal Perth Hospital (RPH) Burns Minimum Dataset (BMDS). Aggregated data of unintentional burn admissions during the same period were provided by the BMDS data manager to enable comparisons with assault burn patients. Assault burn admissions during 2004-2012 accounted for approximately 1% of all adult burn hospitalisations. All assault victims were burned by either thermal or scald agents. A high rate of intubation (24%) and ICU admission (1 in 3 cases) was observed in the fire assault group. The six assault cases undergoing intubation were severe burns, median TBSA 50%, most commonly affecting the face, head and torso, half of these cases had inhalational injuries and also required escharotomies. Comparison of admissions by calendar period showed no statistically significant differences in demographic, burn cause or TBSA%. However, statistically significant differences were found for pre-morbid psychiatric history (15% vs. 58%, p=0.025) and concomitant fractures or dislocations (46% vs. 2%), p=0.011). While the proportion of assault burn admissions per total burn admissions steadily increased from 0.4% in 2009 to 1.5% in mid-2012, this proportion did not exceed that peak level observed of 2.1% for 2004. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

A Census of Residents in Canadian Hospitals Approved for Training by the Royal College of Physicians and Surgeons of Canada, April 1965

PubMed Central

Clarke, G. Grant; Fish, D. G.; Giles, T. J.

1966-01-01

A census taken in April 1965 revealed that there were 3162 residents training in Canadian hospitals approved by the Royal College of Physicians and Surgeons of Canada. Thirty-one of the 151 approved hospitals had no residents in training, and another 43 hospitals each having 20 or more residents accounted for 85% of all residents training in Canada. Fifty-seven per cent of the residents in Canada were Canadian citizens, 19% were landed immigrants, and 24% were foreign trainees. Major teaching hospitals contained 65% of all residents; 70% of Canadian graduates and 60% of non-Canadian graduates were training in major teaching hospitals. Hospitals approved for full training in the specialty of the trainee contained 57% of all residents; 64% of Canadian graduates and 48% of foreign graduates were in such hospitals. PMID:5908720

Major cluster of chilblain cases in a cold dry Western Australian winter.

PubMed

Larkins, Nicholas; Murray, Kevin J

2013-02-01

Primary chilblains are an idiopathic cold-induced vasculopathy affecting the soft tissues of the hands and feet. Secondary chilblains occur in different forms of vasculitis and chronic autoimmune connective tissue disorders. Idiopathic chilblains are rarely reported in children and may generate significant anxiety to doctors and patients. We describe a cluster of idiopathic chilblains encountered over the winter of 2010 in Perth, Western Australia. This is a retrospective review of patients identified from a prospectively compiled database of all new cases seen in our department. Data on history, examination, investigations, prescribed treatments and outcomes were collected. Thirty-two patients with isolated idiopathic chilblains were included, including 20 females and 12 males with a median age at onset of 13.5 years. Lesions were papular with signs of peripheral vasoconstriction causing acrocyanosis, and uncomfortable due to pain and/or pruritis in most. Thickening of the small joints was common where lesions involved these areas. Ulceration of lesions also occurred in some. One patient required hospitalisation for secondary bacterial infection. Most received some form of treatment including non-steroidal anti-inflammatory drugs, prednisolone or nifedipine. Most patients improved spontaneously with warmer weather or responded to cold protection advice. All had resolved completely by late spring (November). Our cluster of chilblains was associated with an unusually cold winter in Perth 2010. It is the largest series reported in the literature, suggesting that chilblains may be more common than previously thought. Chilblains are almost always benign in nature and patients are systemically well and usually need no further investigation and only symptomatic treatment. Prompt recognition can avoid excessive investigation and anxiety, allowing appropriate simple advice and treatment. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

1. Photocopy of measured drawing (original delineated by the Royal ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Photocopy of measured drawing (original delineated by the Royal Danish Academy of Fine Arts (Kunstakademiets), Copenhagen, Denmark, 1961) Photographer and date of photograph unknown HOSPITALSGADE (FRONT) ELEVATION - Hospitalsgade 23 (House), 23 Hospital Street, Christiansted, St. Croix, VI

[Gynecologic oncology at the Royal Hospital for Women, Sidney. Report on a 10 month overseas stay].

PubMed

Gitsch, G

1995-01-01

Gynecologic oncology is centralized in Australia. In centers like the Royal Hospital for Women in Sydney, more than 300 patients/year with gynecologic malignancies are operated on. The establishment of gynecologic oncology as a special field is illustrated. In addition, the 3-year training program of gynecologic oncologists is reviewed. The international trend towards specialization is emphasized, and the advantages of centralization and additional training are pointed out. An adaptation of the Australian model for Austrian circumstances is proposed.

Earth Observations taken by the Expedition 16 Crew

NASA Image and Video Library

2007-12-24

ISS016-E-018493 (24 Dec. 2007) --- Perth Amboy, New Jersey is featured in this image photographed by an Expedition 16 crewmember on the International Space Station. The port city of Perth Amboy is located between the outlets of the Raritan River and Arthur Kill ("river" in Dutch) into Raritan Bay in upper New Jersey. According to scientists, rich clay beds in the region, formed during the Cretaceous Era (approximately 65-144 million years ago), provided the raw materials for numerous pottery and terra cotta manufacturers during the 19th century. The city became an industrial and shipping center, and resort destination, through the early to mid-20th century. While the majority of the industrial factory facilities have left Perth Amboy, petroleum processing and storage remains part of the economic base -- several refining facilities are visible along the banks of Arthur Kill in this image (upper left). Originally known simply as "Amboy", "Perth" was added to the name in honor of the Earl of Perth when the city became the capital of East Jersey in 1686. Together with South Amboy across the Raritan River, both cities are collectively known today as "the Amboys". Perth Amboy is currently undergoing urban renewal and redevelopment to resume its former status of a resort destination. Raritan Bay also provides a source of local income through clam fishing.

Management of Late Onset Perthes: Evaluation of Distraction by External Fixator—5-Year Follow-Up

PubMed Central

Srivastava, Rajeshwar N.; Shukla, Prashant; Pushkar, Amit; Ali, Sabir

2014-01-01

Background. Hip distraction in Perthes' disease unloads the joint, which negates the harmful effect of the stresses on the articular surfaces, which may promote the sound healing of the area of necrosis. We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. Methods and Materials. Twelve children with age more than 8 years with Perthes' disease of less than one year were treated with hip distraction by a hinged monolateral external fixator. Observation and Results. Mean duration of distraction was 13.9 days. These children were evaluated by clinicoradiological parameters for a mean period of 32.4 months. There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant. There was significant improvement in Harris Hip score. Conclusions. Hip distraction by hinged monolateral external fixator seems to be a valid treatment option in cases with Perthes' disease in the selected group of patients, where poor results are expected from conventional treatment. PMID:25580302

Preventing falls in hospital.

PubMed

Pearce, Lynne

2017-01-31

Essential facts Falls are the most frequently reported adverse events in hospitals, especially among older patients. According to the Royal College of Physicians (RCP) more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wale.

Perthes disease in a 2-year-old child.

PubMed

Dhas, Daphne; Viswanath, Aparna; Latimer, Mark David

2015-03-02

Perthes disease represents a transient interruption of the blood supply to the femoral head followed by collapse and subsequent remodelling. The majority of cases present between the ages of 4 and 10 years. We report the case of a child who developed a painful right-sided limp some days after his second birthday. The limp was initially interpreted as a transient synovitis of the hip. However, when the limp persisted, further investigations revealed that he had Perthes disease. 2015 BMJ Publishing Group Ltd.

Perthes disease in a 2-year-old child

PubMed Central

Dhas, Daphne; Viswanath, Aparna

2015-01-01

Perthes disease represents a transient interruption of the blood supply to the femoral head followed by collapse and subsequent remodelling. The majority of cases present between the ages of 4 and 10 years. We report the case of a child who developed a painful right-sided limp some days after his second birthday. The limp was initially interpreted as a transient synovitis of the hip. However, when the limp persisted, further investigations revealed that he had Perthes disease. PMID:25733084

A tale of two hospitals: assessing cultural landscapes and compositions.

PubMed

Braithwaite, Jeffrey; Westbrook, Mary T; Iedema, Rick; Mallock, Nadine A; Forsyth, Rowena; Zhang, Kai

2005-03-01

Clinical directorate service structures (CDs) have been widely implemented in acute settings in the belief that they will enhance efficiency and patient care by bringing teams together and involving clinicians in management. We argue that the achievement of such goals depends not only on changing its formalized structural arrangements but also the culture of the organisation concerned. We conducted comparative observational studies and questionnaire surveys of two large Australian teaching hospitals similar in size, role and CD structure. Martin's conceptualization of culture in terms of integration, differentiation and fragmentation was applied in the analysis of the data. The ethnographic work revealed that compared to Metropolitan Hospital, Royal Hospital was better supported and more favourably viewed by its staff across six categories identified in both settings: leadership, structure, communication, change, finance and human resource management. Royal staff were more optimistic about their organisation's ability to meet future challenges. The surveys revealed that both staff groups preferred CD to traditional structures and shared some favourable and critical views of them. However Royal staff were significantly more positive, reporting many more benefits from CDs e.g. improved working relations, greater accountability and efficiency, better cost management, more devolvement of management to clinicians and a hospital more strategically placed and patient focused. Metropolitan staff were more likely to claim that CDs failed to solve problems and created a range of others including disunity and poor working relationships. There was greater consensus of views among Royal staff and more fragmentation at Metropolitan where both intensely held and uncertain attitudes were more common. The outcomes of implementing CDs in these two similar organisations differed considerably indicating the need to address cultural issues when introducing structural change. Martin's framework provides a useful antidote to researchers' tendency to focus at only one level of culture.

Situational leadership styles, staff nurse job characteristics related to job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army.

PubMed

Intaraprasong, Bhusita; Potjanasitt, Sureporn; Pattaraarchachai, Junya; Meennuch, Chavalit

2012-06-01

To analyze the relationships between the situational leadership styles, staff nurse job characteristic with job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army The cross-sectional analytical study was conducted in 128 head nurses working in hospitals under the jurisdiction of the Royal Thai Army. Data were collected by mailed questionnaires. A total of 117 completed questionnaires (91.4%) were received for analysis. Statistical analysis was done using Pearson's Product Moment Correlation Coefficient. It was found that situational leadership styles were not correlated with job satisfaction and organizational commitment of head nurses. Staff nurse job characteristics had a low level of positive correlation with job satisfaction and organizational commitment of head nurses at 0.05 level of significance (r = 0.202 and 0.189 respectively). The hospital administrators should formulate policy to improve working system, human resource management and formulate policies and strategies based on situational leadership. In addition, they should improve the characteristics of staff nurse job by using surveys to obtain job satisfaction and organizational commitment.

Legg-Calve-Perthes Disease

MedlinePlus

... commonly begins between ages 4 and 8. Your child's sex. Legg-Calve-Perthes is up to five times more common in boys than in girls. Race. White children are more likely to develop the disorder than ...

[Legg-Calvé-Perthes disease].

PubMed

Wiig, Ola; Svenningsen, Svein; Terjesen, Terje

2011-05-20

Legg-Calvé-Perthes disease is characterized by avascular necrosis of the head of the femur. This article deals with the epidemiology, possible causes, treatment and prognostic factors connected with the disease. The article is based on a non-systematic literature search and own clinical practice, with special emphasis on a Norwegian countrywide study of children with Legg-Calvé-Perthes disease. The incidence of Legg-Calvé-Perthes disease varies in different countries and regions. Those who are older than six years at the time of diagnosis and have over 50% femoral head necrosis have a worse prognosis than younger children where the necrosis is less extensive. Treatment has been discussed extensively over the past 100 years, and still varies considerably. The Norwegian countrywide investigation showed that the results in children who were over six years at the time of diagnosis and had more than 50% femoral head necrosis were significantly better after varus femoral osteotomy than after physiotherapy or orthosis. This agrees with the only other prospective study that has been published. Operative treatment should be considered in children who are six years old or older and have over 50% femoral head necrosis when the diagnosis Legg-Calvé-Perthes disease is made. Those who are younger than six years at the time of diagnosis or who have less than 50% femoral head necrosis should be treated symptomatically. Abduction orthosis has no place in the treatment of Legg-Calvé-Perthes disease.

Legg-Calvé-Perthes disease.

PubMed

Carpenter, B N

1975-03-01

The incidence, pathology, etiology, clinical characteristics, differential diagnosis, and treatment of Legg-Calvé-Perthes disease are reviewed. Physical therapy and follow-up care are discussed, with emphasis on the relationship between orthopedic and physical therapy services.

Methicillin-resistant Staphylococcus aureus, Western Australia

PubMed Central

Dailey, Lynne; Coombs, Geoffrey W.; O'Brien, Frances G.; Pearman, John W.; Christiansen, Keryn; Grubb, Warren B.

2005-01-01

Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a notable cause of hospital-acquired infections. A statewide screening and control policy was implemented in Western Australia (WA) after an outbreak of epidemic MRSA in a Perth hospital in 1982. We report on statutory notifications from1998 to 2002 and review the 20-year period from 1983 to 2002. The rate of reporting of community-associated Western Australia MRSA (WAMRSA) escalated from 1998 to 2002 but may have peaked in 2001. Several outbreaks were halted, but they resulted in an increase in reports as a result of screening. A notable increase in ciprofloxacin resistance during the study period was observed as a result of more United Kingdom epidemic MRSA (EMRSA) -15 and -16. WA has seen a persistently low incidence of multidrug-resistant MRSA because of the screening and decolonization program. Non–multidrug-resistant, community-associated WAMRSA strains have not established in WA hospitals. PMID:16318700

Art in wartime: The First Wounded, London Hospital, August 1914.

PubMed

Park, M P; Park, R H R

2011-06-01

John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.

Preventing falls in hospital.

PubMed

Pearce, Lynne

2017-01-04

Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 per day, according to the Royal College of Physicians (RCP).

Retinopathy of prematurity: the high cost of screening regional and remote infants.

PubMed

Yu, Tzu-Ying; Donovan, Tim; Armfield, Nigel; Gole, Glen A

2018-01-25

Demand for retinopathy of prematurity (ROP) screening is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. The objective of this study is to evaluate the cost of ROP screening at a large centralized tertiary neonatal service for infants from regional/rural hospitals. This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28-month period. A total of 131 infants were included in this study. Individual infant costs were calculated from analysis of clinical and administrative records. Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669 413. The average cost per infant screened was highest for infants from a regional centre with a population of 75 000 (AUD$14 856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. Health system costs for ROP screening of remote infants at a centralized hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening. © 2018 Royal Australian and New Zealand College of Ophthalmologists.

Hazardous Waste Cleanup: Chemtura Corporation in Perth Amboy, New Jersey

EPA Pesticide Factsheets

The Chemtura Corporation (formerly Crompton Corp.) is located at 10 Convery Boulevard in Perth Amboy, New Jersey. The site encompasses approximately 25 acres, and is an active facility that manufactures chemicals and chemical intermediates for a variety

The medical career of Robert Seymour Bridges, FRCP (1844-1930): physician and Poet Laureate.

PubMed

Cook, G C

2002-09-01

Robert Bridges OM is the only medical graduate (he was elected to the Fellowship of the Royal College of Physicians of London in 1900) to have held the office of Poet Laureate. Educated at Corpus Christi College, Oxford and St Bartholomew's Hospital he practised as a casualty physician at his teaching hospital (where he made a series of highly critical remarks of the Victorian medical establishment) and subsequently as a full physician to the Great (later Royal) Northern Hospital. He was also a physician to the Hospital for Sick Children. It had for long been his intention to retire from the medical profession at the early age of 40! In 1913, Bridges was appointed Poet Laureate by King George V, and following a disappointingly sparse output of "official" work, published his greatest literary contribution-The Testament of Beauty-on his 85th birthday.

The advent of psychosurgery in Australia-with particular attention to its introduction into Sydney.

PubMed

White, Richard T; McGee-Collett, Martin

2016-10-01

The objective of this study was to describe the advent of prefrontal lobotomy in Sydney and, less comprehensively, its introduction into Australia. Reference to journal articles, books, reports and archival data held at the Royal Prince Alfred Hospital and via internet searches, interviews and personal memory. This paper describes the arrival of psychosurgery in Sydney in the mid-1940s, and less comprehensively, its arrival in other Australian cities. In New South Wales, from 1945 or 1946, prefrontal lobotomies were conducted in private clinics and in public hospitals but, because of legal and practical hurdles, it is unlikely that psychosurgery was performed in mental hospitals prior to December 1958. This paper gives some details regarding the participation of neurosurgeons and of the major public hospitals in psychosurgery, and touches on the attitudes within the Australian medical profession towards this dramatic new therapy. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Assessment of continuous oil and gas resources in the Perth Basin Province, Australia, 2017

USGS Publications Warehouse

Schenk, Christopher J.; Tennyson, Marilyn E.; Finn, Thomas M.; Mercier, Tracey J.; Hawkins, Sarah J.; Gaswirth, Stephanie B.; Marra, Kristen R.; Klett, Timothy R.; Le, Phuong A.; Leathers-Miller, Heidi M.; Woodall, Cheryl A.

2017-07-17

Using a geology-based assessment methodology, the U.S. Geological Survey assessed undiscovered, technically recoverable mean resources of 223 million barrels of oil and 14.5 trillion cubic feet of gas in the Perth Basin Province, Australia.

Management of BK virus nephropathy in kidney transplant recipients at the Royal Hospital - Clinical Audit - Oman.

PubMed

Al-Raisi, Fatma; Mohsin, Nabil; Kamble, Pramod

2015-04-01

Nephropathy from BK virus (BKV) infection is a growing challenge in kidney transplant recipients globally. It is the result of contemporary potent immunosuppressives aimed at reducing acute rejection and improving allograft survival. Untreated BK virus infections lead to kidney allograft dysfunction or loss. Decreased immunosuppression is the principle treatment but predisposes to acute and chronic rejection. Screening for early detection and prevention of symptomatic BK virus nephropathy may improve outcomes. Although no approved antiviral drug is available, leflunomide, cidofovir, quinolones, and intravenous immunoglobulin have been used. Since the introduction of the new immunosuppressive agents in the transplant regimen at the Royal Hospital, Few cases of BK virus have been detected, and the challenge was to decide upon the best treatment option. The audit was carried out at the Royal Hospital-Oman between January 2010 and December 2012. The nephrology consultant and the clinical pharmacist reviewed all the BK cases and the Royal Hospital. Extensive literature review carried out by the pharmacist to look into the prevalence, prognosis and treatment of BK nephropathy. A treatment protocol was prepared by the clinical pharmacist through guidance of the consultant and was peer reviewed by team of clinical pharmacists and nephrology doctors and approved by the consultant. The audit included 19 patients with positive BK virus ployoma nephropathy. The treatment options were applied stepwise in all the patients with BK virus nephropathy with success rate more than 70%. BK virus nephropathy is emerging at an alarming rate and requires increasing awareness. The uses of current treatment options are still questionable. Our audit confirms that reducing immunosuppression appears to be the criterian standard for the treatment of BK nephropathy.

Flamsteed's stars. New perspectives on the life and work of the first Astronomer Royal (1646 - 1719).

NASA Astrophysics Data System (ADS)

Willmoth, F.

Contents: 1. Introduction: the King's "astronomical observer". 2. Flamsteed's career in astronomy: nobility, morality and public utility (J. Bennett). 3. Astronomy and strife: John Flamsteed and the Royal Society (M. Feingold). 4. Models for the practice of astronomy: Flamsteed, Horrocks and Tycho (F. Willmoth). 5. Flamsteed's optics and the identity of the astronomical observer (A. Johns). 6. Equipping an observatory: Flamsteed and Molyneux discuss an astronomical quadrant (H. Higton). 7. Mathematical characters: Flamsteed and Christ's Hospital Royal Mathematical School (R. Iliffe). 8. "Professor" John Flamsteed (I. G. Stewart). 9. Edmond Halley and John Flamsteed at the Royal Observatory (A. Cook). 10. A unique copy of Flamsteed's Historia coelestis (1712) (O. Gingerich). 11. "Labour harder than thrashing": John Flamsteed, property and intellectual labour in nineteenth-century England (W. J. Ashworth). 12. The Flamsteed papers in the archives of the Royal Greenwich Observatory. (A. Perkins). A summary catalogue of Flamsteed's papers in the Royal Greenwich Observatory archives (compiled by F. Willmoth).

Perthes' disease of the hip: socioeconomic inequalities and the urban environment.

PubMed

Perry, Daniel C; Bruce, Colin E; Pope, Daniel; Dangerfield, Peter; Platt, Mary Jane; Hall, Andrew J

2012-12-01

Perthes' disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as a risk factor, however socioeconomic deprivation often occurs within urban environments and it is unclear if this association is the result of confounding. The objective of the current work was to gain a greater understanding of the influence of the urban/rural environment in Perthes' disease. This was a descriptive observational study using the Scottish Morbidity Record, based in Scotland, UK using data from 2000-2010. A total of 443 patients with a discharge diagnosis of Perthes' disease were included. Socioeconomic deprivation was determined using the Scottish Index of Multiple Deprivation, and exposure to the 'urban environment' was recorded based on the Scottish Urban-Rural Classification. There was a strong association with socioeconomic deprivation, with rates among the most deprived quintile more than twice those of the most affluent (RR 2.1 (95% CI 1.5 to 2.9)). Urban areas had a greater rate of Perthes' disease discharges (RR 1.8 (95% CI 1.1 to 3.2)), though this was a reflection of greater deprivation in urban areas. Stratification for socioeconomic deprivation revealed similar discharge rates in urban and rural environments, suggesting that the aetiological determinants were not independently associated with urban environments. The occurrence of Perthes' disease within urban environments is high, yet this appears to be a reflection of higher socioeconomic deprivation exposure. Disease rates appear equivalent in similarly deprived urban and non-urban areas, suggesting that the determinant is not a consequence of the urban environment.

Pliocene-Pleistocene coastal events and history along the western margin of Australia

USGS Publications Warehouse

Kendrick, G.W.; Wyrwoll, K.-H.; Szabo, B. J.

1991-01-01

Coastal deposits along the western coastal margin of Australia, a region of relative tectonic stability, record Plio-Pleistocene events and processes affecting the inner shelf and adjacent hinterland. Tectonic deformation of these deposits is more apparent in the Carnarvon Basin, and rather less so in the Perth Basin. The most complete record comes from the Perth Basin, where units of Pliocene and Pleistocene ages are well represented. In the Perth Basin, the predominantly siliciclastic Yoganup Formation, Ascot Formation and Bassendean Sand represent a complex of shoreline, inner shelf and regressive-dune facies equivalents, the deposition of which began at an undetermined stage of the Pliocene, through to the Early Pleistocene. The deposition of this sequence closed with a major regression and significant faunal extinction. Bioclastic carbonates characterize the Middle and Late Pleistocene of the Perth and Carnarvon basins. Fossil assemblages include a distinct subtropical element, unknown from the Ascot Formation and suggesting a strengthening of the Leeuwin Current. The estuarine arcoid bivalve Anadara trapezia characterizes assemblages of Oxygen Isotope Stages 5 and 7 in the Perth and Carnarvon basins, where it is now extinct. Deposits of Substage 5e (Perth Basin) also record a southerly expansion of warm-water corals and other fauna consistent with shelf temperatures warmer than present. New uranium-series ages on corals from marine sequences of the Tantabiddi Member, of the Bundera Calcarenite of the western Cape Range are consistent with the 'double peak' hypothesis for levels of Substage 5e but the evidence remains less than conclusive. Initial uranium-series dates from the Bibra and Dampier formations of Shark Bay indicate that both derive from the Late Pleistocene. These numerical ages contradict previous interpretations of relative ages obtained from field studies. The age relationship of the units requires further investigation. ?? 1991.

Private finance initiative hospital architecture: towards a political economy of the Royal Liverpool University Hospital.

PubMed

Jones, Paul

2018-02-01

Sociological analysis has done much to illuminate the architectural contexts in which social life takes place. Research on care environments suggests that the built environment should not be understood as a passive backdrop to healthcare, but rather that care is conditioned by the architecture in which it happens. This article argues for the importance of going beyond the hospital walls to include the politics that underwrite the design and construction of hospital buildings. The article assesses the case of the yet-to-be-realised Liverpool Royal University Hospital, and the private finance initiative (PFI) funding that underpins the scheme, which is suggested as a salient 'external' context for understanding architecture's role in the provision of healthcare of many kinds for many years to come. PFI has major implications for democratic accountability and local economy, as well as for the architecture of the hospital as a site of care. Critical studies can illuminate these paradoxically visible-but-opaque hospital spaces by going beyond that which is immediately empirically evident, so as to reveal the ways in which hospital architecture is conditioned by political and economic forces. © 2018 Foundation for the Sociology of Health & Illness.

Central line associated sepsis in children receiving parenteral nutrition in Oman.

PubMed

Al Lawati, Tawfiq T; Al Jamie, Adawaiya; Al Mufarraji, Nasra

Parenteral Nutrition (PN) is used when gut fails to provide complete nutrition. Central line Associate Blood Stream Infection (CLABSI) a major complication of this therapy. The objective of the study was to report the incidence of CLABSI and associated mortality in children receiving PN in the Royal Hospital and study the indication and duration of PN use. All children from the age of 0-48 months who received TPN outside NICU from the period between 1/1/2011 till 31/12/2014 were included. Data were retrieved from the hospital electronic data base. There were 42 children 27 males and 15 females who used PN through a central line for a total duration of 569 days. The incidence of CLABSI was 14 days per 1000 days catheter and mortality of 556 per 10000. The average duration of TPN was 14.5 days. Most of the patient had CLABSI in the PICU and cardiac related illness or surgery was the most common indication of PN use. The average duration of use was 14 days. Inspite of that short duration use of PN, there is a very high incidence of CLABSI and its related mortality. Bundle policy for central line care is not used in the Royal Hospital and this study calls for urgent implementation of central line care bundle policy in the Royal Hospital. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

USING POSITIVE CLINICAL LEADERSHIP TO SUPPORT A CULTURE OF PRESSURE INJURY PREVENTION.

PubMed

Sage, Sarah; Tudor, Hannah

2017-03-01

The Royal Melbourne Hospital (RMH) is an 800 bed tertiary referral service within metropolitan Melbourne. While the hospital acquired pressure injury (HAPI) incidence rate is low (2.5%), there is still work to be done in this area.

Effects of Repeated Annual Inactivated Influenza Vaccination among Healthcare Personnel on Serum Hemagglutinin Inhibition Antibody Response to A/Perth/16/2009 (H3N2)-like virus during 2010–11

PubMed Central

Thompson, Mark G.; Naleway, Allison; Fry, Alicia M.; Ball, Sarah; Spencer, Sarah M.; Reynolds, Sue; Bozeman, Sam; Levine, Min; Katz, Jacqueline M.; Gaglani, Manjusha

2016-01-01

Background Recently, lower estimates of influenza vaccine effectiveness (VE) against A(H3N2) virus illness among those vaccinated during the previous season or multiple seasons have been reported; however, it is unclear whether these effects are due to differences in immunogenicity. Methods We performed hemagglutination inhibition antibody (HI) assays on serum collected at preseason, ∼30 days post-vaccination, and postseason from a prospective cohort of healthcare personnel (HCP). Eligible participants had medical and vaccination records for at least four years (since July, 2006), including 578 HCP who received 2010–11 trivalent inactivated influenza vaccine [IIV3, containing A/Perth/16/2009-like A(H3N2)] and 209 HCP who declined vaccination. Estimates of the percentage with high titers (≥40 and > 100) and geometric mean fold change ratios (GMRs) to A/Perth/16/2009-like virus by number of prior vaccinations were adjusted for age, sex, race, education, household size, hospital care responsibilities, and study site. Results Post-vaccination GMRs were inversely associated with the number of prior vaccinations, increasing from 2.3 among those with 4 prior vaccinations to 6.2 among HCP with zero prior vaccinations (F[4,567] = 9.97, p < .0005). Thirty-two percent of HCP with 1 prior vaccination achieved titers >100 compared to only 11% of HCP with 4 prior vaccinations (adjusted odds ratio = 6.8, 95% CI = 3.1 – 15.3). Conclusion Our findings point to an exposure-response association between repeated IIV3 vaccination and HI for A(H3N2) and are consistent with recent VE observations. Ultimately, better vaccines and vaccine strategies may be needed in order to optimize immunogenicity and VE for HCP and other repeated vaccinees. PMID:26813801

Effects of Repeated Annual Inactivated Influenza Vaccination among Healthcare Personnel on Serum Hemagglutinin Inhibition Antibody Response to A/Perth/16/2009 (H3N2)-like virus during 2010-11.

PubMed

Thompson, Mark G; Naleway, Allison; Fry, Alicia M; Ball, Sarah; Spencer, Sarah M; Reynolds, Sue; Bozeman, Sam; Levine, Min; Katz, Jacqueline M; Gaglani, Manjusha

2016-02-10

Recently, lower estimates of influenza vaccine effectiveness (VE) against A(H3N2) virus illness among those vaccinated during the previous season or multiple seasons have been reported; however, it is unclear whether these effects are due to differences in immunogenicity. We performed hemagglutination inhibition antibody (HI) assays on serum collected at preseason, ∼ 30 days post-vaccination, and postseason from a prospective cohort of healthcare personnel (HCP). Eligible participants had medical and vaccination records for at least four years (since July, 2006), including 578 HCP who received 2010-11 trivalent inactivated influenza vaccine [IIV3, containing A/Perth/16/2009-like A(H3N2)] and 209 HCP who declined vaccination. Estimates of the percentage with high titers (≥ 40 and>100) and geometric mean fold change ratios (GMRs) to A/Perth/16/2009-like virus by number of prior vaccinations were adjusted for age, sex, race, education, household size, hospital care responsibilities, and study site. Post-vaccination GMRs were inversely associated with the number of prior vaccinations, increasing from 2.3 among those with 4 prior vaccinations to 6.2 among HCP with zero prior vaccinations (F[4,567]=9.97, p<.0005). Thirty-two percent of HCP with 1 prior vaccination achieved titers >100 compared to only 11% of HCP with 4 prior vaccinations (adjusted odds ratio=6.8, 95% CI=3.1 - 15.3). Our findings point to an exposure-response association between repeated IIV3 vaccination and HI for A(H3N2) and are consistent with recent VE observations. Ultimately, better vaccines and vaccine strategies may be needed in order to optimize immunogenicity and VE for HCP and other repeated vaccinees. Published by Elsevier Ltd.

Telehealth in paediatric orthopaedic surgery in Queensland: a 10-year review.

PubMed

Rowell, Philip D; Pincus, Paul; White, Megan; Smith, Anthony C

2014-12-01

Telemedicine is a patient consultation method commonly available to patients in rural and remote areas throughout Australia. Its use in paediatric orthopaedics has been rarely described. The primary aim of this study was to identify the patient cohort accessing the orthopaedic paediatric telehealth service through the Royal Children's Hospital Queensland, so as to better allocate this resource. The secondary aims were to identify the orthopaedic conditions the patients utilizing this service suffered and to follow-up on treatment outcomes to potentially assess clinical benefit. A retrospective review of prospectively collected data of paediatric orthopaedic patients consulted using telehealth at the Royal Children's Hospital, Queensland over a 10-year period between January 2004 and September 2012 was conducted. One hundred and twenty-six patient records were assessed with a mean age of 6 years. Results showed that 40% of patients seen using telehealth in paediatric orthopaedics had documented cerebral palsy, an intellectual disability or congenital syndrome. Common paediatric orthopaedic conditions were seen, with lower limb malalignment being the most common presenting complaint. About 58% of patients were seen exclusively via telehealth and did not require in-person consultation or operative therapy. We found that the orthopaedic telepaedriatic consultation service at the Royal Children's Hospital reviewed a large proportion of patients with a known disability. We believe there is a role for telehealth medicine for all patients; however, we propose that even greater benefit can be obtained from telehealth consultation in patients with a disability where the cost and inconvenience of patient transport is considerably increased. © 2014 Royal Australasian College of Surgeons.

Hazardous Waste Cleanup: Chevron Products Company - Division of Chevron USA Incorporated in Perth Amboy, New Jersey

EPA Pesticide Factsheets

The Chevron Refinery is an active, 339-acre facility located in a heavily industrial area on the east side the city of Perth Amboy, Middlesex County, New Jersey. The facility was built by the Barber Asphalt Company in 1920, who operated it as an asphalt

STS-56 Earth observation of Perth in Western Australia

NASA Technical Reports Server (NTRS)

1993-01-01

STS-56 Earth observation taken aboard Discovery, Orbiter Vehicle (OV) 103, is probably the best view of Perth in Western Australia. (For orientation purposes, note that the coastline runs north and south). The major feature on the coast is the large estuary of the Swan River. The large port city of Perth is situated on the north bank and the smaller city of Freemantle on the south bank by the sea. Smaller seaside towns trail off north and south of this center of urban life. Inland lies a prominent escarpment, more than 600 feet high, seen running down the middle of the view and dividing the lighter-colored coastal lowlands from the highlands where dark-colored tree savanna and desert scrub dominates the land. The Moore River can be seen entering the sea at the top of the frame. Rottnest Island is visible in the sea and Garden Island near bottom edge of the frame. Perth is the largest economic center in Western Australia. It receives natural gas from an offshore field hundreds of miles

Using 'reverse triage' to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster.

PubMed

Satterthwaite, Peter S; Atkinson, Carol J

2012-02-01

This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' suitability for discharge. The External Disaster Plan was activated and response protocols were followed. Normal elective activity was suspended. Multidisciplinary teams immediately assessed patients and completed the necessary clinical and administrative requirements to discharge them quickly. As per the Plan there was increased use of community care options: respite nursing home beds and community nursing services. Through a combination of cancellation of all planned admissions, discharging 19 patients at least 1 day earlier than planned and discharging all patients earlier in the day surge capacity was made available in Royal Darwin Hospital to accommodate blast victims. Notably, reverse triage resulted in no increase in clinical risk with only one patient who was discharged early returning for further treatment.

Evaluation of physiotherapy in the treatment of Legg-Calvé-Perthes disease.

PubMed

Brech, Guilherme Carlos; Guarnieiro, Roberto

2006-12-01

Physiotherapy using muscle strengthening and stretching exercises is claimed to have beneficial effects in the treatment of Legg-Calvé-Perthes disease; however, no scientific evidence is available concerning effectiveness of treatment. The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic effects compared to observational follow-up in patients with Legg-Calvé-Perthes disease. A prospective follow-up study was conducted in 17 patients with unilateral Legg-Calvé-Perthes disease, divided into 2 groups: Group A (observational follow-up) and Group B (physiotherapeutic follow-up). In order to evaluate the outcome of the adopted treatments, the following parameters were assessed: articular range of motion, level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. Group B exhibited significant improvement in articular range of motion concerning hip flexion, extension, abduction, adduction, medial rotation, and lateral rotation, while in Group A an equally significant worsening occurred concerning abduction, adduction, and medial rotation. Muscular strength also improved in Group B, mainly in the set of hip flexor muscles, while Group A showed no changes. Articular dysfunction after therapy compared to pretherapy was significantly reduced in Group B and increased in Group A. Patients undergoing physiotherapy exercises showed no changes in their radiographic features. Physiotherapy produced significant improvement in articular range of motion, muscular strength, and articular dysfunction in patients with Legg-Calvé-Perthes disease, but these improvements were not evident on radiographs.

Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman.

PubMed

Al-Ghafri, Mohamed; Al-Bulushi, Abdullah; Al-Qasmi, Ahmed

2016-02-01

The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice (LAMA) in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA (prevalence: 1.6%). Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital's electronic system (27.9%) and telephone conversations with patients' parents (55.0%). No reasons for LAMA were documented in the hospital's electronic system for 109 patients (59.6%). The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA.

Integrated geodetic monitoring of subsidence due to groundwater abstraction in the Perth Basin, Western Australia

NASA Astrophysics Data System (ADS)

Parker, A. L.; Filmer, M. S.; Featherstone, W. E.; Pigois, J. P.; Lyon, T.

2016-12-01

Small-magnitude subsidence due to groundwater abstraction was first observed in Perth, Western Australia, in the 2000s. Ongoing monitoring of ground deformation is required to avoid infrastructure damage, increased risk of seawater inundation and compromised integrity of geodetic benchmarks (e.g. tide-gauges). Subsidence measurements will also be used to provide constraints on aquifer storage properties, which is of significance to groundwater-resource management and proposed managed aquifer recharge. To these ends, a geodetic monitoring system in the Perth Basin has been established incorporating repeat levelling, continuous GPS and >20 years of InSAR data, including four years of TerraSAR-X (2012 to 2016), plus the first Sentinel-1A interferograms over Western Australia. The magnitude of subsidence ( 2-5 mm/yr) is at the limit detectable with InSAR, but through integration with high-precision repeat levelling, groundwater level records and geological information, we are able to constrain and interpret the spatial and temporal characteristics of the deformation field. InSAR datasets reveal a narrow subsiding coastal strip proximal to abstraction bores that came online since the early 2000s. Subsidence is also identified at the eastern margin of the Perth Basin, where seasonal variations of 10 mm measured with repeat-levelling are attributed to expansion and contraction of shallow clays. Elsewhere in the basin, high-resolution time-series from TerraSAR-X record non-linear, often seasonal vertical land motion, which correlates with changes in water levels at artesian monitoring bores. SAR coverage of the Perth Basin is ongoing and is now complemented by corner reflectors co-located with continuous GPS to tie measurements to a consistent reference frame. The ongoing collection of these and other geodetic data ensures that we are well placed to measure and monitor vertical land motion across the Perth Basin, including any effects of proposed managed aquifer recharge.

Comparison of water-energy trajectories of two major regions experiencing water shortage.

PubMed

Lam, Ka Leung; Lant, Paul A; O'Brien, Katherine R; Kenway, Steven J

2016-10-01

Water shortage, increased demand and rising energy costs are major challenges for the water sector worldwide. Here we use a comparative case study to explore the long-term changes in the system-wide water and associated energy use in two different regions that encountered water shortage. In Australia, South East Queensland (SEQ) encountered a drought from 2001 to 2009, while Perth has experienced a decline in rainfall since the 1970s. This novel longitudinal study quantifies and compares the urban water consumption and the energy use of the water supply systems in SEQ and Perth during the period 2002 to 2014. Unlike hypothetical and long-term scenario studies, this comparative study quantifies actual changes in regional water consumption and associated energy, and explores the lessons learned from the two regions. In 2002, Perth had a similar per capita water consumption rate to SEQ and 48% higher per capita energy use in the water supply system. From 2002 to 2014, a strong effort of water conservation can be seen in SEQ during the drought, while Perth has been increasingly relying on seawater desalination. By 2014, even though the drought in SEQ had ended and the drying climate in Perth was continuing, the per capita water consumption in SEQ (266 L/p/d) was still 28% lower than that of Perth (368 L/p/d), while the per capita energy use in Perth (247 kWh/p/yr) had increased to almost five times that of SEQ (53 kWh/p/yr). This comparative study shows that within one decade, major changes in water and associated energy use occurred in regions that were similar historically. The very different "water-energy" trajectories in the two regions arose partly due to the type of water management options implemented, particularly the different emphasis on supply versus demand side management. This study also highlights the significant energy saving benefit of water conservation strategies (i.e. in SEQ, the energy saving was sufficient to offset the total energy use for seawater desalination and water recycling during the period.). The water-energy trajectory diagram provides a new way to illustrate and compare longitudinal water consumption and associated energy use within and between cities. Copyright © 2016. Published by Elsevier Ltd.

Aeromedical transfer of women at risk of preterm delivery in remote and rural Western Australia: why are there no births in flight?

PubMed

Akl, Natalie; Coghlan, Edwina A; Nathan, Elizabeth A; Langford, Stephen A; Newnham, John P

2012-08-01

For more than three decades, women at imminent risk of preterm birth (PTB) in Western Australia have been transferred by small aircraft over long distances to the single tertiary level perinatal centre in Perth, with no known case of birth during the flight. We aimed to review recent experience to understand how aircraft travel may delay PTB. Retrospective observational study of 500 consecutive Royal Flying Doctor Service (RFDS) transfers of women at risk of preterm labour to the tertiary referral centre, from September 2007 to December 31, 2009. In-flight delivery, complications associated with transfer and factors associated with delay in preterm delivery. There were no in-flight deliveries or serious complications associated with the aeromedical transfer of these patients. In a multivariable Cox proportional hazards regression analysis, clinical factors in the presentation that were associated with a shorter time from landing to subsequent delivery included cervical dilatation ≥ 4 cm, ruptured membranes, gestational age > 32 weeks and nulliparity. The aircraft reaching an ambient altitude > 14,000 feet, or cabin altitude above zero (sea level), was associated with a delay in time from landing to delivery for women who were not in spontaneous preterm labour. Our findings add to a 30-year experience that women at risk of preterm labour do not deliver during aeromedical transfer. Ambient and cabin altitude of the aircraft were associated with an extension in the time to delivery after arrival. The mechanisms underpinning this effect warrant further investigation. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Use of OsiriX in developing a digital radiology teaching library.

PubMed

Shamshuddin, S; Matthews, H R

2014-10-01

Widespread adoption of digital imaging in clinical practice and for the image-based examinations of the Royal College of Radiologists has created a desire to provide a digital radiology teaching library in many hospital departments around the UK. This article describes our experience of using OsiriX software in developing digital radiology teaching libraries. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Pinhole imaging in Legg-Perthes disease: further observations.

PubMed

Danigelis, J A

1976-01-01

Fifty-nine patients with Legg-Perthes disease and 12 others were studied using 99mTc-polyphosphate and the pinhole collimator imaging technique. Radiographs of both hips were correlated with images in each patient. In the Legg-Perthes patients, a radionuclide uptake deficiency of variable size was observed in the proximal femoral epiphysis (EOC), which we believe is related to varying degrees of impaired blood supply. During later disease stages, adjacent zones of increased radionuclide activity of revascularization were observed that would replace the uptake defect eventually. Unless radiographic evidence of new bone formation was observed in the EOC, it was impossible to predict either the presence or extent of revascularization until bone imaging was done. Those patients with revascularization activity in the EOC exhibited a relatively short time interval (average, 3.2 months) before evidence of new bone formation radiographically. Others with increased radionuclide concentration limited to the growth plate and/or metaphysis averaged a much longer 7.8 months. In two patients there was a reversal of the initially increased activity in the growth plate, suggesting another vascular insult. There were no false-negative bone-image findings in the 12 cases that clinically and/or radiologically simulated Legg-Perthes disease. Our image studies correlate well with published histopathologic investigations, indicating to us that assessment of extent of pathologic involvement and of the disease course is facilitated by this technique. Subsequently, this could influence treatment selection and provide a more objective baseline from which to judge treatment results. Continued experience suggests pinhole bone imaging has useful clinical application in Legg-Perthes disease and other childhood hip disorders.

The use of garden boreholes in Cape Town, South Africa: lessons learnt from Perth, Western Australia

NASA Astrophysics Data System (ADS)

Saayman, I. C.; Adams, S.

The similarities in climate and geology offer water resource managers in Cape Town and Perth an opportunity to learn from each other's experiences. While Cape Town relies mostly on surface water for supply, Perth uses 50% groundwater for its domestic and industrial use. It is proposed that certain aspects of Perth's water supply infrastructure could successfully be transposed for the exploitation of Cape Towns' groundwater resources. In Perth private boreholes is used to tap a shallow phreatic aquifer for garden irrigation. The Government of Western Australia encourages this practice. Cape Town has an opportunity to use water from the Cape Flats Aquifer in a similar manner. In this paper the use of the Cape Flats Aquifer for private garden irrigation is evaluated. By encouraging private landowners to develop private wells, large savings could be made in the amount of treated bulk water supply required by Cape Town. The Cape Flats Aquifer has the potential to meet a large part of the city's garden irrigation requirements. Though the impact of pollution on water quality remains uncertain and a concern, the general quality of water in the aquifer is adequate for irrigation requirements. If the use of private garden boreholes is to be successful, education of the public will be vital. It is envisaged that the City of Cape Town and the Department of Water Affairs and Forestry in partnership with private, education and research institutions take the lead in such education and the development of appropriate legislation and guidelines.

Earth Observations taken by the Expedition 16 Crew

NASA Image and Video Library

2008-01-11

ISS016-E-022772 (11 Jan. 2008) --- Perth, Australia is featured in this image photographed by an Expedition 16 crewmember on the International Space Station (ISS). Perth is the capital of the state of Western Australia, and the largest city of the southwestern continent of Australia with an estimated population of over 1.5 million (December 2006). The downtown area of Perth and the surrounding suburbs are located on flood plain deposits of the Swan and Canning Rivers that flow through the center of the metropolitan area. Perth enjoys a Mediterranean climate, where the summers are hot and dry and winters are cool and moist. Wildfires can develop during the summer months; several large fires threatened the eastern portion of the metropolitan area in 2005. This view captures variations in urban land cover in the visible wavelengths to which the human eye is sensitive (visible red, green, and blue). The downtown center of Perth at left is characterized by large buildings (such as skyscrapers) with white reflective rooftops. Suburbs to the south (across the Swan River) are characterized by higher density of small buildings with predominantly reddish-purple roofs. Several areas of green vegetation are visible in the image. Parks and golf courses comprised mainly of grass present an even green coloration, while the dense tree canopy of Kings Park appears dark green. Variations in the coloration of the Swan and Canning Rivers is due to sunglint, or light reflected off the water surface back to the observer (in this case, a crewmember onboard the ISS).

Indigenous Mothers' Aspirations for Their Children in Perth, Western Australia: The Value of Education and Schooling

ERIC Educational Resources Information Center

Lette, Helen; D'Espaignet, Edouard Tursan; Slack-Smith, Linda; Hunt, Kerry; Nannup, Janine

2009-01-01

This project involved the collection of stories about the aspirations, goals and strategies from a sample of mothers of Indigenous children living in Perth, Western Australia. Analysis of the semi-structured interviews indicated that the education of their children was important for many of the mothers. Whilst some of the mothers preferred their…

A Preschool with Promise: How One District Provides Early Education for All

ERIC Educational Resources Information Center

Dubin, Jennifer

2010-01-01

This article features a school district in Perth Amboy, New Jersey, that has created a full-day preschool program that helps prepare all children socially and academically for school. For students ages 3 and 4 in Perth Amboy, the two ideas--learning and fun--are one and the same. Through the district's full-day preschool program, teachers…

Teacher Unions, (Neo) Liberalism and the State: The Perth County Conspiracy of 1885

ERIC Educational Resources Information Center

Smaller, Harry

2004-01-01

In 1885, following a period of severe economic depression and social unrest in colonial Canada, state teachers in rural Perth County, Ontario met and formed the nucleus of what could clearly be described as a teachers' union. The idea spread quickly, and within six months the founding convention of a province-wide union was held in Toronto.…

STS-56 Earth observation of Perth in Western Australia

NASA Image and Video Library

1993-04-17

STS-56 Earth observation taken aboard Discovery, Orbiter Vehicle (OV) 103, is probably the best view of Perth in Western Australia. (For orientation purposes, note that the coastline runs north and south). The major feature on the coast is the large estuary of the Swan River. The large port city of Perth is situated on the north bank and the smaller city of Freemantle on the south bank by the sea. Smaller seaside towns trail off north and south of this center of urban life. Inland lies a prominent escarpment, more than 600 feet high, seen running down the middle of the view and dividing the lighter-colored coastal lowlands from the highlands where dark-colored tree savanna and desert scrub dominates the land. The Moore River can be seen entering the sea at the top of the frame. Rottnest Island is visible in the sea and Garden Island near bottom edge of the frame. Perth is the largest economic center in Western Australia. It receives natural gas from an offshore field hundreds of miles to the north. It lies 3,400 kilometers west of Sydney on the opposite side of this island continent.

Preventing falls in hospital.

PubMed

Pearce, Lynne

2017-02-27

Essential facts Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 a day, according to the Royal College of Physicians (RCP). But research shows that when nurses, doctors and therapists work together, falls can be reduced by 20-30%.

[Nutritional assessment of alcoholic liver cirrhotic patients treated in the liver Clinic of the Mexico's General Hospital].

PubMed

Landa-Galván, H V; Milke-García, Ma P; León-Oviedo, C; Gutiérrez-Reyes, G; Higuera-de la Tijera, F; Pérez-Hernández, J L; Serralde-Zúñiga, A E

2012-01-01

Malnutrition in the cirrhotic patient is associated to a higher morbidity and mortality rate; however, the diagnosis is complex, so the study objective was to assess the nutritional status using different methods. Adult patients with alcoholic liver cirrhosis treated in the Liver Clinic of the Mexico's General Hospital were evaluated. Anthropometric measurements and a 24 hours recall were made; screening tools (Malnutrition Universal Screening Tool, Nutritional Risk Screening-2002) and a method for assessing nutritional status specifically in cirrhotic patients (Royal Free Hospital Global Assessment) were used. We included 62 patients, 51.6% of them were men. Malnutrition by arm muscle area was 31.3% in men and 10% in women, and by arm fat area was 23.3% in women and 3.1% in men (p < 0.05). With the screening tools the percentages of malnutrition risk were 43.5% and 54.8% respectively, vs. 1.6% identified as "low weight" with the Body Mass Index. With the Royal Free Hospital Global Assessment tool the percentage of malnutrition was 45.2%. Patients with malnutrition had an energy and protein intake significantly lower than the well-nourished: 19.7 kcal/kg and 0.89 g/kg vs 30 kcal/kg and 1.25 g/kg (p < 0.005). Malnutrition is a common complication in patients with liver cirrhosis. Men have higher depletion of muscle mass and women a higher loss of body fat. The Body Mass Index is not a reliable tool for assessing malnutrition. It's advisable to use tools with indicators of body composition such as the Royal Free Hospital Global Assessment.

Plasma CXCL10, sCD163 and sCD14 Levels Have Distinct Associations with Antiretroviral Treatment and Cardiovascular Disease Risk Factors

PubMed Central

Castley, Alison; Williams, Leah; James, Ian; Guelfi, George; Berry, Cassandra; Nolan, David

2016-01-01

We investigate the associations of three established plasma biomarkers in the context of HIV and treatment-related variables including a comprehensive cardiovascular disease risk assessment, within a large ambulatory HIV cohort. Patients were recruited in 2010 to form the Royal Perth Hospital HIV/CVD risk cohort. Plasma sCD14, sCD163 and CXCL10 levels were measured in 475 consecutive patients with documented CVD risk (age, ethnicity, gender, smoking, blood pressure, BMI, fasting metabolic profile) and HIV treatment history including immunological/virological outcomes. The biomarkers assessed showed distinct associations with virological response: CXCL10 strongly correlated with HIV-1 RNA (p<0.001), sCD163 was significantly reduced among ‘aviraemic’ patients only (p = 0.02), while sCD14 was unaffected by virological status under 10,000 copies/mL (p>0.2). Associations between higher sCD163 and protease inhibitor therapy (p = 0.05) and lower sCD14 with integrase inhibitor therapy (p = 0.02) were observed. Levels of sCD163 were also associated with CVD risk factors (age, ethnicity, HDL, BMI), with a favourable influence of Framingham score <10% (p = 0.04). Soluble CD14 levels were higher among smokers (p = 0.002), with no effect of other CVD risk factors, except age (p = 0.045). Our findings confirm CXCL10, sCD163 and sCD14 have distinct associations with different aspects of HIV infection and treatment. Levels of CXCL10 correlated with routinely monitored variables, sCD163 levels reflect a deeper level of virological suppression and influence of CVD risk factors, while sCD14 levels were not associated with routinely monitored variables, with evidence of specific effects of smoking and integrase inhibitor therapy warranting further investigation. PMID:27355513

Pathophysiology and new strategies for the treatment of Legg-Calvé-Perthes disease.

PubMed

Kim, Harry K W

2012-04-04

Legg-Calvé-Perthes disease is a juvenile form of idiopathic osteonecrosis of the femoral head that can lead to permanent femoral head deformity and premature osteoarthritis. According to two recent multicenter, prospective cohort studies, current nonoperative and operative treatments have modest success rates of producing a good outcome with a spherical femoral head in older children with Legg-Calvé-Perthes disease. Experimental studies have revealed that the immature femoral head is mechanically weakened following ischemic necrosis. Increased bone resorption and delayed new bone formation, in combination with continued mechanical loading of the hip, contribute to the pathogenesis of the femoral head deformity. Biological treatment strategies to improve the healing process by decreasing bone resorption and stimulating bone formation appear promising in nonhuman preclinical studies.

Perthes Disease: The Quality and Reliability of Information on the Internet.

PubMed

Nassiri, Mujtaba; Bruce-Brand, Robert A; O'Neill, Francis; Chenouri, Shojaeddin; Curtin, Paul

2015-01-01

Research has shown that up to 89% of parents used the Internet to seek health information regarding their child's medical condition. Much of the information on the Internet is valuable; however, the quality of health information is variable and unregulated. The aim of this study was to evaluate the quality and content of information about Perthes disease on the Internet using recognized scoring systems, identification of quality markers, and describe a novel specific score. We searched the top 3 search engines (Google, Yahoo!, and Bing) for the following keywords: "Perthes disease." Forty-five unique Web sites were identified. The Web sites were then categorized by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel Perthes-specific Content score. The presence of the Health On the Net (HON) code, a reported quality assurance marker, was noted. Of the Web sites analyzed, the Majority were Governmental and Nonprofit Organizations (NPO) (37.8%), followed by commercial Web sites (22.2%). Only 6 of the Web sites were HONcode certified. The mean DISCERN score was 53.1 (SD=9.0). The Governmental and NPO Web sites had the highest overall DISCERN scores followed closely by Physician Web sites. The mean JAMA benchmark criteria score was 2.1 (SD=1.2). Nine Web sites had maximal scores and the Academic Web sites had the highest overall JAMA benchmark scores. DISCERN scores, JAMA benchmark scores, and Perthes-specific Content scores were all greater for Web sites that bore the HONcode seal. The quality of information available online regarding Perthes disease is of variable quality. Governmental and NPO Web sites predominate and also provide higher quality content. The HONcode seal is a reliable indicator of Web site quality. Physicians should recommend the HONcode seal to their patients as a reliable indicator of Web site quality or, better yet, refer patients to sites they have personally reviewed. Supplying parents with a guide to health information on the Internet will help exclude Web sites as sources of misinformation.

Closing forensic psychiatric hospitals in Italy: a new revolution begins?

PubMed

Barbui, Corrado; Saraceno, Benedetto

2015-06-01

On 30 May 2014 the Italian Parliament approved a new law regarding forensic psychiatric hospitals. Forensic psychiatric hospitals are facilities that admit individuals who have committed a criminal offence but lack criminal responsibility because of a mental disorder and are deemed as dangerous to public safety. Here we report the key aspects of the new legislation together with some critical considerations. © The Royal College of Psychiatrists 2015.

MI group launch.

PubMed

2002-10-01

The RCN minor injuries group was due to be launched last month as Emergency Nurse went to press. The sub-group of the RCN A&E Nursing Association is to be chaired by Mark Preston, senior nurse and modern matron at Alfred Bean Hospital, East Yorkshire. A&E sister at the Royal Preston Hospital Sarifa Kabir is to be secretary, with clinical nurse manager at Heatherwood Hospital, Berkshire, Gail King as vice chair.

Research and Operational Support for the Study of Militarily Relevant Infectious Diseases of Interest to the United States Army and the Royal Thai Army

DTIC Science & Technology

2009-01-01

to provide funding support for Royal Thai Army at Armed Forces Research Institute of Medical Sciences (AFRIMS) engaged in research activities in...City, Philippines (WRAIR #1385) 77 (a) Investigators 77 (b) Objectives 77 12 (c) Methods 78 (d) Results 78 (e) Future Plans 79 10...Title of Research Project: Sentinel Surveillance for Emerging Diseases Causing Hospitalized Dengue-like Illness in Cebu, Philippines (SEDC) 79

Was the real Sherlock Holmes a pediatric surgeon?

PubMed

Raffensperger, John

2010-07-01

This article reviews the pioneering efforts of Joseph Bell, the model for Sherlock Holmes, in the surgical care of children during the antiseptic era. I reviewed biographies of Sir Arthur Conan Doyle; the biography of Joseph Bell; his surgical textbook, Edinburgh Medical Journals; and the history of the Royal Edinburgh Hospital for Sick Children. Dr Bell was a colleague of Joseph Lister and one of the first surgeons to apply antiseptic methods to operations involving children. He was the surgeon appointed to the first surgical ward of the Royal Edinburgh Hospital for Sick Children; in that role, he cared for many children with surgical diseases. Dr Joseph Bell, by his compassion for children and his surgical skill, was indeed a pioneer pediatric surgeon. Copyright 2010 Elsevier Inc. All rights reserved.

Development of postgraduate research supervisors within a teaching hospital setting.

PubMed

Scott, K M; Caldwell, P H Y; Oldmeadow, W; Dale, R C; Jones, C A

2015-08-01

The recent trend to embed medical research at point of care has created a need for postgraduate research supervisors in hospitals who are practising clinicians and lab-based researchers. We explored the training needs of supervisors to inform the design and evaluation of a hospital-based development programme. We found that if hospital-based supervisors are to improve their practice, the programme needs to be on-site to ensure access and relevance to local issues. © 2015 Royal Australasian College of Physicians.

New insights into the biomechanics of Legg-Calvé-Perthes' disease: The Role of Epiphyseal Skeletal Immaturity in Vascular Obstruction.

PubMed

Pinheiro, M; Dobson, C A; Perry, D; Fagan, M J

2018-02-01

Legg-Calvé-Perthes' disease (LCP) is an idiopathic osteonecrosis of the femoral head that is most common in children between four and eight years old. The factors that lead to the onset of LCP are still unclear; however, it is believed that interruption of the blood supply to the developing epiphysis is an important factor in the development of the condition. Finite element analysis modelling of the blood supply to the juvenile epiphysis was investigated to understand under which circumstances the blood vessels supplying the femoral epiphysis could become obstructed. The identification of these conditions is likely to be important in understanding the biomechanics of LCP. The results support the hypothesis that vascular obstruction to the epiphysis may arise when there is delayed ossification and when articular cartilage has reduced stiffness under compression. The findings support the theory of vascular occlusion as being important in the pathophysiology of Perthes disease. Cite this article : M. Pinheiro, C. A. Dobson, D. Perry, M. J. Fagan. New insights into the biomechanics of Legg-Calvé-Perthes' disease: The Role of Epiphyseal Skeletal Immaturity in Vascular Obstruction. Bone Joint Res 2018;7:148-156. DOI: 10.1302/2046-3758.72.BJR-2017-0191.R1. © 2018 Pinheiro et al.

["The Society for letters and natural science" The young Ole H. Mynster and the chemical revolution around 1800].

PubMed

Hansen, Sven Erik

2015-01-01

Ole H. Mynster (1772-1818) was a stepson of the leading physician at the Royal Frederik Hospital in Copenhagen. At an early age he became fond of zoology and mineralogy. He created "societies" in Enlightenment-style for boys and young people with lectures and collections. Later on a circle of talented young students, scientists and poets met in his small room at the hospital. Some of them with Ole Mynster as the head set up a modern scientific journal, Physicalsk, oeconomisk og medicochirurgisk Bibliotek for Danmark og Norge which encouraged the introduction of antiphlogistic chemistry. Ole Mynster became physician at the Royal Frederik Hospital and lecturer in clinical pharmacology. He wrote the first book in Danish on pharmacology based upon chemistry. In their memoirs, prominent members of his circle have told about him, and his son F.L. Mynster has written a draft for a biography. An overview of the activities within natural science and medicine of the young Ole Hieronymus Mynster is presented.

Learning between Schools and Hospitals--Young People and a Curriculum of (Dis)connection

ERIC Educational Resources Information Center

Dixon, Mary

2014-01-01

As noted in other papers in this volume, a group of health and education researchers and practitioners came together to further develop their understanding of the situation of young people, who were clients of The Royal Children's Hospital Education Institute in 2007 in Melbourne, Australia. The resultant research project, funded by the Australian…

Pre-wired systems prove their worth.

PubMed

2012-03-01

The 'new generation' of modular wiring systems from Apex Wiring Solutions have been specified for two of the world's foremost teaching hospitals - the Royal London and St Bartholomew's Hospital, as part of a pounds sterling 1 billion redevelopment project, to cut electrical installation times, reduce on-site waste, and provide a pre-wired, factory-tested, power and lighting system. HEJ reports.

Franchise. Quantum leap.

PubMed

Mooney, Helen

2008-05-15

The Royal Marsden's chemotherapy unit in Kingston will not only treat its own patients who live locally, but also accept referrals from local GPs. The move is part of a trend by well-known hospitals to open franchises, led by the Moorfields Eye Hospital which has 11 satellite units, including one in Dubai. Franchising by specialist hospitals can increase services, raise income and expand their brand. It also allows specialist staff to work in a range of settings.

Patient‐friendly hospital environments: exploring the patients’ perspective

PubMed Central

Douglas, Calbert H.; Douglas, Mary R.

2004-01-01

Abstract Objective  To investigate the perceptions and attitudes of patients to the built environments of NHS Trust hospitals, in order to inform design excellence so as to make future hospitals places and spaces responsive to patient needs. Design  An exploratory study of patients perceptions based on qualitative semi‐structured personal interviews. Setting and participants  Fifty one‐to‐one interviews held with hospital in‐patients across the four directorates of surgery, medicine, care of the elderly and maternity at Salford Royal Hospitals NHS Trust, Salford, UK. Results  The research found that there was much similarity in the priorities, issues and concerns raised by patients in each of the four directorates. Patients perceived the built environment of the hospital as a supportive environment. Their accounts in each area pointed to the significance of the factors that immediately impacted on them and their families. Patients identified having a need for personal space, a homely welcoming atmosphere, a supportive environment, good physical design, access to external areas and provision of facilities for recreation and leisure. Responses suggest that patient attitudes and perceptions to the built environment of hospital facilities relates to whether the hospital provides a welcoming homely space for themselves and their visitors that promotes health and wellbeing. Conclusions  The findings have important implications for capital development teams, clinical staff, managers and NHS Estates personnel. Although the study has immediate relevance for Salford Royal Hospitals Trust, findings and recommendations reported provide NHS Estates and other relevant stakeholders with evidence‐based knowledge and understanding of patients’ perceptions and expectations of and preferences for particular facilities and estates provision in NHS hospitals. PMID:14982500

Perthes disease: A new finding in Floating-Harbor syndrome.

PubMed

Milani, Donatella; Scuvera, Giulietta; Gatti, Marta; Tolva, Gianluca; Bonarrigo, Francesca; Esposito, Susanna; Gervasini, Cristina

2018-03-01

Floating-Harbor Syndrome (FHS; OMIM #136140) is an ultra-rare autosomal dominant genetic condition characterized by expressive language delay, short stature with delayed bone mineralization, a triangular face with a prominent nose, and deep-set eyes, and hand anomalies. First reported in 1973, FHS is associated with mutations in the SRCAP gene, which encodes SNF2-related CREBBP activator protein. Mutations in the CREBBP gene cause Rubinstein-Taybi Syndrome (RSTS; OMIM #180849, #613684), another rare disease characterized by broad thumbs and halluces, facial dysmorphisms, short stature, and intellectual disability, which has a phenotypic overlap with FHS. We describe a case of FHS associated with a novel SRCAP mutation and characterized by Perthes disease, a skeletal anomaly described in approximately 3% of patients with RSTS. Thus Perthes disease can be added to the list of clinical features that overlap between FHS and RSTS. © 2018 Wiley Periodicals, Inc.

Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia.

PubMed

Katzenellenbogen, Judith M; Miller, Laura J; Somerford, Peter; McEvoy, Suzanne; Bessarab, Dawn

2015-09-01

The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006-11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital readmissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes.

Adopting seven-day working in practice: a report by the Royal College of Physicians and Surgeons of Glasgow.

PubMed

Scott, H R; Isles, C J; Fisher, B M; Long, J; Dunn, F G

2014-11-01

Following the UK Academy of Medical Royal Colleges Report on seven day consultant present care, the Royal College of Physicians and Surgeons of Glasgow held a symposium to explore clinicians' views on the ways in which clinical care should best be enhanced outside 'normal' working hours. In addition, a survey of members and fellows was undertaken to identify the tests which would make the greatest impact on care out of hours. Key messages were: (a) that seven-day consultant delivered care would not achieve the desired benefit to patient care if introduced in isolation from other inter-relating factors. These include alternatives to hospital admission, enhanced nursing support, increased junior medical, pharmacy, social care and ambulance availability and greater access to selected diagnostic services; (b) that the care of hospital inpatients is a service which is one part of the totality of secondary care provision. Any significant change in the deployment of staff for inpatient care must be carefully managed so as not to result in a reduced quality of care provided by the rest of the system. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Sport, age, and sex specific incidence of sports injuries in Western Australia

PubMed Central

Stevenson, M.; Hamer, P.; Finch, C.; Elliot, B.; Kresnow, M.

2000-01-01

Objective—To describe the trends in recreational sports injury in Perth, Western Australia. Design—A prospective cohort study of sports injuries during the 1997 winter season (May to September). Setting—Sample of Australian football, field hockey, basketball, and netball players from the Perth metropolitan area, Western Australia. Methods—A cohort of sports participants was followed over the five month winter sports season. Before the season, participants completed a baseline questionnaire and during the season were interviewed every four weeks by telephone. Results—Overall, 92% of participants (n = 1391) who completed a baseline questionnaire completed at least one follow up telephone interview. About half (51%) of the cohort sustained one or more injuries during the winter season accounting for a total of 1034 injuries. Most injuries were of moderate (58%, n = 598) or minor (40%, n = 412) severity, with only 3% (n = 24) requiring emergency department treatment or a hospital stay. The injury incidence rate was greatest for football (20.3/1000 hours of participation), similar for field hockey and basketball (15.2/1000 hours and 15.1/1000 hours respectively), and lowest for netball (12.1/1000 hours). The incidence of injury was greatest in the first four weeks of the season, and participants aged between 26 and 30 years had about a 55% greater risk of injury than those aged less than 18 years. Conclusions—This is one of the first studies to show that recreational sports are safe. Although the likelihood of injury was greatest in the first month of the season, few injuries required admission to hospital or emergency department treatment. A greater emphasis on prevention in the early part of the season should help to reduce the elevated incidence of injury found at this time. Key Words: injury incidence; prospective study; time at risk PMID:10854018

[Health Institutions of the Hungarian and Imperial-Royal Armed Forces in the First World War].

PubMed

Kiss, Gábor

2006-01-01

The Military Health Institutes established during the World War I. aimed maintenance and recovery of soldiers' fighting value. Establishing an effective sanitary control was rather important, since the Hungarian Royal Honvéd Army attempted to prevent epidemics and diseases, especially venereal diseases and tuberculosis. The sanitary establishments consisted of three parts: they belonged to the operational area, to the provisional zone and to the homeland territory. These institutions were divided into permanent and temporary ones. Permanent sanitary institutions were the garrison hospitals; troop and military ("honvéd") hospitals and houses for invalids, while temporary sanitary establishments worked only in case of mobilization. In their arrangement not the distance was taken into consideration, but the potential for transport of the wounded. The Hungarian sanitary institutions proved to be rather successful in World War I.

Lessons From a 17-Year Radiosurgery Experience at the Royal Adelaide Hospital

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roos, Daniel E., E-mail: daniel.roos@health.sa.gov.au; Brophy, Brian P.; Taylor, James

2012-01-01

Purpose: To illustrate some of the potential pitfalls of cranial stereotactic radiosurgery (SRS) and its planning based on prospectively gathered data from a 17-year experience at the Royal Adelaide Hospital. Methods and Materials: More than 250 treatments have been planned since 1993 using previously described standard SRS techniques for intracranial benign and malignant lesions. Results: Five case studies are presented (1 meningioma, 1 acoustic neuroma, 2 solitary brain metastasis, 1 arteriovenous malformation), each of which demonstrates at least one salutary lesson. Conclusions: Because SRS delivers a highly conformal dose distribution, it is unforgiving of any geographic miss due to inaccuratemore » outlining and thus dependent on neuroradiological expertise and collaboration. There are also potentially significant implications of misdiagnosis in SRS cases without histological proof-in particular, presumed brain metastases.« less

Improving preterm infants' immunisation status: a follow-up audit.

PubMed

Crawford, Nigel W; Barfield, Charles; Hunt, Rod W; Pitcher, Helen; Buttery, Jim P

2014-04-01

Preterm infants are at increased risk of vaccine preventable diseases. An audit in 2007 identified suboptimal immunisation status of preterm infants. The aim of this study was to complete the 'audit loop', reviewing preterm infants' immunisation status at a single tertiary paediatric hospital. A retrospective follow-up immunisation audit was conducted at The Royal Children's Hospital, Melbourne, neonatal unit. The 'audit loop' included a preterm infants' reminder sticker and feedback of the original audit findings to Royal Children's Hospital health-care professionals. Immunisation status was determined using the Australian Childhood Immunisation Register record for all admitted preterm infants born <32 weeks gestation (July 2008-June 2009). Conducted in March 2011, the median age of participants (n = 57) was 2.5 years (range 1.7-3.1 years). Forty-four per cent (25/57) had a history of chronic lung disease, 86% (49/57) were <1500 g and 42% (24/57) <28 weeks gestation. The majority (96% (55/57)) were up to date with routine immunisations at 12 months of age. There was a 2.4-fold increase, compared with the original audit, for receipt of the additional recommended hepatitis B vaccine at 12 months of age, as well as influenza vaccine in infants with chronic lung disease. This study showed that a simple reminder combined with education strategies can improve vaccine delivery in special risk groups such as preterm infants. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

CPR and the RCP (1). Training of doctors in NHS hospitals.

PubMed

Wheatly, S; Redmond, A D

1993-10-01

Six years after the Royal College of Physicians published its report, most hospitals in the UK with acute coronary beds fail to train or test their doctors adequately in the skills of cardiopulmonary resuscitation. Doctors want more training, and consultants try to give it, but there is a lack of funds for this basic yet critical task.

Creating a "Psychological Nest" for Vulnerable Infants and Children: An Interview with Annette Mendelsohn

ERIC Educational Resources Information Center

Midgley, Nick

2008-01-01

This is an edited version of a recent interview with Annette Mendelsohn, Child and Adolescent Psychotherapist at the Royal Free Hospital, London, UK. It aims to make available in published form Mendelsohn's thinking and approach in relation to her work with traumatised children in a hospital setting. Mendelsohn also discusses her work in a…

Pharmaceuticals in Australia: priorities in a teaching hospital.

PubMed

Kearney, B J

1993-01-01

In spite of rigorous government programs for control of the pricing and dissemination of pharmaceutical products in Australia, the list of new drugs continues to grow and prices to increase. To regain control over drug usage at Royal Adelaide Hospital, the Hospital Drug Committee developed a rating method that judged drugs on the basis of their cost-benefit to patients. The ratio of a total quality score to a total cost score becomes the determinant of additions to the hospital formulary. The background for the Australian approach to pharmaceuticals and the new evaluation technique at the teaching hospital are described in this report.

Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology.

PubMed

McKenzie, Nicole; Williams, Teresa A; Ho, Kwok M; Inoue, Madoka; Bailey, Paul; Celenza, Antonio; Fatovich, Daniel; Jenkins, Ian; Finn, Judith

2018-05-02

To compare survival outcomes of adults with out-of-hospital cardiac arrest (OHCA) of medical aetiology directly transported to a percutaneous-coronary-intervention capable (PCI-capable) hospital (direct transport) with patients transferred to a PCI-capable hospital via another hospital without PCI services available (indirect transport) by emergency medical services (EMS). This retrospective cohort study used the St John Ambulance Western Australia OHCA Database and medical chart review. We included OHCA patients (≥18 years) admitted to any one of five PCI-capable hospitals in Perth between January 2012 and December 2015. Survival to hospital discharge (STHD) and survival up to 12-months after OHCA were compared between the direct and indirect transport groups using multivariable logistic and Cox-proportional hazards regression, respectively, while adjusting for so-called "Utstein variables" and other potential confounders. Of the 509 included patients, 404 (79.4%) were directly transported to a PCI-capable hospital and 105 (20.6%) transferred via another hospital to a PCI-capable hospital; 274/509 (53.8%) patients STHD and 253/509 (49.7%) survived to 12-months after OHCA. Direct transport patients were twice as likely to STHD (adjusted odds ratio 1.97, 95% confidence interval [CI] 1.13-3.43) than those transferred via another hospital. Indirect transport was also associated with a possible increased risk of death, up to 12-months, compared to direct transport (adjusted hazard ratio 1.36, 95% CI 1.00-1.84). Direct transport to a PCI-capable hospital for post-resuscitation care is associated with a survival advantage for adults with OHCA of medical aetiology. This has implications for EMS transport protocols for patients with OHCA. Copyright © 2018 Elsevier B.V. All rights reserved.

Comparison between vaginal royal jelly and vaginal estrogen effects on quality of life and vaginal atrophy in postmenopausal women: a clinical trial study

PubMed Central

Seyyedi, Fatemeh; Kopaei, Mahmoud Rafiean; Miraj, Sepideh

2016-01-01

Objective This study was conducted to evaluate the therapeutic effects of vaginal royal jelly and vaginal estrogen on quality of life and vaginal atrophy in postmenopausal women. Methods This double-blind randomized controlled clinical trial was carried out at gynecology and obstetrics clinics of Hajar Hospital of Shahrekord University of Medical Sciences (Iran) from January 2013 to January 2014. The study was conducted on married postmenopausal women between 50 and 65 years old. Of 120 patients, 30 individuals were excluded based on the exclusion criteria, and 90 women were randomly distributed into three groups of 30 royal jelly vaginal cream 15%, vaginal Premarin, and placebo (lubricant), for three months. At the beginning and the end of the study, quality of life and vaginal cytology assay were evaluated. Data were analyzed by SPSS Version 11. Results Vaginal cream of royal jelly is significantly more effective than vaginal cream of Premarin and lubricant in improvement of quality of life in postmenopausal women (p<0.05). Moreover, Pap smear results showed that vaginal atrophy in vaginal Premarin group was lower than the other groups (p<0.001), and there was no significant difference between lubricant and royal jelly groups (p=0.89). Conclusion Administration of vaginal royal jelly was effective in quality-of-life improvement of postmenopausal women. Given to the various properties of royal jelly and its effectiveness on quality of life and vaginal atrophy in postmenopausal women, further studies are recommended for using =royal jelly in improving menopausal symptoms. Clinical trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT code: 2014112220043n1. Funding Shahrekord University of Medical Sciences supported this research (project no. 1440). PMID:28070251

Comparison between vaginal royal jelly and vaginal estrogen effects on quality of life and vaginal atrophy in postmenopausal women: a clinical trial study.

PubMed

Seyyedi, Fatemeh; Kopaei, Mahmoud Rafiean; Miraj, Sepideh

2016-11-01

This study was conducted to evaluate the therapeutic effects of vaginal royal jelly and vaginal estrogen on quality of life and vaginal atrophy in postmenopausal women. This double-blind randomized controlled clinical trial was carried out at gynecology and obstetrics clinics of Hajar Hospital of Shahrekord University of Medical Sciences (Iran) from January 2013 to January 2014. The study was conducted on married postmenopausal women between 50 and 65 years old. Of 120 patients, 30 individuals were excluded based on the exclusion criteria, and 90 women were randomly distributed into three groups of 30 royal jelly vaginal cream 15%, vaginal Premarin, and placebo (lubricant), for three months. At the beginning and the end of the study, quality of life and vaginal cytology assay were evaluated. Data were analyzed by SPSS Version 11. Vaginal cream of royal jelly is significantly more effective than vaginal cream of Premarin and lubricant in improvement of quality of life in postmenopausal women (p<0.05). Moreover, Pap smear results showed that vaginal atrophy in vaginal Premarin group was lower than the other groups (p<0.001), and there was no significant difference between lubricant and royal jelly groups (p=0.89). Administration of vaginal royal jelly was effective in quality-of-life improvement of postmenopausal women. Given to the various properties of royal jelly and its effectiveness on quality of life and vaginal atrophy in postmenopausal women, further studies are recommended for using =royal jelly in improving menopausal symptoms. The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT code: 2014112220043n1. Shahrekord University of Medical Sciences supported this research (project no. 1440).

Hospital discharge summary scorecard: a quality improvement tool used in a tertiary hospital general medicine service.

PubMed

Singh, G; Harvey, R; Dyne, A; Said, A; Scott, I

2015-12-01

We assessed the impact of completion and feedback of discharge summary scorecards on the quality of discharge summaries written by interns in a general medicine service of a tertiary hospital. The scorecards significantly improved summary quality in the first three rotations of the intern year and could be readily adopted by other units as a quality improvement intervention for optimizing clinical handover to primary care providers. © 2015 Royal Australasian College of Physicians.

Impact of an antimicrobial stewardship intervention on appropriateness of prescribing for community-acquired pneumonia in an Australian regional hospital.

PubMed

Bond, Stuart E; Boutlis, Craig S; Yeo, Wilfred W; Miyakis, Spiros

2017-05-01

Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP. © 2017 Royal Australasian College of Physicians.

Legg-Calvé-Perthes disease in a child with osteopetrosis

PubMed Central

Sims, Alex L.; Barwick, Thomas W.; Montgomery, Richard J.

2011-01-01

Osteopetrosis is a rare inherited disorder of bone causing increased bone density. Legg-Calvé-Perthes disease (LCPD), by contrast, is a more common idiopathic condition leading to variable avascular necrosis of the immature femoral head. We present a case of a 5-year-old boy presenting with these co-morbidities. We have found only one previous reference suggesting these two conditions can coexist in the literature. We discuss the basic principles of management of this interesting case. PMID:24765380

A brief history of Legg-Calvé-Perthes disease.

PubMed

Wenger, Dennis R; Pandya, Nirav K

2011-09-01

Legg-Calvé-Perthes (LCP) disease has an extensive history that has provided an ongoing intellectual challenge for the orthopaedic community. Debate around etiology and treatment of LCP disease continues even after its initial description in the early 1900 s. In order for modern day clinicians to have a full understanding of the condition, one must be a scholar of its development. The purpose of our review will be to discuss the scientific communities' understanding of presentation, etiology, and treatment of LCP disease over time.

Improving transfusion practice: ongoing education and audit at two tertiary speciality hospitals in Western Australia.

PubMed

Gallagher-Swann, M; Ingleby, B; Cole, C; Barr, A

2011-02-01

Institutions undertaking transfusion have a responsibility to ensure safe and appropriate practice. The hospital transfusion committee (HTC) plays a major role in monitoring all aspects of transfusion. Dedicated staff with the responsibility of undertaking transfusion education and audit have been employed at many hospitals. The question is 'Do these positions improve practice?'. In 2005, a transfusion coordinator was employed by the King Edward Memorial Hospital (KEMH) and Princess Margaret Hospital (PMH) in Perth, Western Australia. After an initial audit to collect baseline data on transfusion documentation and compliance with national guidelines, a series of interventions was undertaken. In addition, the transfusion protocols were rewritten and published electronically. Further audits were undertaken in 2006, 2007 and 2009. Sequential audits show measured improvements in transfusion documentation. Baseline, hourly and completion observations are now correctly recorded in >94% of records at KEMH and >96% of records at PMH. Compliance with recording of 15 min observations has shown a 23% magnitude increase at KEMH and 36% at PMH. Compliance with recording of consent has increased by 20% at KEMH and 31% at PMH. Promotion of positive patient identification, when collecting specimens and administering blood, has been undertaken. The initiatives implemented by the transfusion coordinator and endorsed by the HTCs have improved the standard of transfusion documentation and practice at both institutions. © 2010 The Authors. Transfusion Medicine © 2010 British Blood Transfusion Society.

Audit of anesthetic trainees' 'hands-on' operating room experience in an Australian tertiary children's hospital.

PubMed

Hogan, Bridget; Keating, Matthew; Chambers, Neil A; von Ungern-Sternberg, Britta

2016-05-01

There are no internationally accepted guidelines about what constitutes adequate clinical exposure during pediatric anesthetic training. In Australia, no data have been published on the level of experience obtained by anesthetic trainees in pediatric anesthesia. There is, however, a new ANZCA (Australian and New Zealand College of Anaesthetists) curriculum that quantifies new training requirements. To quantify our trainees' exposure to clinical work in order to assess compliance with new curriculum and to provide other institutions with a benchmark for pediatric anesthetic training. We performed a prospective audit to estimate and quantify our anesthetic registrars' exposure to pediatric anesthesia during their 6-month rotation at our institution, a tertiary pediatric hospital in Perth, Western Australia. Our data suggest that trainees at our institution will achieve the new ANZCA training standards comfortably, in terms of the required volume and breadth of exposure. Experience, however, of some advanced pediatric anesthetic procedures appears limited. Experience gained at our hospital easily meets the new College requirements. Experience of fiber-optic intubation and regional blocks would appear insufficient to develop sufficient skills or confidence. The study provides other institutions with information to benchmark against their own trainee experience. © 2016 John Wiley & Sons Ltd.

The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.

PubMed

Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O

2016-02-01

To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p < 0.001). Around a third of Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

40 CFR 30.54 - Quality assurance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER... Guidelines for Quality Systems for Environmental Data Collection and Environmental Technology Programs”, which may be obtained from the National Technical Information Service (NTIS), 5885 Port Royal Road...

40 CFR 30.54 - Quality assurance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER... Guidelines for Quality Systems for Environmental Data Collection and Environmental Technology Programs”, which may be obtained from the National Technical Information Service (NTIS), 5885 Port Royal Road...

40 CFR 30.54 - Quality assurance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER... Guidelines for Quality Systems for Environmental Data Collection and Environmental Technology Programs”, which may be obtained from the National Technical Information Service (NTIS), 5885 Port Royal Road...

40 CFR 30.54 - Quality assurance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER... Guidelines for Quality Systems for Environmental Data Collection and Environmental Technology Programs”, which may be obtained from the National Technical Information Service (NTIS), 5885 Port Royal Road...

Getting the balance right-tackling the obesogenic environment by reducing unhealthy options in a hospital shop without affecting profit.

PubMed

Simpson, Nandi; Bartley, Angela; Davies, Alisha; Perman, Sarah; Rodger, Alison J

2018-04-07

UK hospitals have been criticized for fuelling obesity by allowing contracts with food retailers selling high fat and high-sugar products on hospital premises. We assessed the impact for a major retailer of increasing healthy food choices at their Royal Free London NHS Foundation Trust outlet. To assess the impact on sales, profit and acceptability to customers, a multi-component intervention based on behavioural insights theory was enacted over 2 months (November-December 2014) at the Royal Free site WHSmith. Sales data on all food and drink were assessed over three time periods: (i) 2 months immediately prior to, and (ii) immediately after the intervention, and (iii) the equivalent period 10 months later. Acceptability to customers was assessed via questionnaires, and profit assessed as a proxy for retailer satisfaction. Compared to the pre-intervention period, total sales increased immediately after the intervention, and again 10 months after the intervention. Sales of healthier options increased as a proportion of total sales following the intervention, sales of sweets and chocolates decreased, while the relative sales of other items remained similar. We demonstrated that healthier alternatives could be provided in a hospital retail premises without negatively affecting total sales, retailer or customer satisfaction.

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.

PubMed

Schroeder, Liz; Patel, Nishma; Keeler, Michelle; Rocca-Ihenacho, Lucia; Macfarlane, Alison J

2017-02-01

to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes. the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital. women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these services. This finding from this study contribute a local perspective and thus further weight to the evidence from the Birthplace Programme in support of freestanding midwifery unit care for women without obstetric complications. Copyright © 2016. Published by Elsevier Ltd.

Diagnostic Dilemma of Hb Perth [β32(B14)Leu→Pro; HBB: c.98T > C] in Mainland China.

PubMed

Jiang, Hua; Yan, Jin-Mei; Li, Jian; Xie, Xing-Mei; Li, Dong-Zhi

2016-06-01

Unstable hemoglobin (Hb) variants represent a rare etiology of congenital hemolytic anemia. Correct diagnosis can be a challenge due to the relative rarity or lack of awareness of this disorder. We report an 18-month-old girl, who presented with a long-standing hemolytic anemia. Her diagnosis of unstable Hb Perth [β32(B14)Leu→Pro, HBB: c.98T > C] had not been made until gene sequencing of the β-globin gene was performed.

A tertiary hospital audit of the use of medical imaging in the 24 h preceding death.

PubMed

Liu, D; Weil, J; Boughey, M; Sutherland, T

2016-02-01

This study aims to investigate the number, modality and indication for imaging studies performed on acute hospital inpatients in the 24 h prior to death. Data were obtained from retrospective analysis of deceased patients from a university affiliated tertiary hospital over a 2-year period and it was found that around one in five inpatients received medical imaging in the last 24 h of their life (364 of 1855, 19.6%). © 2016 Royal Australasian College of Physicians.

Re Inquiry into the Confidentiality of Health Records in Ontario.

PubMed

1978-06-30

Several members of the Royal Canadian Mounted Police testified at hearings conducted by a commission appointed to study the confidentiality of health records. On approximately 300 occasions, the police had obtained medical information from physicians and hospitals in Ontario without the prior consent of the patient. The court established that the identity of persons who had furnished the information was privileged information for physicians and other persons subject to the control of a hospital board, but not for various employees of the hospital who were not subject to professional standards of discipline.

Analysis of 22,655 presentations with back pain to Perth emergency departments over five years.

PubMed

Lovegrove, Michael T; Jelinek, George A; Gibson, Nicholas P; Jacobs, Ian G

2011-09-17

Back pain is a significant cause of disability in the community, but the impact on Emergency Departments (EDs) has not been formally studied. Patients with back pain often require significant time and resources in the ED. To examine the characteristics of patients presenting with back pain to the ED, including final diagnosis, demographics of those attending and temporal distribution of presentations. Emergency presentations in the metropolitan area of Perth, Western Australia, for 2000-2004 were searched using a linked database covering all the major hospitals (Emergency Care Hospitalisation and Outcome Study database). All presentations with the triage code for back pain were extracted and analysed. A total of 22,655 presentations with back pain were identified, representing 1.9% of total presentations. Simple muscular or non-specific back pain accounted for only 43.8% of presentations, with other causes such as renal colic and pyelonephritis accounting for the majority. The young (<15 years old) and elderly (>75 years old) were more likely to have non-muscular causes for their back pain. Muscular back pain presentations occurred mostly between 0800 and 1600, with high proportions presenting on the weekends. Patients with simple muscular back pain spent a mean of 4.4 h in the ED, representing a significant outlay of resources. Back pain has a significant impact on EDs, and staff should be alert for another pathology presenting as back pain. There is a need for multidisciplinary back pain teams to be available 7 days a week, but only during the day.

On the impact of spatial heterogeneous permeability distributions on the development of free convection cells in the Perth Basin, Australia.

NASA Astrophysics Data System (ADS)

Niederau, Jan; Ebigbo, Anozie; Freitag, Sebastian; Marquart, Gabriele; Clauser, Christoph

2014-05-01

Recent increase in exploration of the geothermal energy potential of the Perth Metropolitan Area (PMA) results in the need for reliable and robust reservoir models in order to explore rock properties and temperature distributions in the subsurface, where free convection in the main reservoir (Yarragadee Aquifer) is likely to occur [1]. While the structure of the Perth Basin has been refined recently, the heterogeneity and spatial complexity of permeability was up till now mainly neglected. An integrated, three dimensional tectonostratigraphic model of the PMA is constructed, using the modeling software '3D GeoModeller' and data of numerous artesian and petroleum wells. Comprising the region around the city of Perth, the model covers an area of about 5000 km2 up to a depth of 4.5 km, with focus on adequate representation of the main reservoir. We further construct a numerical model for fluid flow and heat transport in the Yarragadee Aquifer. Porosity distributions are deduced from well logs and linked to permeability by a calibrated correlation, based on a fractal approach. Three different cases are simulated using the FD code SHEMAT-Suite, in order to assess the influence of spatial heterogeneity of porosity and permeability on the development of free convection cells. constant porosity and permeability for the entire aquifer porosity and permeability decreasing with depth, thus reflecting compaction a conditional random permeability field within prescribed limits and for given correlation length In order to improve understanding of model correctness, as well as identification and comparison of convection cells in different simulations, we are developing a specialized visualization tool tailored to this purpose. The three different scenarios show distinctions in the distribution of convection cells. Where the Yarragadee Aquifer is in contact with overlying aquifers, regions of downflow develop. These in turn have a strong impact on the regional flow field and therefore temperature. The heterogeneous distribution of permeability seems to control the convection pattern on a smaller scale. References [1] Schilling, O., Sheldon, H.A., Reid, L.B., Corbel, S. 2013. Hydrothermal models of the Perth metropolitan area, Western Australia: implications for geothermal energy. Hydrogeology Journal, Vol. 21, 605-621.

RAndomised controlled trial to imProve depressIon and the quality of life of people with Dementia using cognitive bias modification: RAPID study protocol.

PubMed

Almeida, Osvaldo P; MacLeod, Colin; Flicker, Leon; Ford, Andrew; Grafton, Ben; Etherton-Beer, Christopher

2014-07-23

Depressive symptoms are common and undermine the quality of life of people with Alzheimer's disease (AD). Cholinesterase inhibitors and antidepressants have all but no effect on the mood of patients, and their use increases adverse events. Cognitive bias modification (CBM) targets attentional and interpretative biases associated with anxiety, dysphoria and depression and may be useful to treat depression in AD (DAD). This trial aims to determine the effect of CBM on depression scores and the quality of life of people with DAD. Randomised, double-blind, parallel, controlled trial of CBM (1:1 allocation ratio). Participants will be 80 adults with probable AD living in the Western Australian community who score 8 or more on the Cornell Scale for Depression in Dementia (CSDD). They will have mild to moderate dementia (Mini-Mental State Examination-MMSE score ≥15) and will be free of severe sensory impairment or suicidal intent. The intervention will consist of 10 40 min sessions of CBM delivered over 2 weeks using a high-resolution monitor using a local computer station at the Western Australian Centre for Health and Ageing. The primary outcomes of interest are the 2-week change, from baseline, in the severity of CSDD scores and the Quality of Life AD (QoL-AD) scores. Secondary outcomes include changes in the CSDD, QoL-AD after 12 weeks, and changes in MMSE scores, negative attentional and interpretative bias and the proportion of participants with CSDD <8 after 2 and 12 weeks. The study will comply with the principles of the Declaration of Helsinki and participants will provide written informed consent. The Ethics Committee of the Royal Perth Hospital will approve and oversee the study (REG14-036). The results of this trial will provide level 2 evidence of efficacy for CBM as a treatment of DAD. Australian and New Zealand Clinical Trials Registry number ACTRN12614000420640, date registered 06/04/2014. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The treatment of nursing home-acquired pneumonia using a medically intensive Hospital in the Home service.

PubMed

Montalto, Michael; Chu, Man Yee; Ratnam, Irani; Spelman, Tim; Thursky, Karin

2015-12-14

To compare the outcomes for patients with nursing home-acquired pneumonia (NHAP) treated completely in a Hospital in the Home (HITH) setting with those of patients treated in a traditional hospital ward. Case-control study. All patients admitted by the Royal Melbourne Hospital for treatment of NHAP from 1 July 2013 to 31 January 2014. Admission to the Royal Melbourne Hospital HITH Unit within 48 hours of presentation. Length of stay, in-hospital and 30-day mortality, hospital readmissions (30-day), complications and unplanned returns to hospital. Sixty HITH patients and 54 hospital (control) patients were identified. Thirty-two patients (53%) were admitted directly to HITH without any hospital or emergency stay, 25 (42%) were referred directly from the emergency department. HITH patients were more likely to be male, older and dehydrated, and less likely to have an advanced care directive or to have had non-invasive ventilation. There were no significant differences in CURB-65 or CORB scores between the two patient groups; similar proportions were given intravenous fluids or supplemental oxygen. There were no adjusted differences in median length of stay between HITH and control patients (-1.00 days; 95% CI, -2.72 to 0.72; P = 0.252) or in overall mortality at 30 days (HITH v control patients: adjusted odds ratio [aOR], 1.97; 95% CI, 0.67-5.73). Inpatient mortality was lower for HITH patients (aOR, 0.19; 95% CI, 0.05-0.75) but unadjusted postdischarge 30-day mortality was higher (OR, 13.25; 95% CI 1.67-105.75). There were no differences between the two groups with regard to complications (falls and pressure wounds) and 30-day readmission rates (aOR, 1.59; 95% CI, 0.30-8.53). This study suggests that HITH may be an effective and safe alternative to hospital treatment for residents of aged care facilities presenting with NHAP.

Hip arthroscopy for Legg-Calvè-Perthes disease: minimum 2-year follow-up.

PubMed

Freeman, Carl R; Jones, Kay; Byrd, J W Thomas

2013-04-01

The purpose of this study is to report the results of arthroscopy for the treatment of adolescents and adults with hip pain cause by sequelae of Legg-Calvè-Perthes disease. All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score at 3, 6, 12, 24, 60, 120, and 180 months. We identified a cohort of 22 consecutive patients (23 hips) with Legg-Calvè-Perthes disease who had undergone arthroscopy with at least 2-year follow-up; this cohort represents the substance of this report. There was 100% follow-up at 24 months (range, 24 to 180 months). The median age was 27 years (range, 7 to 58 years) with 14 male and 8 female patients. Findings during arthroscopy included 18 labral tears, 17 hypertrophic or torn ligamentum teres, 9 femoral and 8 acetabular chondral lesions, 5 loose bodies, 3 osteochondral defects, and 2 cam lesions. The mean improvement at 24 months was 28 points (56.7 preoperatively and 82 postoperatively). All patients were improved, although this improvement was negligible in 2 patients who underwent repeat arthroscopy. There were no complications. This series reports the results of arthroscopy for Legg-Calvè-Perthes disease and reflects that it does have a role in the management of painful sequelae. Successful outcomes can often be expected with minimal morbidity. Reduced symptoms and improved quality of life are reasonable expectations, although these data do not suggest that hip arthroscopy alters the natural history of the disease process. Level IV, therapeutic case series. Published by Elsevier Inc.

The decriminalization of prostitution is associated with better coverage of health promotion programs for sex workers.

PubMed

Harcourt, Christine; O'Connor, Jody; Egger, Sandra; Fairley, Christopher K; Wand, Handan; Chen, Marcus Y; Marshall, Lewis; Kaldor, John M; Donovan, Basil

2010-10-01

In order to assess whether the law has an impact on the delivery of health promotion services to sex workers, we compared health promotion programs in three Australian cities with different prostitution laws. The cities were Melbourne (brothels legalized if licensed, unlicensed brothels criminalized), Perth (criminalization of all forms of sex work) and Sydney (sex work largely decriminalized, without licensing). We interviewed key informants and gave questionnaires to representative samples of female sex workers in urban brothels. Despite the different laws, each city had a thriving and diverse sex industry and a government-funded sex worker health promotion program with shopfront, phone, online and outreach facilities. The Sydney program was the only one run by a community-based organisation and the only program employing multi-lingual staff with evening outreach to all brothels. The Melbourne program did not service the unlicensed sector, while the Perth program accessed the minority of brothels by invitation only. More Sydney workers reported a sexual health centre as a source of safer sex training and information (Sydney 52% v Melbourne 33% and Perth 35%; p<0.001). Sex workers in Melbourne's licensed brothels were the most likely to have access to free condoms (Melbourne 88%, Sydney 39%, Perth 12%; p<0.001). The legal context appeared to affect the conduct of health promotion programs targeting the sex industry. Brothel licensing and police-controlled illegal brothels can result in the unlicensed sector being isolated from peer-education and support. © 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.

Primary Tumours of the Fallopian Tube

PubMed Central

Ross, Winifred M.

1967-01-01

Nine patients with primary tumour of the fallopian tube were seen at the Royal Marsden Hospital and Chelsea Hospital for Women, London. All the tumours except one were adenocarcinomas. Histologically, the exception resembled an adenomatoid tumour, but was clinically malignant and had some features of a hemangiopericytoma. Postoperative irradiation did not increase survival. The only five-year survivor was a patient who received radiation therapy for a late local recurrence. ImagesFig. 1Fig. 2 PMID:5334754

Remember, remember, firework safety.

PubMed

1998-01-01

A&E nurses at Blackburn Royal Infirmary talk to local youngsters to warn them about the dangers of being reckless with fireworks. Sister Alison Walmsley (left) and auxiliary Frances Walsh are pictured giving safety tips to ten-year-old Louise Greenwood at the hospital's awareness stand.

Burns first aid treatment in remote Northern Australia.

PubMed

Read, David J; Tan, Swee Chin; Ward, Linda; McDermott, Kathleen

2018-03-01

It is well demonstrated that adequate burns first aid treatment (BFAT) improves clinical outcomes for the injured but adequacy remains low in many studies. This study presents a twelve month assessment of the adequacy of burns first aid treatment for patients managed by the Burns Service, Royal Darwin Hospital (RDH). Prospective study design of all patients managed by the Burns Service, Royal Darwin Hospital. Data were collated from two sources; RDH Burns Registry, and the Burns Registry of Australia and New Zealand (BRANZ). Inclusion criterion was all patients managed by the Burns Service, Royal Darwin Hospital for the period 1 January 2014-31 December 2014. Variables collected and analysed include: demographics, burn mechanism, burn wound depth and adequacy of and circumstances around first aid. Overall 310 cases were analysed. Most injuries involved adults (68%), 19% Indigenous persons and 70% of all patients had their burn injury occur in the urban region. Adequate BFAT occurred in 41% of cases. Adults, contact burns and those where the burn injury occurred in the remote regions were less likely to receive adequate BFAT. Indigenous persons were less likely to attempt any BFAT at all and when they did receive BFAT it was more likely applied by an emergency responder or health professional. Overall adequacy of BFAT is low in the Top End of the Northern Territory. Remote dwellers and Indigenous persons are at increased risk of not applying or receiving adequate BFAT. The poor level of adequate BFAT demonstrated in this study suggests that the Top End community particularly remote and Indigenous persons would benefit from targeted BFAT education programs that are delivered in a culturally and linguistically appropriate fashion. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Robotic and open radical prostatectomy in the public health sector: cost comparison.

PubMed

Hall, Rohan Matthew; Linklater, Nicholas; Coughlin, Geoff

2014-06-01

During 2008, the Royal Brisbane and Women's Hospital became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding. The cost of performing robotic surgery in the public sector is a contentious issue. This study is a single centre, cost analysis comparing open radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RALP) based on the newly introduced pure case-mix funding model. A retrospective chart review was performed for the first 100 RALPs and the previous 100 RRPs. Estimates of tangible costing and funding were generated for each admission and readmission, using the Royal Brisbane Hospital Transition II database, based on pure case-mix funding. The average cost for admission for RRP was A$13 605, compared to A$17 582 for the RALP. The average funding received for a RRP was A$11 781 compared to A$5496 for a RALP based on the newly introduced case-mix model. The average length of stay for RRP was 4.4 days (2-14) and for RALP, 1.2 days (1-4). The total cost of readmissions for RRP patients was A$70 487, compared to that of the RALP patients, A$7160. These were funded at A$55 639 and A$7624, respectively. RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

High quality acute care for the severely injured is not consistently available in England, Wales and Northern Ireland: report of a survey by the Trauma Committee, The Royal College of Surgeons of England.

PubMed

Browne, J; Coats, T J; Lloyd, D A; Oakley, P A; Pigott, T; Willett, K J; Yates, D W

2006-03-01

A survey was undertaken to determine the extent to which acute hospitals in England, Wales and Northern Ireland were meeting the acute trauma management standards published in 2000 by The Royal College of Surgeons of England and the British Orthopaedic Association. A questionnaire comprising 72 questions in 16 categories of management was distributed in July 2003 to all eligible hospitals via the link network of the British Orthopaedic Association. Data were collected over a 3-month period. Of 213 eligible hospitals, 161 (76%) responded. In every category of acute care, failure to meet the standards was reported. Only 34 (21%) hospitals met all the 13 indicative standards that were considered pivotal to good trauma care, but all hospitals met at least 7 of these standards. Failures were usually in the organisation of services rather than a lack of resources, with the exception of the inadequate capacity for admission to specialist neurosurgery units. A minority of hospitals reported an inability to provide emergency airway control or insertion of chest tube. The data have not been verified and deficiencies in reporting cannot be excluded. The findings of this survey suggest that high quality care for the severely injured is not available consistently across England, Wales and Northern Ireland, and appear to justify concerns about the ability of the NHS to deal effectively with the current trauma workload and the consequences of a major incident.

Destination healthcare facility of shocked trauma patients in Scotland: analysis of transfusion and surgical capability of receiving hospitals.

PubMed

Peach, Christopher M; Morrison, Jonathan J; Apodaca, Amy N; Egan, Gerry; Watson, Henry G; Jansen, Jan O

2013-10-01

Haemorrhage is a leading cause of death from trauma. Management requires a combination of haemorrhage control and resuscitation which may incur significant surgical and transfusion utilisation. The aim of this study is to evaluate the resource provision of the destination hospital of Scottish trauma patients exhibiting evidence of pre-hospital shock. Patients who sustained a traumatic injury between November 2008 and October 2010 were retrospectively identified from the Scottish Ambulance Service electronic patients record system. Patients with a systolic blood pressure less than 110 mmHg or if missing, a heart rate greater than 120 bpm, were considered in shock. The level of the destination healthcare facility was classified in terms of surgical and transfusion capability. Patients with and without shock were compared. There were 135,004 patients identified, 133,651 (99.0%) of whom had sustained blunt trauma, 68,411 (50.7%) were male and the median (IQR) age was 59 (46). There were 6721 (5.0%) patients with shock, with a similar age and gender distribution to non-shocked patients. Only 1332 (19.8%) of shocked patients were taken to facilities with full surgical capability, 5137 (76.4%) to hospitals with limited (general and orthopaedic surgery only) and 252 (3.7%) to hospitals with no surgical services. In terms of transfusion capability, 5556 (82.7%) shocked patients were admitted to facilities with full capability and 1165 (17.3%) to a hospital with minimal or no capability. The majority of Scottish trauma patients are transported to a hospital with full transfusion capability, although the majority lack surgical sub-specialty representation. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Characterising the ambient sound environment for infants in intensive care wards.

PubMed

Shoemark, Helen; Harcourt, Edward; Arnup, Sarah J; Hunt, Rod W

2016-04-01

The purpose of this study is to characterise ambient sound levels of paediatric and neonatal intensive care units in an old and new hospital according to current standards. The sound environment was surveyed for 24-h data collection periods (n = 80) in the Neonatal and Paediatric Intensive Care Units (NICUs and PICUs) and Special Care Nursery of the old and new Royal Children's Hospital Melbourne. The ambient sound environment was characterised as the proportion of time the ongoing ambient sound met standard benchmarks, the mean 5-s sound levels and the number and duration of noise events. In the old hospital, none of the data collection periods in the NICU and PICU met the standard benchmark for ongoing ambient sound, while only 5 of the 22 data collection periods in the new hospital met the recommended level. There was no change in proportion of time at recommended Leq between the old and the new Special Care Nursery. There was strong evidence for a difference in the mean number of events >65 dBA (Lmax ) in the old and new hospital (rate ratio = 0.82, 95% confidence interval: 0.73 to 0.92, P = 0.001). The NICU and PICU were above 50 dBA in 75% of all data collection periods, with ventilatory equipment associated with higher ongoing ambient sound levels. The ongoing ambient sound suggests that the background sound environment of the new hospital is not different to the old hospital. However, there may be a reduction in the number of noise events. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

A Simple Insightful Approach to Investigating a Hospital Standardised Mortality Ratio: An Illustrative Case-Study

PubMed Central

Mohammed, Mohammed A.; Stevens, Andrew J.

2013-01-01

Background Despite methodological concerns Hospital Standardised Mortality Ratios (HSMRs) are promoted as measures of performance. Hospitals that experience an increase in their HSMR are presented with a serious challenge but with little guidance on how to investigate this complex phenomenon. We illustrate a simple penetrating approach. Methods Retrospective analysis of routinely collected hospital admissions data comparing observed and expected deaths predicted by the Dr Foster Unit case mix adjustment method over three years (n = 74,860 admissions) in Shropshire and Telford NHS Trust Hospital (SaTH) constituting PRH (Princess Royal Hospital) and RSH (Royal Shrewsbury Hospital); whose HSMR increased from 99 in the year 2008/09 to 118 in the year 2009/10. Results The step up in HSMR was primarily located in PRH (109 to 130 vs. 105 to 118 RSH). Disentangling the HSMR by plotting run charts of observed and expected deaths showed that observed deaths were stable in RSH and PRH but expected deaths, especially at PRH, had fallen. The fall in expected deaths has two possible explanations–genuinely lower risk admissions or that the case-mix adjustment model is underestimating the risk of admissions perhaps because of inadequate clinical coding. There was no evidence that the case-mix profile of admissions had changed but there was considerable evidence that clinical coding process at PRH was producing a lower depth of coding resulting in lower expected mortality. Conclusion Knowing whether the change (increase/decrease) in HSMR is driven by the numerator or the denominator is a crucial pivotal first step in understanding a given HSMR and so such information should be an integral part of the HSMR reporting methodology. PMID:23472111

Avascular necrosis of the femoral heads in a red panda (Ailurus fulgens fulgens): possible Legg-Calve-Perthes disease.

PubMed

Delclaux, María; Talavera, Covadonga; López, Manuel; Sánchez, Jose Miguel; García, María Isabel

2002-09-01

A 17-mo-old captive-born female red panda (Ailurus fulgens fulgens) presented with a sudden onset of lameness in its left hind leg was diagnosed radiographically as having possible severe, bilateral Legg-Calve-Perthes disease with fracture of the great trochanter of the left femur. Surgical repair of the fracture was performed using pins and a tension band wire through a lateral approach to the hip. This is the first case reported at Madrid Zoo-Aquarium, where 63 individuals have been bred over 15 yr.

[Traumatic asphyxia or Perthe's syndrome. About two paediatric cases].

PubMed

El koraichi, A; Benafitou, R; Tadili, J; Rafii, M; El Kharaz, H; Al Haddoury, M; El Kettani, S

2012-03-01

The traumatic asphyxia or Perthes' syndrome is a condition characterized by a classic triad involving head and neck cyanosis, subconjonctival bleeding, and petechiae. The pathophysiology of traumatic asphyxia is different in children compared to adults, because of the greater elasticity of the thorax in children. The purpose of this paper is to describe through two cases of traumatic asphyxia in young children the characteristics of this disease in children. Copyright © 2011 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Computerized gait analysis in Legg Calvé Perthes disease--analysis of the frontal plane.

PubMed

Westhoff, Bettina; Petermann, Andrea; Hirsch, Mark A; Willers, Reinhart; Krauspe, Rüdiger

2006-10-01

Current follow-up and outcome studies of Legg Calvé Perthes disease (LCPD) are based on subjective measures of function, clinical parameters and radiological changes [Herring JA, Kim HT, Browne RH. Legg-Calvé-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg 2004;86A:2121-34; Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C. J Pediatr Orthop 2005;14 B:88-91; Kitakoji T, Hattori T, Kitoh H, Katho M, Ishiguro N. Which is a better method for Perthes' disease: femoral varus or Salter osteotomy? Clin Orthop 2005;430:163-170; Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does femoral varus osteotomy alter the natural evolution of Perthes' disease. J Pediatr Orthop 2005;14B:10-5; Ishida A, Kuwajima SS, Laredo FJ, Milani C. Salter innominate osteotomy in the treatment of severe Legg-Calvé-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop 2004;24:257-64.]. The objective of this study was to evaluate the frontal plane kinematics and the effect on hip joint loading on the affected side in children with a radiographic diagnosis of LCPD. Computerized, three-dimensional gait analysis was performed in 33 individuals aged > or =5 years (mean 8.0+/-2 years) with unilateral LCPD and no history of previous surgery to the hip or any disorder leading to gait abnormality. Frontal plane kinematics and kinetics were compared to a group of healthy children (n=30, mean age 8.1+/-1.2 years). Hip joint loading was estimated as a function of the hip abductor moment. Subjects with LCPD demonstrated two distinct frontal plane gait patterns, both deviating from normal. Type 1 (n=3) was characterized by a pelvic drop of the swinging limb, a trunk lean in relation to the pelvis towards the stance limb and hip adduction during stance phase and corresponded well to the description of Trendelenburg gait caused by abductor insufficiency. Type 2 (n=12) is characterized by a trunk lean toward the affected stance limb with the pelvis stable or elevated on the swinging limb during single stance phase. The abductor moment of the involved side during single stance was significantly reduced in type 2 compared to the controls (p=0.004) indicating a hip-unloading mechanism. These results may influence the physiotherapy regimen, which may require to work towards a hip-unloading gait pattern.

Diffusion-weighted imaging and the skeletal system: a literature review.

PubMed

Yao, K; Troupis, J M

2016-11-01

Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) sequence that has a well-established role in neuroimaging, and is increasingly being utilised in other clinical contexts, including the assessment of various skeletal disorders. It utilises the variability of Brownian motion of water molecules; the differing patterns of water molecular diffusion in various biological tissues help determine the contrast obtained in DWI. Although early research on the clinical role of DWI focused mainly on the field of neuroimaging, there are now more studies demonstrating the promising role DWI has in the diagnosis and monitoring of various osseous diseases. DWI has been shown to be useful in assessing a patient's skeletal tumour burden, monitoring the post-chemotherapy response of various bony malignancies, detecting hip ischaemia in patients with Legg-Calvé-Perthes disease, as well as determining the quality of repaired articular cartilage. Despite its relative successes, DWI has several limitations, including its limited clinical value in differentiating chondrosarcomas from benign bone lesions, as well as osteoporotic vertebral compression fractures from compression fractures due to malignancy. This literature review aims to provide an overview of the recent developments in the use of DWI in imaging the skeletal system, and to clarify the role of DWI in assessing various osseous diseases. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Interobserver and intraobserver reliability of the modified Waldenström classification system for staging of Legg-Calvé-Perthes disease.

PubMed

Hyman, Joshua E; Trupia, Evan P; Wright, Margaret L; Matsumoto, Hiroko; Jo, Chan-Hee; Mulpuri, Kishore; Joseph, Benjamin; Kim, Harry K W

2015-04-15

The absence of a reliable classification system for Legg-Calvé-Perthes disease has contributed to difficulty in establishing consistent management strategies and in interpreting outcome studies. The purpose of this study was to assess interobserver and intraobserver reliability of the modified Waldenström classification system among a large and diverse group of pediatric orthopaedic surgeons. Twenty surgeons independently completed the first two rounds of staging: two assessments of forty deidentified radiographs of patients with Legg-Calvé-Perthes disease in various stages. Ten of the twenty surgeons completed another two rounds of staging after the addition of a second pair of radiographs in sequence. Kappa values were calculated within and between each of the rounds. Interobserver kappa values for the classification for surveys 1, 2, 3, and 4 were 0.81, 0.82, 0.76, and 0.80, respectively (with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.0, nearly perfect agreement). Intraobserver agreement for the classification was an average of 0.88 (range, 0.77 to 0.96) between surveys 1 and 2 and an average of 0.87 (range, 0.81 to 0.94) between surveys 3 and 4. The modified Waldenström classification system for staging of Legg-Calvé-Perthes disease demonstrated substantial to almost perfect agreement between and within observers across multiple rounds of study. In doing so, the results of this study provide a foundation for future validation studies, in which the classification stage will be associated with clinical outcomes. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

What is the clinical course of transient synovitis in children: a systematic review of the literature.

PubMed

Asche, Sylvana S; van Rijn, Rogier M; Bessems, Johannes Hjm; Krul, Marjolein; Bierma-Zeinstra, Sita Ma

2013-11-14

Transient synovitis of the hip (TS) is considered to be a self-limiting disease in childhood. However, because the etiology is unclear and some cases precede Legg-Perthes' disease, data on follow-up are important. Our aim was to summarize the knowledge on the clinical course of TS in children. The study design was a systematic review and a literature search was conducted in Medline and Embase. Studies describing short and/or long-term follow-up of TS in children were included. Case reports, reviews and studies describing traumatic hip pain were excluded. Study quality was scored and data extraction was performed. The main outcome measures were short-term and long-term clinical course, and recurrence of symptoms. A total of 25 studies were included of which 14 were of high quality. At two-week follow-up, almost all children with TS were symptom free. Those with symptoms persisting for over one month were more prone to develop other hip pathology, such as Legg-Perthes' disease. The recurrence rate of TS ranged from 0-26.3%. At long-term follow-up, 0-10% of the children diagnosed with TS developed Legg-Perthes' disease. Hip pain after intensive physical effort and limited range of motion of the hip at long-term follow-up was reported in 12-28% and in 0-18% of the children, respectively. The majority of the studies indicate that children with TS recover within two weeks; recurrence was seen in 0-26% of the cases. Children with TS should be followed at least six months to increase the likelihood of not missing Legg-Perthes' disease.

Paediatric Low-Vision Assessment and Management in a Specialist Clinic in the UK

ERIC Educational Resources Information Center

Lennon, Julie; Harper, Robert; Biswas, Sus; Lloyd, Chris

2007-01-01

This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal Eye Hospital. Comprehensive data were collected retrospectively from children attending the paediatric low-vision clinic between January 2003 and…

Intrathecal Baclofen Therapy: Benefits and Complications

ERIC Educational Resources Information Center

Zdolsek, Helena Aniansson; Olesch, Christine; Antolovich, Giuliana; Reddihough, Dinah

2011-01-01

Background: Spasticity and dystonia in children with cerebral palsy has been treated with intrathecal baclofen therapy (ITB) at the Royal Children's Hospital, Melbourne, Australia (RCH) since 1999. Methods: The records of children having received or still receiving ITB during the period September 1999 until August 2005 were studied to evaluate…

The remodeling of the neck-shaft angle after proximal femoral varus osteotomy for the treatment of Legg-Calve-Perthes syndrome.

PubMed

Chiarapattanakom, Pariyut; Thanacharoenpanich, Songkiat; Pakpianpairoj, Charoenchai; Liupolvanish, Prasert

2012-10-01

To study the corrections of the neck-shaft angle (NSA) and the related clinical symptoms after proximal femoral varus osteotomy (PFVO) for the treatment of Legg-Calve-Perthes syndrome (LCPS). Retrospective cohort study. Consecutive cases of LCPS treated at Lerdsin General Hospital during 1999 to 2010 were reviewed. The patients were excluded if they had less than 3 years of follow-up, there was incomplete data, and bilateral involvement. Demographic data and clinical symptoms were collected. The NSA were measured before and after PFVO. Twenty-two patients were treated by PFVO. The mean pre-operative NSA was 140 degrees. The mean varus angle created by PFVO was 20 degrees. The mean post-operative NSA at 6 weeks, 6 months, 1 year, 2 years and 3 years were 119, 119, 118, 120 and 120 degrees respectively. No statistical difference between the mean NSA at 6 weeks and 3 years (p = 0.65). There were 9 patients whose NSA increased more than 5 degrees at 3 years after operation. This group of patients had a more varus angulation at the early post-operative period. No physeal arrest was detected in any cases at 3 years after PFVO. No correlation between the NSA and pain or limitation of the hip abduction were observed. There were 3 patients, who had NSA less than 110 degrees after PFVO, had limping gait. It is difficult to predict the degree of remodeling of an individual hip after proximal femoral varus osteotomy. Special attention should be paid to avoid excessive varus of the proximal femur less than 110 degrees whenever PFVO is performed.

Telecommunications model for continuing education of health professionals: the Royal Brompton case.

PubMed

Kotis, Takis

2003-01-01

Telemedicine is said to be helpful to both patients and providers, but we need real-world examples to demonstrate its effectiveness. This paper presents such an example. Royal Brompton, under the Tele-remedy Program of EC Telecom, conducted a project with the Children's Hospital of Athens, Greece, to provide remote diagnosis management and continuing education for heart disease, using European ISDN technology. Preliminary results showed that, when carried out in a large scale multi-site environment, Teleremedy program significantly reduced geographic and socio-economic isolation for the patient and the professional isolation for the physician. Comparison of original vs. transmitted data revealed no significant differences, with diagnosis accuracy of 100%.

Complications following circumcision: Presentations to the emergency department.

PubMed

Gold, Grace; Young, Simon; O'Brien, Mike; Babl, Franz E

2015-12-01

Circumcision is the most common surgical procedure performed on boys in Australia. Patient presentations to the emergency department (ED) following circumcision are common; however, no Australian research has investigated acute care presentations. To identify reasons for presentation to the ED after circumcision and determine whether the setting (community vs. hospital) in which the procedure had been performed has any bearing on the sequelae seen. Retrospective chart review of children presenting with circumcision related problems to the Royal Children's Hospital, Melbourne, Australia, between 2012 and 2014. Descriptive and χ(2) analysis included sequelae of community- versus hospital-performed procedures. Over a 29-month period, we identified 167 children with a circumcision-related ED presentation. Mean age was 3 years. A percentage of 54.5 had been performed for non-medical, 29.9% for medical reasons and 14.4% for reasons unknown. When location was known (n = 152), 60.5% were performed in the community and 39.5% in hospital. Reasons for presentation were: bleeding (53.9%), pain (38.3%), swelling (37.1%), redness (25.7%), decreased urine output (13.8%), fever (7.2%) and pus (6%). 29.9% were diagnosed as normal healing post circumcision. Patients were admitted in 39.1% versus 15% (P = 0.001) and re-operated in 18.5% versus 1.7% (P = 0.001) after community- versus hospital-operated circumcisions. A range of reasons cause patients to seek help in the ED following a circumcision. Parents would have profited from better explanation of post-circumcision appearance of the penis. ED presentations after community-performed procedures required more re-operations than after hospital-performed circumcisions. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Varicella-Zoster Virus in Perth, Western Australia: Seasonality and Reactivation

PubMed Central

Korostil, Igor A.; Regan, David G.

2016-01-01

Background Identification of the factors affecting reactivation of varicella-zoster virus (VZV) largely remains an open question. Exposure to solar ultra violet (UV) radiation is speculated to facilitate reactivation. Should the role of UV in reactivation be significant, VZV reactivation patterns would generally be expected to be synchronous with seasonal UV profiles in temperate climates. Methods We analysed age and gender specific VZV notification time series data from Perth, Western Australia (WA). This city has more daily sunshine hours than any other major Australian city. Using the cosinor and generalized linear models, we tested these data for seasonality and correlation with UV and temperature. Results We established significant seasonality of varicella notifications and showed that while herpes-zoster (HZ) was not seasonal it had a more stable seasonal component in males over 60 than in any other subpopulation tested. We also detected significant association between HZ notifications and UV for the entire Perth population as well as for females and males separately. In most cases, temperature proved to be a significant factor as well. Conclusions Our findings suggest that UV radiation may be important for VZV reactivation, under the assumption that notification data represent an acceptably accurate qualitative measure of true VZV incidence. PMID:26963841

Varicella-Zoster Virus in Perth, Western Australia: Seasonality and Reactivation.

PubMed

Korostil, Igor A; Regan, David G

2016-01-01

Identification of the factors affecting reactivation of varicella-zoster virus (VZV) largely remains an open question. Exposure to solar ultra violet (UV) radiation is speculated to facilitate reactivation. Should the role of UV in reactivation be significant, VZV reactivation patterns would generally be expected to be synchronous with seasonal UV profiles in temperate climates. We analysed age and gender specific VZV notification time series data from Perth, Western Australia (WA). This city has more daily sunshine hours than any other major Australian city. Using the cosinor and generalized linear models, we tested these data for seasonality and correlation with UV and temperature. We established significant seasonality of varicella notifications and showed that while herpes-zoster (HZ) was not seasonal it had a more stable seasonal component in males over 60 than in any other subpopulation tested. We also detected significant association between HZ notifications and UV for the entire Perth population as well as for females and males separately. In most cases, temperature proved to be a significant factor as well. Our findings suggest that UV radiation may be important for VZV reactivation, under the assumption that notification data represent an acceptably accurate qualitative measure of true VZV incidence.

A high-precision digital astrogeodetic traverse in an area of steep geoid gradients close to the coast of Perth, Western Australia

NASA Astrophysics Data System (ADS)

Schack, P.; Hirt, C.; Hauk, M.; Featherstone, W. E.; Lyon, T. J.; Guillaume, S.

2018-01-01

We present results from a new vertical deflection (VD) traverse observed in Perth, Western Australia, which is the first of its kind in the Southern Hemisphere. A digital astrogeodetic QDaedalus instrument was deployed to measure VDs with {˜ } 0.2'' precision at 39 benchmarks with a {{˜ }}1 km spacing. For the conversion of VDs to quasigeoid height differences, the method of astronomical-topographical levelling was applied, based on topographical information from the Shuttle Radar Topography Mission. The astronomical quasigeoid heights are in 20-30 mm (RMS) agreement with three independent gravimetric quasigeoid models, and the astrogeodetic VDs agree to 0.2-0.3'' (north-south) and 0.6-0.9'' (east-west) RMS. Tilt-like biases of {˜ }1 mm over {˜ }1 km are present for all quasigeoid models within {˜ }20 km of the coastline, suggesting inconsistencies in the coastal zone gravity data. The VD campaign in Perth was designed as a low-cost effort, possibly allowing replication in other Southern Hemisphere countries (e.g., Asia, Africa, South America and Antarctica), where VD data are particularly scarce.

A comparative modeling analysis of multiscale temporal variability of rainfall in Australia

NASA Astrophysics Data System (ADS)

Samuel, Jos M.; Sivapalan, Murugesu

2008-07-01

The effects of long-term natural climate variability and human-induced climate change on rainfall variability have become the focus of much concern and recent research efforts. In this paper, we present the results of a comparative analysis of observed multiscale temporal variability of rainfall in the Perth, Newcastle, and Darwin regions of Australia. This empirical and stochastic modeling analysis explores multiscale rainfall variability, i.e., ranging from short to long term, including within-storm patterns, and intra-annual, interannual, and interdecadal variabilities, using data taken from each of these regions. The analyses investigated how storm durations, interstorm periods, and average storm rainfall intensities differ for different climate states and demonstrated significant differences in this regard between the three selected regions. In Perth, the average storm intensity is stronger during La Niña years than during El Niño years, whereas in Newcastle and Darwin storm duration is longer during La Niña years. Increase of either storm duration or average storm intensity is the cause of higher average annual rainfall during La Niña years as compared to El Niño years. On the other hand, within-storm variability does not differ significantly between different ENSO states in all three locations. In the case of long-term rainfall variability, the statistical analyses indicated that in Newcastle the long-term rainfall pattern reflects the variability of the Interdecadal Pacific Oscillation (IPO) index, whereas in Perth and Darwin the long-term variability exhibits a step change in average annual rainfall (up in Darwin and down in Perth) which occurred around 1970. The step changes in Perth and Darwin and the switch in IPO states in Newcastle manifested differently in the three study regions in terms of changes in the annual number of rainy days or the average daily rainfall intensity or both. On the basis of these empirical data analyses, a stochastic rainfall time series model was developed that incorporates the entire range of multiscale variabilities observed in each region, including within-storm, intra-annual, interannual, and interdecadal variability. Such ability to characterize, model, and synthetically generate realistic time series of rainfall intensities is essential for addressing many hydrological problems, including estimation of flood and drought frequencies, pesticide risk assessment, and landslide frequencies.

In-patient physiotherapy for adults on veno-venous extracorporeal membrane oxygenation – United Kingdom ECMO Physiotherapy Network: A consensus agreement for best practice

PubMed Central

Purkiss, Claire; Cork, Gabriella; Baddeley, Adam; Morris, Kelly; Carey, Leah; Brown, Mike; McGarrigle, Laura; Kennedy, Samantha

2017-01-01

Clinical specialist physiotherapists from the five severe respiratory failure centres in England where respiratory extracorporeal membrane oxygenation (ECMO) is practiced have established this consensus agreement for physiotherapy best practice. The severe respiratory failure centres are Wythenshawe Hospital, Manchester; Glenfield Hospital, Leicester; Papworth Hospital, Cambridge; Guy’s and St Thomas’ Hospital, London and The Royal Brompton Hospital, London. Although research into physiotherapy and ECMO is increasing, there is not a sufficient amount to write evidence-based guidelines; hence the development of a consensus document, using knowledge and experience of the specialist physiotherapists working with patients receiving ECMO. The document outlines safety aspects, practicalities and additional treatment considerations for physiotherapists conducting respiratory care and physical rehabilitation. PMID:29118833

Implementation of a clinical practice guideline for antenatal magnesium sulphate for neuroprotection in Australia and New Zealand.

PubMed

Bain, Emily; Bubner, Tanya; Ashwood, Pat; Crowther, Caroline A; Middleton, Philippa

2013-02-01

Health professionals at 25 Australian and New Zealand tertiary maternity hospitals were surveyed about local implementation of a clinical practice guideline for antenatal magnesium sulphate for fetal neuroprotection. Seventy-six percent of respondents reported that their hospital is currently following a guideline; 36% confirmed that their hospital is auditing uptake. Estimates of uptake ranged from 53 to 90%. Ongoing education and support are needed to ensure that the guidelines are optimally implemented, and uptake and important health outcomes are monitored. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Gorlin's syndrome.

PubMed

Ramsden, R T; Barrett, A

1975-06-01

The uncommon familial syndrome of multiple odontogenic keratocysts, basal cell naevi and skeletal anomalies is reviewed, and seven cases are described, including one patient who developed squamous cell carcinoma in a previous odontogenic keratocyst of the maxilla. We wish to thank Consultants from the Royal National Throat, Nose and Ear Hospital, The Middlesex Hospital and the Eastman Dental Hospital, who allowed us access to their patients; Mr. D. Garfield Davies, Dr. M. F. Spittle, Mr. D. Winstock, Mr. H. P. Cook, Professor H. C. Killey and Mr. L. W. Kay. We are grateful to Professor L. Michaels and Mr. D. J. Connolly for preparation of the illustrations and to Mrs. A. Matthews for the typescript.

Helping the employee victim of violence in hospitals.

PubMed

Engel, F; Marsh, S

1986-02-01

Violent behavior of patients is an occupational health hazard of health care professionals that the authors believe has not been fully recognized. Hospitals have developed a wide variety of techniques to manage patients who assault staff but have consistently ignored the plight of the victimized employee. Although professional staff who have been assaulted resist seeing themselves as victims, the authors believe they experience the feelings and reactions typical of other victims and therefore may need help in dealing with emotional trauma. The authors describe a victims' assistance program adopted by Royal Victoria Hospital in Montreal and discuss problems associated with implementing programs like it.

Music therapy with hospitalized infants-the art and science of communicative musicality.

PubMed

Malloch, Stephen; Shoemark, Helen; Črnčec, Rudi; Newnham, Carol; Paul, Campbell; Prior, Margot; Coward, Sean; Burnham, Denis

2012-07-01

Infants seek contingent, companionable interactions with others. Infants in a Neonatal Intensive Care Unit (NICU), while receiving care that optimizes their chances of survival, often do not have the kind of interactions that are optimal for their social development. Live music therapy (MT) with infants is an intervention that aims for contingent, social interaction between therapist and infant. This study, with a limited numbers of infants, examined the effectiveness of an MT intervention in the NICU at The Royal Children's Hospital Melbourne. Two groups of late pre-term and full-term infants were recruited to the study; one was given MT and the other was not. A healthy group of infants not given MT served as an additional control. The effect of MT was indexed using two measures reflecting infant social engagement: the Neurobehavioral Assessment of the Preterm Infant (NAPI) and the Alarm Distress Baby Scale (ADBB). Results suggest that the MT intervention used at The Royal Children's Hospital Melbourne supports infants' neurobehavioral development. In particular, hospitalized infants who received MT were better able to maintain self-regulation during social interaction with an adult, were less irritable and cried less, and were more positive in their response to adult handling, when compared with infants who did not receive the intervention. These are important prerequisites for social interaction and development. Further and larger scale research using MT with this population is indicated. Copyright © 2012 Michigan Association for Infant Mental Health.

Benchmarking against the National Emergency Laparotomy Audit recommendations.

PubMed

Ho, Yiu Ming; Cappello, Julie; Kousary, Ramin; McGowan, Brian; Wysocki, Arkadiusz P

2018-05-01

The Royal College of Anaesthetists published the National Emergency Laparotomy Audit (NELA) to describe and compare inpatient care and outcomes of major emergency abdominal surgery in England and Wales in 2015 and 2016. The purpose of this article is to compare emergency abdominal surgical care and mortality in a regional hospital (Logan Hospital, Queensland, Australia) with NELA results. Data were extracted from two databases. All deaths from May 2010 to April 2015 were reviewed and patients who had an emergency abdominal operation within 30 days of death were identified. The health records of all patients who underwent abdominal surgery were extracted and those who had an emergency laparotomy were identified for analysis. Three hundred and fifty patients underwent emergency laparotomy and were included in the analysis. The total 30-day mortality during this 5-year period was 9.7%. Factors affecting mortality included age, Portsmouth-Physiological and Operative Severity Score (P-POSSUM) and admission source. Timing of antibiotic administration, use of perioperative medical service and frequency of intensive care admission were the same in patients who died and survived. Mortality in patients following emergency laparotomy at Logan Hospital compares favourably with 11.1% reported by NELA. This may be partly attributable to case mix distribution as for each P-POSSUM risk Logan Hospital mortality was at the upper end of that reported by NELA. Further Australia data are required. Improved compliance with NELA recommendations may improve outcomes. © 2017 Royal Australasian College of Surgeons.

The impact of the National Treatment Purchase Fund on numbers of core urology training cases at University Hospital Galway.

PubMed

Harney, T J; Dowling, C M; Brady, C M

2011-06-01

Since the National Treatment Purchase Fund (NTPF) scheme was introduced in 2002, public patients waiting longer than three months for investigations and treatment are offered care in the private medical sector. Our aim was to assess the impact of the NTPF scheme on the number of training cases performed at University Hospital Galway (UHG). The number and type of urological procedures performed in the private medical sector under the NTFP scheme in 2008 were obtained from the UHG waiting list office. The number of these procedures performed on public patients by trainees at UHG in 2008 was determined retrospectively by reviewing theatre records. A significant number of core urology procedures were performed in the private sector via the NTPF scheme. Cancer centre designation and implementation of the EWTD will also place further pressures on urological training opportunities in Ireland. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

The age-specific prevalence of human parvovirus immunity in Victoria, Australia compared with other parts of the world.

PubMed Central

Kelly, H. A.; Siebert, D.; Hammond, R.; Leydon, J.; Kiely, P.; Maskill, W.

2000-01-01

The age-specific immunity to human parvovirus infection was estimated in Victoria, Australia using prospectively collected samples from the Royal Children's Hospital, the Royal Women's Hospital and the Australian Red Cross Blood Service and from sera stored at the Victorian Infectious Diseases Reference Laboratory (VIDRL). All testing was performed at VIDRL using a commercial enzyme-linked immunosorbent assay (Biotrin). Of the 824 sera tested, 28% of those drawn from people aged 0-9 years contained protective antibodies to human parvovirus. This rose to 51% in the next decade of life. There was then a slow rise to about 78% immunity over 50 years of age. An analysis of all requests for parvovirus serology at VIDRL from 1992 to 1998 suggested that parvovirus tended to occur in 4-year cycles, with 2 epidemic years followed by 2 endemic years. A review of published reports of parvovirus immunity suggested that parvovirus infection may be more common, with a correspondingly higher proportion of the community immune, in temperate as opposed to tropical countries. PMID:10982069

Hospital-based glaucoma clinics: what are the costs to patients?

PubMed

Sharma, A; Jofre-Bonet, M; Panca, M; Lawrenson, J G; Murdoch, I

2010-06-01

To investigate the costs to patients attending hospital-based glaucoma clinics. A patient-based costs questionnaire was developed and completed for patients attending six ophthalmology units across London (Ealing General Hospital, St Georges Hospital, Mile End Hospital, Upney Centre Barking, St Ann's Hospital and the Royal London Hospital). The questionnaire considered age, sex, ethnicity as well as patient-based costs, opportunity costs, and companion costs. All patients visiting for review or appointments were approached non-selectively. A total of 100 patients were sampled from each unit. The mean age of the full sample was 69.6 years (SD 12.6), with little variation between sites (68.5-71.8 years). There was an almost equal sex distribution (male (298 (50.6%)). There was no major difference in occupational distribution between sites. The majority of people came to hospital by bus (40%) or car (26%). Female patients went slightly more by cab or car, whereas male patients went slightly more by foot or train. There was some variability in transport method by site. The data showed that the Royal London hospital had the highest mean cost per visit (pound16.20), whereas St Georges had the lowest (pound12.90). Upney had the second highest mean cost per visit (pound15.20), whereas Ealing and St Ann's had similar mean costs of (pound13.25) and (pound13), respectively. Travel costs accounted for about one-fifth of the total patient's costs. For all glaucoma clinics, total societal costs were higher than the sum of patients' costs because of the high frequency of companions. A surprising finding was that two-thirds of the population (392 or 66.6%) reported no qualification-considerably higher than the national census statistics for the same population. To our knowledge this paper presents direct and indirect patient costs in attending hospital glaucoma units for the first time. It highlights the significance of opportunity costs when considering health-care interventions as they amount to a third or more of the total costs of patient attendances to clinics.

Arthroscopy in 19 children with Perthes' disease. Pathologic changes of the synovium and the joint surface.

PubMed

Suzuki, S; Kasahara, Y; Seto, Y; Futami, T; Furukawa, K; Nishino, Y

1994-12-01

Arthroscopy of the hip joint was performed in 19 children with Legg-Calvé-Perthes' disease. Proliferation of the synovium was pronounced both in the acetabular fossa and over the inner wall of the capsule. Hypervascularity was seen on the acetabular labrum in every stage of the disease. Microscopically, hyperplasia of the synovial lining cells was observed, but inflammatory changes in the synovial tissue were inconspicuous in the early stage of the disease. Although hypertrophy of the endothelial cells of the vessels was seen in the late stage of the disease, it was not distinct in the initial or fragmentation stages. Joint pain improved after irrigation during arthroscopy.

Changed and changing gender and family roles and domestic violence in African refugee background communities post-settlement in Perth, Australia.

PubMed

Fisher, Colleen

2013-07-01

In this study, domestic violence (DV) in five African refugee background communities post-settlement in Perth, Australia, is investigated-specifically, the interrelationship between experiences of DV, and changed and changing gender and family roles and responsibilities. The participatory qualitative design utilized in-depth interviews with 54 members of the Somalian, Sierra Leonean, Ethiopian, Liberian and Sudanese Communities, and focus groups with 24 professionals who support them. Three key dimensions of this interrelationship are discussed: "male loss of the breadwinner role and status," "financial independence," and "mismatch between formal response and expectations." The importance of understanding experiences of DV within the context of cultural transition is highlighted here.

Primary obstructive megaureter.

PubMed

Sripathi, V; King, P A; Thomson, M R; Bogle, M S

1991-07-01

Twenty-three children with primary obstructive megaureters presented between 1978 and 1988 to the Princess Margaret Hospital for Children in Perth. Twenty-eight ureters were treated. Urinary infections were the presenting feature in 14 children. The obstructive segment was transvesically excised. Histopathologic examination of the distal, intramural ureter showed fibromuscular disarray with a relative increase in fibrous tissue and reduction of musculature in all specimens. Twenty-two ureters were tapered by excision and all 28 were reimplanted using an antireflux technique. Seventeen children were followed for an average of 3 years. Seven children showed renal growth, reduction in ureteric size by greater than 2 cm, improvement in glomerular filtration rate by more than 10%, no obstruction on reflux, and no infections in postoperative period. Four children showed all the above but suffered one or more infections after the operation. Of the remaining 6 children, 3 had postoperative obstruction and 3 had vesicoureteric reflux.

Evaluation of paediatric radiology services in hospitals in the UK.

PubMed

Halliday, K; Drinkwater, K; Howlett, D C

2016-12-01

To compare paediatric radiology provision across the UK with national standards published by the Department of Health and the Royal College of Radiologists (RCR). Audit standards and indicators for paediatric imaging were derived from "Delivering quality imaging services for children", 1 "Standards for imaging in cases of suspected non-accidental injury" 2 and "Improving paediatric interventional radiology services" 3 and agreed jointly by the Clinical Radiology Audit Committee and the British Society of Paediatric Radiology. A questionnaire was sent to all hospitals and NHS trusts imaging children aged 16 or younger in the UK in October 2013. The target for all indicators was 100%. Eighty-seven of 196 (44%) eligible institutions submitted data, the size distribution of the institutions was representative when compared to data from "Facing the future: a review of paediatric services" 4 published by the Royal College of Paediatrics and Child health. Only 65% of paediatric images were obtained by staff who had had specific training and only 60% were reported by radiographers or radiologists with appropriate training. Sixty-two percent of centres did not have access to a paediatric opinion 24 hours a day, 7 days a week all year; only 34% of radiographers who regularly imaged children had had any access to continuing professional development (CPD) in the 12 months of the audit. Although all hospitals had facilities for image transfer, only 57% had any formal funding arrangements in place for external reporting of images. The standards set for a network approach to paediatric radiology provision in "Delivering quality imaging services for children" are largely unmet. This failure to make the most of the workforce and resources puts vulnerable children at risk. The authors urge NHS England to work with the RCR to organise and administer a national network for paediatric imaging. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Emergency eye care in rural Australia: role of internet.

PubMed

Kumar, S; Yogesan, K; Hudson, B; Tay-Kearney, M-L; Constable, I J

2006-12-01

Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia. The teleophthalmology service was initiated in the Carnarvon Regional Hospital (CRH) of the Gascoyne region in Western Australia. A digital, slit lamp and fundus camera were used for the service. Economic data was gathered from the Department of Health of Western Australia (DOHWA), the CRH and the Lions Eye Institute. During the study period (January-December, 2003) 118 persons took part in teleophthalmology consultations. Emergency cases constituted 3% of these consultations. Previous year, there were seven eye-related emergency evacuations (inter-hospital air transfers) from the Gascoyne region to City of Perth. Analysis demonstrates implementation of internet-based health services has a marked impact on rural emergency eye care delivery. Internet is well suited to ophthalmology for the diagnosis and management of acute conditions in remote areas. Integration of such services to mainstream health care is recommended.

Growth disturbance in Legg-Calvé-Perthes disease and the consequences of surgical treatment.

PubMed

Leitch, J M; Paterson, D C; Foster, B K

1991-01-01

Seventy-two patients with Legg-Calvé-Perthes disease were studied to assess the interference with proximal femoral growth as a result of the disease itself and of surgical treatment. Twenty-five patients were treated nonoperatively, 20 were treated by femoral varus derotation osteotomy, and 27 by innominate osteotomy. All patients were studied clinically for evidence of abductor weakness and leg-length discrepancy. They were also studied roentgenographically for evidence of femoral head deformity and trochanteric overgrowth. The overall results showed a 6% incidence of leg-length discrepancy greater than 2 cm after both operative and nonoperative treatment. The articulo-trochanteric distance (ATD) was less than +5 mm in 23% of patients, of which 43% had a positive Trendelenburg sign. A significantly lower mean ATD was found in patients treated by femoral varus osteotomy, which should be avoided in patients over eight years of age. The study also demonstrated a strong association between coxa magna and growth disturbance of the proximal femoral physis manifesting itself as either a leg-length discrepancy or as a low ATD. The significant effects of growth disturbance after treatment must be considered, as well as the sphericity of the healed femoral head, in the final assessment in Legg-Calvé-Perthes disease.

Unusual Rebuilding Method of Historic St Mary's Cathedral in the Capital of Western Australia

NASA Astrophysics Data System (ADS)

Wysokowski, Adam

2016-06-01

St Mary's Cathedral is the Archbishop church of the Archdiocese in Perth in Western Australia. The presented sacral building was built in neo-Gothic style during the years 1863-1865. Cathedral was officially dedicated and opened for the service on 29th January, 1865. In 1973 was proclaimed the Marian Sanctuary and now represents one of the largest religious facilities in Perth. In 2005, the city authorities, together with the Archdiocese took a collective decision on the necessity of a comprehensive renovation of this sacred object. The renovation was due to the technical condition and the lack of usability of the object. The author of the paper had the opportunity to experience these problems by visiting this place several times, first time in 1989 and next years. Thus, the renovation of the present Cathedral was in its assumption not only to perform maintenance of the building and its specific architectural elements but also to increase its functional features - usable for the faithful and tourists. Reconstruction of St Mary's Cathedral in Perth can be a good example increasing the wider functionality of such facilities while keeping their antique and historical qualities. In this paper the above-mentioned issues will be more widely developed by the author.

Current educational issues in the clinical neurosciences.

PubMed

Desbiens, R; Elleker, M G; Goldsand, G; Hugenholtz, H; Puddester, D; Toyota, B; Findlay, J M

2001-11-01

Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system. A special symposium on current challenges in clinical neuroscience training was held at the Canadian Congress of Neurological Sciences in June 2000. Representatives from the Canadian Association of Interns and Residents, the Royal College of Physicians and Surgeons of Canada and English and French neurology and neurosurgery training programs made presentations, which are summarized in this report. Residency training has become less service-oriented, and this trend will continue. In order to manage the increasingly sophisticated hospital services of neurology and neurosurgery, resident-alternatives in the form of physician "moonlighters" or more permanent hospital-based clinicians or "hospitalists" will be necessary in order to operate major neuroclinical units. Health authorities and hospitals will need to recognize and assume this responsibility. As clinical experience diminishes during residency training, inevitably so will the concept of the fully competent "generalist" at the end of specialty training. Additional subspecialty training is being increasingly sought by graduates, particularly in neurosurgery. Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully qualified specialists in neurology and neurosurgery and the provision of optimal care to patients in clinical teaching units.

A possible case of acquired syphilis at the former Royal Hospital of All-Saints (RHAS) in Lisbon, Portugal (18th century): a comparative methodological approach to differential diagnosis.

PubMed

Assis, Sandra; Casimiro, Sílvia; Alves Cardoso, Francisca

2015-01-01

Between the years of 1999 and 2001, during the excavation of the Praça da Figueira (Lisbon, Portugal), several human osteological remains from various chronological periods were discovered. Amongst them several skeletons are known to be related with the Hospital Real de Todos-os-Santos (Royal Hospital of All Saints - RHAS), which had an important role. The hospital history begun in 1492 and ended in 1755 largely as a consequence of the Lisbon earthquake. Of the skeletons exhumed, one in particular, the adult female Sk. 1310 showed significant pathological changes. The bone lesions characterized by new bone deposition, with a symmetric and disseminate pattern, were found in the upper limbs, distal end of femurs and in tibia and fibula diaphyses. A bowing deformity with "sabre shape" morphology was also observed in the tibiae. The most striking lesions, characterized by healed nodular cavitations and similar to those of caries sicca, were recorded on the frontal bone. Considering the value of a complete description, as well as the application of multiple lines of enquiry for a reliable differential diagnosis, three distinct techniques were applied and compared: visual examination, imagiology and histology. The results showed that the macroscopic analysis coupled with conventional X-ray analysis were fundamental to obtain a possible diagnosis of acquired syphilis. In contrast, the CT-scan and the histological analyses were less informative. The application of a new scoring system also supports a diagnosis of acquired syphilis. This case-study constitutes the first evidence of syphilis associated with the RHAS, supporting historical data on the pivotal role that this hospital had on the treatment of several conditions, namely, syphilis.

A national audit of retail lamb loin quality in Australia.

PubMed

Safari, E; Channon, H A; Hopkins, D L; Hall, D G; van de Ven, R

2002-07-01

A retail audit of lamb loin tenderness was conducted over a 12-month period to determine the variation in tenderness of Australian lamb. Tenderness was objectively measured using Warner-Bratzler (WB) shear force. Muscle pH and cooking loss were determined on all samples and colour was measured on a sub-sample of loins. A total of 909 midloins from retail butcher shops and supermarkets located in four Australian capital cities (Sydney, Canberra, Melbourne, and Perth) were evaluated at four sampling times (December 1997 and March, June, and October 1998). Overall, 20.3% of all midloins purchased had a WB shear force value above the threshold level of 5 kg. Generic samples from Melbourne butcher shops were similar for WB shear force on average to the generic samples from Canberra and Sydney, whereas those from Melbourne supermarkets had significantly (P<0.001) higher WB shear force and were in line with generic samples from Perth. In both Canberra and Perth, alliance (branded) lamb had a greater WB shear force (P<0.05) than generic lamb. No relationship was found between price per kg and shear force (r=0.02) for loins purchased in Sydney (n=220). Price per kg differed between months (P<0.001) and suburbs (P<0.001), but not between retail butcher shops and supermarkets. Of the midloins tested, 10.3% had a pH above the critical point of 5.8. Midloins from the December 1997 sampling had a lower pH (P<0.01) than those sampled at other months. Those sampled in Melbourne and Perth had a similar mean pH, which were lower (P<0.001) than Canberra and Sydney samples. The findings from this quality audit suggest that there is room to improve the tenderness of Australian lamb sold in the domestic market. A lamb eating quality assurance system, based on set protocols, is one approach that is currently being investigated in Australia to ensure the supply of consistently high eating quality lamb to consumers.

Perfusion MRI in Early Stage of Legg-Calvé-Perthes Disease to Predict Lateral Pillar Involvement: A Preliminary Study.

PubMed

Kim, Harry K W; Wiesman, Kathryn D; Kulkarni, Vedant; Burgess, Jamie; Chen, Elena; Brabham, Case; Ikram, Haseeb; Du, Jerry; Lu, Amanda; Kulkarni, Ashok V; Dempsey, Molly; Herring, J Anthony

2014-07-16

Current radiographic classifications for Legg-Calvé-Perthes disease cannot be applied at the early stages of the disease. The purpose of this study was to quantify the perfusion of the femoral epiphysis in the early stages of Legg-Calvé-Perthes disease with use of perfusion magnetic resonance imaging (MRI) and to determine if the extent of epiphyseal perfusion can predict the lateral pillar involvement at the mid-fragmentation stage. Twenty-nine patients had gadolinium-enhanced perfusion MRI at the initial stage or early fragmentation stage of Legg-Calvé-Perthes disease and were followed prospectively. The percent perfusion of the whole epiphysis and its lateral third was measured by four independent observers using image analysis software. The radiographs obtained at the mid-fragmentation stage were used for the lateral pillar classification. Intraclass correlation coefficient (ICC) and logistic regression analyses were performed. The mean age (and standard deviation) at diagnosis was 7.7 ± 1.7 years (range, 5.3 to 11.3 years). The mean interval between the MRI and the time of maximum fragmentation was 8.2 ± 5.5 months. The interobserver ICC for the percent perfusion of the lateral third of the epiphysis was 0.90 (95% confidence interval [CI]: 0.83 to 0.95). The mean percent perfusion of the lateral third of the epiphysis was 92% ± 2%, 68% ± 18%, and 46% ± 12% for the hips in which the lateral pillar was later classified as A, B, and C, respectively (p = 0.001). When the perfusion level was ≥90% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group A, as opposed to B or C, was 72.0 (CI: 3.5 to 1476). With a perfusion level of ≤55% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group C, as opposed to A or B, was 33.3 (CI: 2.8 to 392). Similar results were obtained for the whole epiphysis. Perfusion MRI measurements of the total epiphysis and its lateral third obtained at the early stages of Legg-Calvé-Perthes disease were predictive of lateral pillar involvement at the mid-fragmentation stage of the disease. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

A Randomised Controlled Trial to Determine the Effectiveness of an Early Psychological Intervention with Children Involved in Road Traffic Accidents

ERIC Educational Resources Information Center

Stallard, Paul; Velleman, Richard; Salter, Emma; Howse, Imogen; Yule, William; Taylor, Gordon

2006-01-01

Objective: To determine whether an early intervention using a psychological debriefing format is effective in preventing psychological distress in child road traffic accident survivors. Design: Randomised controlled trial. Setting: Accident and Emergency Department, Royal United Hospital, Bath. Subjects: 158 children aged 7-18. Follow-up…

Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney.

PubMed

Rodgers, R; Beik, N; Nassar, N; Brito, I; de Vries, B

2017-04-01

To report the complication rate associated with external cephalic version (ECV) at term. Single-centre retrospective study. A major tertiary hospital in Sydney, Australia. All women who underwent an ECV at Royal Prince Alfred Hospital from 1995-2013 were included. ECV was attempted on all consenting women with a breech presentation at term in the absence of contraindications. Complications were classified as minor (transient cardiotocography abnormalities, ruptured membranes, small antepartum haemorrhage) or serious (fetal death, placental abruption, fetal distress requiring emergency caesarean section, fetal bone injury, cord prolapse). ECV success rates and rate of reversion to breech were recorded. The primary outcome was the incidence of serious complications. Secondary outcome measures were the rate of minor complications and reversion to breech. Of 1121 patients that underwent ECV, five (0.45%) experienced a serious complication. There was one placental abruption, one emergency caesarean section for fetal distress and two cord prolapses. There was one fetal death attributable to a successful ECV. Forty-eight women (4.28%) experienced a minor complication. Reversion to the breech occurred in sixteen patients (3.32%). ECV at term is associated with a low rate of serious complications. Study of 1121 consecutive ECV attempts shows low rate of complications although one fetal death reported. © 2016 Royal College of Obstetricians and Gynaecologists.

The variability of Halley's Comet during the Vega, Planet-A, and Giotto encounters

NASA Technical Reports Server (NTRS)

Schleicher, D. G.; Millis, R. L.; Tholen, D.; Lark, N.; Birch, Peter V.; Martin, Ralph; Ahearn, Michael F.

1986-01-01

Narrowband photometry of Halley obtained at Cerro Tololo Inter-American Observatory (CTIO), Mauna Kea Observatory (MKO), and Perth Observatory was combined to determine the relative level of activity during the interval spanning the spacecraft encounters. Measurements of the flux from the comet in emission bands of OH, NH, CN, C3, and C2, as well as at 2 continuum points, were obtained at CTIO on each night between 5 March and 17 March 1986. Observations were made on many of these same dates at MKO and Perth using comparable interference filters. The date clearly show variation of a factor of 2.5 in the production of all observed species with a characteristic time scale of a few days.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Komhyr, W.D.; Quincy, D.M.; Grass, R.D.

This report describes work to improve the quality of total ozone and Umkehr data obtained in the past at the NOAA Climate Monitoring and Diagnostics Laboratory and the Dobson spectrophotometer ozone observatories. The authors present results of total ozone data re-evaluations for ten stations: Byrd, Antarctica; Fairbanks, Alaska; Hallett, Antarctica; Huancayo, Peru; Haute Provence, France; Lauder, New Zealand; Perth, Australia; Poker Flat, Alaska; Puerto Montt, Chile; and South Pole, Antarctica. The improved data will be submitted in early 1996 to the World Meteorological Organization (WMO) World Ozone Data Center (WODC), and the Atmospheric Environment Service for archiving. Considerable work hasmore » been accomplished, also, in reevaluating Umkehr data from seven of the stations, viz., Huancayo, Haute Provence, Lauder, Perth, Poker Flat, Boulder, Colorado; and Mauna Loa, Hawaii.« less

A randomized trial comparing digital video disc with written delivery of falls prevention education for older patients in hospital.

PubMed

Hill, Anne-Marie; McPhail, Steven; Hoffmann, Tammy; Hill, Keith; Oliver, David; Beer, Christopher; Brauer, Sandra; Haines, Terry P

2009-08-01

To compare the effectiveness of a digital video disc (DVD) with that of a written workbook delivering falls prevention education to older hospital patients on self-perceived risk of falls, perception of falls epidemiology, knowledge of prevention strategies, and motivation and confidence to engage in self-protective strategies. To compare the effect of receiving either education approach versus no education on patients' perception of falls epidemiology. Randomized trial (DVD vs workbook) with additional quasi-experimental control group. Geriatric, medical, and orthopedic wards in Perth and Brisbane, Australia. One hundred (n=51 DVD, n=49 workbook) hospital inpatients aged 60 and older receiving an intervention (mean age 75.3+/-10.1) and 122 in the control group (mean age 79.3+/-8.3). Participants randomly assigned to receive identical educational material on falls prevention delivered on a DVD or in a workbook. Control group received usual care. Custom-designed survey addressing elements of the Health Belief Model of health behavior change. Participants randomized to DVD delivery had a higher self-perceived risk of falling (P=.04) and higher levels of confidence (P=.03) and motivation (P=.04) to engage in self-protective strategies than participants who received the workbook. A higher proportion of participants who received either form of the education provided "desired" responses than of control group participants across all knowledge items (P<.001). Delivery of falls prevention education on a DVD compared to a written workbook is more likely to achieve important changes in parameters likely to affect successful uptake of falls prevention messages in the hospital setting.

Retrospective hospital based surveillance of intussusception in children in a sentinel paediatric hospital: benefits and pitfalls for use in post-marketing surveillance of rotavirus vaccines.

PubMed

Lloyd-Johnsen, C; Justice, F; Donath, S; Bines, J E

2012-04-27

Evaluation of the safety of rotavirus vaccines, particularly with respect to the risk of intussusception, is recommended for countries planning to introduce rotavirus vaccines into the National Immunisation Program. However, as prospective studies are costly, require time to conduct and may be difficult to perform in some settings, retrospective hospital based surveillance at sentinel sites has been suggested as an option for surveillance for intussusception following introduction of rotavirus vaccines. To assess the value of retrospective hospital based surveillance to describe clinical and epidemiological features of intussusception in children aged <24 months and to investigate any temporal association between receipt of a rotavirus vaccine and intussusception. A retrospective chart review of all patients diagnosed with intussusception at Royal Children's Hospital, Melbourne, Australia over an 8-year period including before and after rotavirus vaccine introduction into the National Immunisation Program, was conducted using patients identified by a medical record database (ICD-10-CM 56.1). Patient profile, clinical presentation, treatment and outcome were analysed along with records of immunisation status obtained using the Australian Childhood Immunisation Register. A 9% misclassification rate of discharge diagnosis of intussusception was identified on critical chart review. The incidence rate of intussusception at the Royal Children's Hospital over the study period was 1.91 per 10,000 infants <24 months (95% CI 1.65-2.20). Intestinal resection was required in 6.5% of infants (95% CI 3.6%, 11.0%). Intussusception occurred within 30 days after vaccination in 2 of 27 patients who had received at least 1 dose of a rotavirus vaccine. Valuable data on the incidence, clinical presentation and treatment outcomes of intussusception can be obtained from data retrieved from hospital medical records in a sentinel paediatric hospital using standardised methodology. However, there are methodological limitations and the quality of the data is highly dependent on the accuracy and completeness of the patient information recorded, the system of coding and record retrieval. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pressure sores following elective total hip arthroplasty: pitfalls of misinterpretation.

PubMed Central

Keong, Nicole; Ricketts, David; Alakeson, Nuki; Rust, Philippa

2004-01-01

OBJECTIVE: To assess the reliability of reporting protocols regarding pressure sores. METHODS: Retrospective data were collected regarding pressure sore rates following total hip arthroplasty operations carried out during 2001 at two orthopaedic units in an NHS hospital (Princess Royal Hospital) and in a local private hospital. RESULTS: Preliminary results presented in audit and interim reports indicated an alarmingly high pressure sore rate across the two sites (17/172 [9.9%] NHS, 23/71 [32.4%] private hospital). On analysis, the data collection system was revealed to be flawed. Grade 1 areas (erythema with no ulceration) were included, leading to a dramatic discrepancy between reported and confirmed pressure sores. Re-analysis showed the confirmed pressure sore rates to be much lower (2.3% NHS, 1.0% private hospital). CONCLUSIONS: This audit suggests that both poor data collection and education lead to inaccurate audit. This may lead to subsequent inappropriate management and inappropriate NHS star ratings. PMID:15140301

The application of a "6S Lean" initiative to improve workflow for emergency eye examination rooms.

PubMed

Nazarali, Samir; Rayat, Jaspreet; Salmonson, Hilary; Moss, Theodora; Mathura, Pamela; Damji, Karim F

2017-10-01

Ophthalmology residents on call at the Royal Alexandra Hospital identified workplace disorganization and lack of standardization in emergency eye examination rooms as an impediment to efficient patient treatment. The aim of the study was to use the "6S Lean" model to improve workflow in eye examination rooms at the Royal Alexandra Hospital. With the assistance of quality improvement consultants, the "6S Lean" model was applied to the current operation of the emergency eye clinic examination rooms. This model, considering 8 waste categories, was then used to recommend and implement changes to the examination rooms and to workplace protocols to enhance efficiency and safety. Eye examination rooms were improved with regards to setup, organization of supplies, inventory control, and maintenance. All targets were achieved, and the 5S audit checklist score increased by 33 points from 44 to 77. Implementation of the 6S methodology is a simple approach that removes inefficiencies from the workplace. The ophthalmology clinic removed waste from all 8 waste categories, increased audit results, mitigated patient and resident safety risks, and ultimately redirected resident time back to patient care delivery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Post eLetter Solutions: Healthy Results for Improving Patient Communication Processes at the Royal Hobart Hospital.

PubMed

Boulter, Rhonda

2009-06-01

The primary objective of the Australia Post eLetter project 1 was to determine the feasibility of using the eLetter service with the Patient Administration System Appointment Scheduling Module to provide a fully automated mailing function that would eliminate the need for manual processing of mail delivery. Issues with timely delivery of letters throughout all outpatient sites at the Royal Hobart Hospital (RHH) have been identified as being mainly due to limited human resources being available to perform mailing duties and the like. This new desktop service enables staff to transmit data electronically in conjunction with the appointment software for large quantity mail postings to Australia Post via a secure line. Australia Post then validates the address, appends a barcode, prints the letter, envelopes it and inserts it into the mail distribution network in the state of the recipient. This article depicts the process that has eliminated the manual processing of a letter via the traditional Microsoft application, Wordmate, a system at RHH that was always difficult to use. With the introduction of eLetter, the RHH's Specialist Clinics have significantly improved the timeliness and quality of communication with patients as well as reducing administration tasks for staff.

Hierarchical multi-taxa models inform riparian vs. hydrologic restoration of urban streams in a permeable landscape.

PubMed

Gwinn, Daniel C; Middleton, Jen A; Beesley, Leah; Close, Paul; Quinton, Belinda; Storer, Tim; Davies, Peter M

2018-03-01

The degradation of streams caused by urbanization tends to follow predictable patterns; however, there is a growing appreciation for heterogeneity in stream response to urbanization due to the local geoclimatic context. Furthermore, there is building evidence that streams in mildly sloped, permeable landscapes respond uncharacteristically to urban stress calling for a more nuanced approach to restoration. We evaluated the relative influence of local-scale riparian characteristics and catchment-scale imperviousness on the macroinvertebrate assemblages of streams in the flat, permeable urban landscape of Perth, Western Australia. Using a hierarchical multi-taxa model, we predicted the outcomes of stylized stream restoration strategies to increase the riparian integrity at the local scale or decrease the influences of imperviousness at the catchment scale. In the urban streams of Perth, we show that local-scale riparian restoration can influence the structure of macroinvertebrate assemblages to a greater degree than managing the influences of catchment-scale imperviousness. We also observed an interaction between the effect of riparian integrity and imperviousness such that the effect of increased riparian integrity was enhanced at lower levels of catchment imperviousness. This study represents one of few conducted in flat, permeable landscapes and the first aimed at informing urban stream restoration in Perth, adding to the growing appreciation for heterogeneity of the Urban Stream Syndrome and its importance for urban stream restoration. © 2017 by the Ecological Society of America.

An extended baseline examination of indoor VOCs in a city of low ambient pollution: Perth, Western Australia

NASA Astrophysics Data System (ADS)

Maisey, S. J.; Saunders, S. M.; West, N.; Franklin, P. J.

2013-12-01

This study of indoor air quality reports VOC concentrations in 386 suburban homes located in Perth Western Australia, a city of low ambient pollution and temperate climate. Details of indoor VOC concentrations, temperature, relative humidity, and information on house characteristics and occupant activities were collected during the sampling periods. The concentration of VOCs observed in typical homes was low and individual compounds rarely exceeded 5 μg m-3. Median individual VOC concentrations ranged from 0.06 μg m-3 for 1,1,1 trichloroethane and butyl ether to 26.6 μg m-3 for cis/trans 2-butene. Recently renovated homes had higher concentrations of VOCs than non renovated homes, including ∑VOCs (p = 0.026), ∑BTEX (p = 0.03), ∑xylene (p = 0.013), toluene (p = 0.05), cyclohexane (p = 0.039), and propyl benzene (p = 0.039). Statistical analyses showed house age and attached garages were not significant factors for any of the VOCs tested. The concentrations of indoor VOCs in Perth were lower than overseas observations and those reported in recent Australian studies, with inferences made to differences in the climate and the occupant behaviour. The results are a baseline profile of indoor VOCs over the period 2006-2011, in an Australian city of low population density and of generally low ambient pollution.

Evolution of water recycling in Australian cities since 2003.

PubMed

Radcliffe, J C

2010-01-01

The prolonged Australian drought which commenced in 2002, and the agreement between Australia's Commonwealth and States/Territories governments to progress water reform through the National Water Initiative, has resulted in many new recycling projects in Australia's capital cities. Dual reticulation systems are being advanced in new subdivision developments in Sydney, Melbourne and Adelaide. Brisbane has installed three large Advanced Water Treatment Plants that are designed to send indirect potable recycled water to the Wivenhoe Dam which is Brisbane's principal water reservoir. Numerous water recycling projects are serving industry and agriculture. Experimental managed aquifer recharge is being undertaken with wetland-treated stormwater in Adelaide and reverse osmosis treated wastewater in Perth. New National Water Quality Management Strategy recycled water guidelines have been developed for managing environmental risks, for augmentation of drinking water supplies, for managed aquifer recharge and for stormwater harvesting and reuse. Many recent investments are part-supported through Commonwealth government grants. Desalination plants are being established in Melbourne and Adelaide and a second one in Perth in addition to the newly-operational plants in Perth, South-East Queensland and Sydney. Despite there being numerous examples of unplanned indirect potable recycling, most governments remain reluctant about moving towards planned potable recycling. There is evidence of some policy bans still being maintained by governments but the National Water Commission continues to reinforce the necessity of an even-handed objective consideration of all water supply options.

The marine soundscape of the Perth Canyon

NASA Astrophysics Data System (ADS)

Erbe, Christine; Verma, Arti; McCauley, Robert; Gavrilov, Alexander; Parnum, Iain

2015-09-01

The Perth Canyon is a submarine canyon off Rottnest Island in Western Australia. It is rich in biodiversity in general, and important as a feeding and resting ground for great whales on migration. Australia's Integrated Marine Observing System (IMOS) has moorings in the Perth Canyon monitoring its acoustical, physical and biological oceanography. Data from these moorings, as well as weather data from a near-by Bureau of Meteorology weather station on Rottnest Island and ship traffic data from the Australian Maritime Safety Authority were correlated to characterise and quantify the marine soundscape between 5 and 3000 Hz, consisting of its geophony, biophony and anthrophony. Overall, biological sources are a strong contributor to the soundscape at the IMOS site, with whales dominating seasonally at low (15-100 Hz) and mid frequencies (200-400 Hz), and fish or invertebrate choruses dominating at high frequencies (1800-2500 Hz) at night time throughout the year. Ships contribute significantly to the 8-100 Hz band at all times of the day, all year round, albeit for a few hours at a time only. Wind-dependent noise is significant at 200-3000 Hz; winter rains are audible underwater at 2000-3000 Hz. We discuss how passive acoustic data can be used as a proxy for ocean weather. Passive acoustics is an efficient way of monitoring animal visitation times and relative densities, and potential anthropogenic influences.

Epworth HealthCare cardiac surgery audit report 2011.

PubMed

Chorley, T; Baker, L

2012-10-01

2011 is the first year Epworth has contributed to Australian and New Zealand Society of Cardiac and Thoracic Surgeons cardiac surgery database. There is now a 30-day follow-up data for all cardiac surgical patients as well as benchmarking of our results with 19 public hospitals and 6 private hospitals contributing data to the Australian and New Zealand Society of Cardiac and Thoracic Surgeons. This is an extension of the John Fuller Melbourne University database that has compiled cardiac surgery data for the last 30 years. © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

Outcomes and predictive tests from a dedicated specialist clinic for women at high risk of preterm labour: A ten year audit.

PubMed

Hughes, Kelly; Sim, Shirlene; Roman, Alina; Michalak, Kasia; Kane, Stefan; Sheehan, Penelope

2017-08-01

Preterm birth continues to be a major cause of infant morbidity and mortality worldwide, but advances have recently been made in its prediction and prevention. A short cervix (<25 mm) in the second trimester on transvaginal ultrasound scan and fetal fibronectin are important predictive tests. For over ten years, the Preterm Labour Clinic at the Royal Women's Hospital, Melbourne, Australia has provided care for women at high risk of preterm birth, including those with a previous preterm birth, previous cervical surgery, uterine malformation or incidental finding of short cervix at routine ultrasound. The purpose of this study was to review this clinic's outcomes for the first decade. This was a retrospective cohort study of all referrals to the Preterm Labour Clinic during the period 2004-2013 inclusive. Seven hundred and fifty-six cases met the study inclusion criteria of appropriate risk factor, singleton pregnancy, surveillance undertaken and outcome data available. The preterm birth rate (<37 weeks) was 21.4%. The rate of preterm birth by year decreased significantly when adjusted for risk (P = 0.002). A short cervix was diagnosed in 32% of the sample, and positively correlated with lower gestational age at delivery. Fetal fibronectin and serum alkaline phosphatase were independent predictors of preterm birth <34 weeks and <37 weeks. The adjusted preterm birth rate at the Royal Women's Hospital's Preterm Labour Clinic has decreased significantly over the decade studied. Positive fetal fibronectin at 26 weeks and elevated serum alkaline phosphatase are independent predictors of preterm birth. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Geography does not limit optimal diabetes care: use of a tertiary centre model of care in an outreach service for type 1 diabetes mellitus.

PubMed

Simm, Peter J; Wong, Nicole; Fraser, Lynne; Kearney, John; Fenton, Judy; Jachno, Kim; Cameron, Fergus J

2014-06-01

Young people with type 1 diabetes mellitus living in rural and regional Australia have previously been shown to have limited access to specialised diabetes services. The Royal Children's Hospital Melbourne has been running diabetes outreach clinics to Western Victoria, Australia, for over 13 years. We aim to evaluate this service by comparing the outcomes of three outreach clinics with our urban diabetes clinic at the Royal Children's Hospital Melbourne. We examine our tertiary, multidisciplinary team-based model of care, where visiting specialist medical staff work alongside local allied health teams. The local teams provide interim care between clinics utilising the same protocols and treatment practices as the tertiary centre. Longitudinal data encapsulating the years 2005-2010, as a cohort study with a control group, are reviewed. A total of 69 rural patients were compared with 1387 metropolitan patients. Metabolic control was comparable, with no difference in mean HbA1c (8.3%/67 mmol/mol for both groups). Treatment options varied slightly at diagnosis, while insulin pump usage was comparable between treatment settings (20.3% rural compared with 27.6% urban, P = 0.19). Of note was that the number of visits per year was higher in the rural group (3.3 per year rural compared with 2.7 urban, P < 0.001). We conclude that the outreach service is able to provide a comparable level of care when the urban model is translated to a rural setting. This model may be further able to be extrapolated to other geographic areas and also other chronic health conditions of childhood. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Legg-Calvé-Perthes disease.

PubMed

Schoenecker, P L

1986-09-01

Legg-Calvé-Perthes disease, or osteochondrosis of the femoral head, occurs predominantly in boys 4 to 7 years of age. The disease progresses through synovitis, necrosis, fragmentation, and a residual stage. Outcome can be affected by age at disease onset, the extent of femoral head involvement as determined by x-ray, and the degree to which normal range of motion is maintained. The goal of treatment is to minimize residual deformity of the femoral head and acetabulum. This is accomplished by containing the femoral head well within the acetabulum and maintaining range of motion while the disease process runs its course. In extremely young patients, containment is often achieved during normal daily living activities. Containment treatment methods include abduction casting or orthosis; surgical containment can be accomplished by femoral or innominate osteotomy.

Measuring surgical performance: A risky game?

PubMed

Kiernan, F; Rahman, F

2015-08-01

Interest in performance measurement has been driven by increased demand for better indicators of hospital quality of care. This is due in part to policy makers wishing to benchmark standards of care and implement quality improvements, and also by an increased demand for transparency and accountability. We describe the role of performance measurement, which is not only about quality improvement, but also serves as a guide in allocating resources within health systems, and between health, education, and social welfare systems. As hospital based healthcare is responsible for the most cost within the healthcare system, and treats the most severely ill of patients, it is no surprise that performance measurement has focused attention on hospital based care, and in particular on surgery, as an important means of improving quality and accountability. We are particularly concerned about the choice of mortality as an outcome measure in surgery, as this choice assumes that all mortality in surgery is preventable. In reality, as a low quality indicator of care it risks both gaming, and cream-skimming, unless accurate risk adjustment exists. Further concerns relate to the public reporting of this outcome measure. As mortality rates are an imperfect measure of quality, the reputation of individual surgeons will be threatened by the public release of this data. Significant effort should be made to communicate the results to the public in an appropriate manner. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

A survey of current practice in out of hours percutaneous nephrostomy insertion in the United Kingdom.

PubMed

Riddell, A M; Charig, M J

2002-12-01

To establish the current out of hours service provided in the United Kingdom for nephrostomy insertion. Using the Royal College of Radiologists' (RCR) database a questionnaire was sent to all the current clinical directors. Questionnaires were sent to 246 hospitals, with replies received from 178 (72.3%). The number of consultants doing nephrostomies as part of their routine work was 476; this increased to 625 including those who perform nephrostomies out of hours. Therefore 24% of consultants only perform nephrostomies out of hours. For the times when there was no formal out of hours nephrostomy service, the arrangements varied and included calling a consultant who was not on call (52%), or transferring the patient (37%). Only 19 hospitals (11%) had a separate interventional on call rota, the majority of these being teaching hospitals (68%). The availability of assistance was limited, with nursing staff available only 43% of the time. In institutions with specialist registrars, the registrars were involved with the nephrostomies 75% of the time. There is a wide variation in the out of hours service provided by radiology departments for nephrostomy insertion. A large percentage of out of hours nephrostomies are done by consultants who do not perform do the procedure as part of their routine clinical practice, which is contrary to the advice of the Royal College of Radiologists for out of hours working. In addition the provision of nursing assistance for the procedure is inadequate.

Lumbar microdiscectomy as a day-case procedure: Scope for improvement?

PubMed

Ahuja, Neeraj; Sharma, Himanshu

2018-06-01

There are no significant differences in outcomes between patients receiving inpatient and day-case lumbar microdiscectomy, but the latter is still underused in the NHS. Here we aimed to identify factors contributing to successful same-day discharge in day-case patients. This was a retrospective observational study of patients undergoing elective lumbar microdiscectomy between August 2012 and December 2014. Age, gender, day of surgery, distance to hospital, ASA grade, regular opiate use, smoking status, order on the operating list, and side and level of surgery were examined by logistic regression to assess their influence on same-day discharge. 28/95 (29.5%) patients were discharged on the day of surgery. Age (p = 0.041), ASA grade (p = 0.016), distance to hospital (p = 0.011), and position on the list (p = 0.004) were associated with day-case discharge by univariate analysis. ASA grade (p = 0.032; OR 0.176), distance to hospital (p = 0.003; OR 0.965), and position on the operating list (morning case; p = 0.011; OR 8.901) remained significant in multivariate analysis. Thirteen (13.7%) patients were identified who could have been managed as day cases had they been listed for morning operations. Day-case lumbar microdiscectomy is viable when patients are carefully selected. Younger, fit patients living close to the hospital and operated on in the morning are more likely to be discharged on the same day. Knowledge of these factors while planning elective lists can help optimise bed space and improve spinal services. Copyright © 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Factors associated with early neonatal attendance to a paediatric emergency department.

PubMed

Flanagan, C F; Stewart, M

2014-03-01

To examine the demographic and perinatal factors involved in the presentation of newborn babies to a paediatric emergency department (PED) and outcome following attendance. Term babies who attended the PED of the Royal Belfast Hospital for Sick Children (RBHSC) in the first 2 weeks of life, during two separate 3-month periods in summer and winter 2010-2011 were identified retrospectively from the PED electronic database. Perinatal and demographic data were also obtained on all babies born in the Royal Jubilee Maternity Hospital (RJMH) during the same time period. A total of 223 attendances to the PED involving 208 babies were identified with almost equal distribution during summer and winter months. Almost two thirds (n=139, 62%) of babies presented out-of-hours. Over half of babies were self-referred by parent/carer. The most common presentation was feeding difficulty, vomiting or faltering growth, accounting for 36%. Significant factors associated with attendance to PED included birth weight <2500 g, deprivation and postnatal stay more than 2 days. Sixty-one babies (24%) presenting to PED were admitted to hospital. Significant factors for admission included age ≤ 48 h and presentation during the standard working day. Overall, a third of babies admitted stayed less than 24 h (34%). Large numbers of babies attend the PED in the first 2 weeks of life, commonly out of hours, from deprived areas and with feeding difficulties. A quarter of babies attending are admitted to hospital, with one-third discharged following an overnight stay. Services should be reevaluated, particularly in this current financial climate, in an attempt to find new models of care for these young babies.

Defense.gov Special Report: Travels with Panetta

Science.gov Websites

in Australia Defense Secretary Leon E. Panetta and Australian Defense Minister Stephen Smith have , Secretary Clinton, Minister Carr and Minister Smith at AUSMIN Ministerial, Perth, Australia Media

Cooking and oxygen. An explosive recipe.

PubMed

Burns, H L; Ralston, D; Muller, M; Pegg, S

2001-02-01

Home oxygen therapy is commonly prescribed for the treatment of chronic obstructive pulmonary disease (COPD). The risks of smoking while using this therapy have been well described. To discuss the Royal Brisbane Hospital Burns Unit's experience and present case studies which illustrate the danger of alternative ignition sources while using home oxygen. The dangers of home oxygen therapy can be minimised by careful patient selection, education and ongoing monitoring.

Experience gained from treating facial injuries due to civil unrest

PubMed Central

Whitlock, R I H

1981-01-01

During the past 10 years of civil unrest in Northern Ireland a wide variety of facial injuries have been treated at the Royal Victoria Hospital, Belfast. The causes and nature of these injuries are described and the experience gained in their management is reviewed. Imagesp[35]-ap[42]-aFig. 1Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7 PMID:7247260

Improving communication between emergency department staff.

PubMed

Moore, Kate

2014-05-01

During redevelopment of the emergency department at the Royal Sussex County Hospital, Brighton, it was deemed vital that its internal communication system should be as effective as possible. An audit of staff perceptions of the existing communication system and a relevant literature review were undertaken, therefore, to inform a proposal for the development of a new online system. This article describes the development and implementation of the system.

Developing Decision-Making Skills Using Immersive VR

DTIC Science & Technology

2013-06-14

Institution: Department of Otolaryngology Mailing Address: Level 2, Royal Victorian Eye and Ear Hospital, 32, Gisborne St, East Melbourne...reliability of this measure. We will also intend to integrate other data models into to the feedback system such as Pattern based models [8], and... Pattern -Based Real-Time Feedback for a Temporal Bone Simulator’, Proc. of the 19th ACM Symposium on Virtual Reality Software and Technology, 2013

New law on staffing levels will save lives.

PubMed

2016-02-17

Good news about nurse staffing levels can be hard to find, so how fantastic that a protracted campaign in Wales finally paid off last week with the passage of legislation to ensure hospital wards are staffed safely. Next month, the Queen will give royal assent to the Safe Nurse Staffing Levels (Wales) Bill, which will save lives, produce better outcomes and enhance the patient experience of care.

John Newsom-Davis: clinician-scientist and so much more

PubMed Central

2011-01-01

John Newsom-Davis was born in 1932 and died, aged 74, in 2007. After national service in the Royal Air Force, he read Natural Sciences at Cambridge. Following clinical studies at the Middlesex Hospital, he began research into respiratory neurophysiology with Tom Sears at the National Hospital, Queen Square, in London, and spent 1 year with Fred Plum at Cornell University in New York. After neurology specialist training at Queen Square, he became the director of the Batten Unit, continuing his interest in respiratory physiology. There he began to work on myasthenia gravis in collaboration with Ricardo Miledi at University College London and in 1978, after performing the first studies on plasma exchange in that disease, he established a myasthenia gravis research group at the Royal Free Hospital. There he investigated the role of the thymus in this disease and demonstrated an autoimmune basis for the Lambert Eaton myasthenic syndrome and ‘seronegative’ myasthenia. He was awarded the first Medical Research Council Clinical Research Professorship in 1979 but moved to Oxford in 1987 when he was elected Action Research Professor of Neurology. While at Oxford, he continued to run a very successful multidisciplinary group, researched further into the thymic abnormalities and cellular immunology of myasthenia, identified antibody-mediated mechanisms in acquired neuromyotonia, and began the molecular work that identified the genetic basis for many forms of congenital myasthenic syndrome. Meanwhile, he was also involved in university and college governance and contributed widely to the Medical Research Council, government committees, research charities and the Association of British Neurologists. Among many honours, he was elected Fellow of the Royal Society in 1991, appointed Commander of the British Empire in 1996 and made a Foreign Associate Member of the Institute of Medicine of the United States in 2001. Nearing and following retirement from Oxford, where he continued to see patients with myasthenia, he was the President of the Association of British Neurologists and Editor of Brain, and led a National Institutes of Health-funded international trial of thymectomy. PMID:22171357

The role of family and maternal factors in childhood obesity.

PubMed

Gibson, Lisa Y; Byrne, Susan M; Davis, Elizabeth A; Blair, Eve; Jacoby, Peter; Zubrick, Stephen R

2007-06-04

To investigate the relationship between a child's weight and a broad range of family and maternal factors. Cross-sectional data from a population-based prospective study, collected between January 2004 and December 2005, for 329 children aged 6-13 years (192 healthy weight, 97 overweight and 40 obese) and their mothers (n=265) recruited from a paediatric hospital endocrinology department and eight randomly selected primary schools in Perth, Western Australia. Height, weight and body mass index (BMI) of children and mothers; demographic information; maternal depression, anxiety, stress and self-esteem; general family functioning; parenting style; and negative life events. In a multilevel model, maternal BMI and family structure (single-parent v two-parent families) were the only significant predictors of child BMI z scores. Childhood obesity is not associated with adverse maternal or family characteristics such as maternal depression, negative life events, poor general family functioning or ineffective parenting style. However, having an overweight mother and a single-parent (single-mother) family increases the likelihood of a child being overweight or obese.

National Osteonecrosis Foundation

MedlinePlus

Home Osteonecrosis Osteonecrosis of the Jaw Mission Statement More About Us Related Sites Questions & Answers NONF Brochure Legg-Calve'-Perthes Disease ... Newsletter Volunteers Needed Patient Questionnaire Find A Physician Osteonecrosis - A bone disease that few have heard of. ...

Nonsurgical treatment to regain hip abduction motion in Perthes disease: a retrospective review.

PubMed

Carney, Brian T; Minter, Christin L

2004-05-01

The purpose of this study was to document the ability of a nonsurgical program to improve restricted passive hip abduction in children with Perthes disease. Containment as a form of treatment was recommended if passive hip abduction of 30 degrees or more could be achieved. Medical records and radiographs were retrospectively reviewed for 74 children. Age at admission and onset, side, length of stay, and measurement of passive hip abduction at admission/discharge were recorded. The average increase in abduction with the hip extended was 13 degrees. Forty-two children achieved 30 degrees or more of abduction with the hip extended. Average length of stay was 13 days. Management of restricted abduction in an inpatient setting can allow consideration of containment in 61% of children previously not thought to have the required motion.

The medical response to the Boston Marathon bombings: an analysis of social media commentary and professional opinion.

PubMed

Côté, Emilie; Hearn, Russell

2016-11-01

To explore the differences in perception of the medical response to the victims of the 2013 Boston Marathon bombings between laypeople and healthcare professionals. Commentary accessible and available on Internet discussion websites by non-medically trained persons and in the academic literature by healthcare professionals was analysed qualitatively. Major themes were found relating to both the pre-hospital and hospital-based phases of the medical response to the disaster. Laypeople focused more on pre-hospital care and the actions of specific bystanders, while healthcare professionals focused on hospital care, the importance of a disaster plan, and frequent training for the success of the response. Laypeople and healthcare professionals have positive but differing perceptions of the medical response to the victims of the bombings. This may have implications for future funding and implementation of disaster preparedness. © Royal Society for Public Health 2016.

The Revised Basel Statements on the Future of Hospital Pharmacy: What Do They Mean for Saudi Arabia?

PubMed

Al Sabban, Hanadi; Al-Jedai, Ahmed; Bajis, Dalia; Penm, Jonathan

2018-06-01

To describe the current hospital pharmacy practice in Saudi Arabia according to the revised Basel statements. A review of the available data based on published literature in the subject area was carried out. The original Basel Statements were developed at the 2008 Global Conference on the Future of Hospital Pharmacy in Basel, Switzerland. Representatives from 98 countries, including Saudi Arabia, attended this conference. The revision of the Basel statements simplified and merged many of the original Basel statements. In addition to making the Basel statements more concise, the revision added new statements to reflect global trends and the expanded responsibilities of hospital pharmacists. The release of the Basel statements represents an important opportunity to bring Saudi Arabian practices into complete concurrence with international standards and to identify areas that should be prioritized. © 2017 Royal Pharmaceutical Society.

The time of the insult/triggering event in Legg-Calvé-Perthes' disease determined by incubation period modeling and the age distribution of children with Perthes'.

PubMed

Loder, Randall T; Browne, Richard H; Millis, Andrew; Kim, Wook-Cheol; Shah, Hitesh; Cosgrove, Aidan P; Wiig, Ola

2012-01-01

The time when the insult/triggering event occurs in Legg-Calvé-Perthes' (LCPD) is unknown. the purpose of this study was to determine, using the mathematical tool of incubation period modeling, the time of such event and the incubation period for LCPD. We reviewed 2,911 children with LCPD from 10 different centers around the world. They were divided into two groups: those from India (505 children, mean age 8.1 ± 2.3 years) and those from other than India (2,406 children, mean age 5.8 ± 2.2 years). A simple distribution with an excellent fit to the data was ln(y) = a + bx + cxln(x), where y is the proportion of children with LCPD at age of diagnosis x (r(2) = 0.994 for non-Indian and 0.959 for Indian children). The age of the triggering event was 1.32 years for non-Indian and 2.77 years for Indian children; the median incubation period was 4.30 years non-Indian and 5.33 years for Indian patients. Knowing the incubation period and age of triggering event narrows the number of potential etiologies in LCPD. this study does not support a prenatal triggering event as postulated in the past. similar incubation periods with different ages at diagnosis supports a common insult which occurs at different ages in different populations dependent upon local factors such as geographic location and ethnicity.

The accuracy of coin-operated breath analysers installed in licensed premises in the Perth metropolitan area.

PubMed

Hay, Greg; Cercarelli, L Rina

2004-04-01

To examine the accuracy of coin-operated breath analysers installed in licensed premises in the Perth metropolitan area. Two hundred licensed premises were contacted, which resulted in the location of 36 wall-mounted, coin-operated breath analysers. One instrument was removed prior to testing. These premises were then visited and the accuracy of the instruments was tested in situ using National Association of Testing Authorities Australia (NATA) certified 0.080% and 0.100% ethanol in nitrogen gas. The instruments were installed in the licensed premises as follows: 15 in the lounge bar, 10 in the main entrance, six in the public bar, two in the passageway to the toilets, and one in the male toilets. One licensed premise provided a handheld breath instrument. All instruments were accompanied by warning and operating instructions, but only five had any educational material. Only seven of the licensed premises had staff who had received any training in the operation of the wall-mounted instruments. Half of the licensees were unaware of the servicing requirements of the instruments. The testing found that only nine (25%) of the instruments provided acceptable results. The low level of accuracy of coin-operated breath analysers in the Perth metropolitan area is alarming and users should be informed of the potential inaccuracies. This paper, however, does not rule out that some wall-mounted breath analysing instruments may provide accurate results when properly maintained.

Strategies for improving antibiotic use in Qatar: a survey of pharmacists' perceptions and experiences.

PubMed

Pawluk, Shane; Black, Emily; El-Awaisi, Alla

2015-02-01

The objectives of this study were to identify antimicrobial stewardship activities in Qatar, identify pharmacist involvement in activities and summarize perceived barriers for implementation of antimicrobial stewardship programs (ASPs). A cross-sectional survey was developed based on study objectives and completed by pharmacists in Qatar. Most hospital settings have implemented components of ASP. Lack of infectious disease specialists and training of healthcare providers was the most common barrier to implementation or expansion of ASP identified in the hospital and community settings respectively. Pharmacists report some components of ASP have been implemented; however, barriers must be overcome to further expand ASPs. © 2014 Royal Pharmaceutical Society.

The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities.

PubMed

Barnett, Adrian G; Williams, Gail M; Schwartz, Joel; Best, Trudi L; Neller, Anne H; Petroeschevsky, Anna L; Simpson, Rod W

2006-07-01

The goal of this study was to estimate the associations between outdoor air pollution and cardiovascular hospital admissions for the elderly. Associations were assessed using the case-crossover method for seven cities: Auckland and Christchurch, New Zealand; and Brisbane, Canberra, Melbourne, Perth, and Sydney Australia. Results were combined across cities using a random-effects meta-analysis and stratified for two adult age groups: 15-64 years and >/= 65 years of age (elderly). Pollutants considered were nitrogen dioxide, carbon monoxide, daily measures of particulate matter (PM) and ozone. Where multiple pollutant associations were found, a matched case-control analysis was used to identify the most consistent association. In the elderly, all pollutants except O3 were significantly associated with five categories of cardiovascular disease admissions. No associations were found for arrhythmia and stroke. For a 0.9-ppm increase in CO, there were significant increases in elderly hospital admissions for total cardiovascular disease (2.2%) , all cardiac disease (2.8%), cardiac failure (6.0%), ischemic heart disease (2.3%), and myocardial infarction (2.9%). There was some heterogeneity between cities, possibly due to differences in humidity and the percentage of elderly people. In matched analyses, CO had the most consistent association. The results suggest that air pollution arising from common emission sources for CO, NO2, and PM (e.g., motor vehicle exhausts) has significant associations with adult cardiovascular hospital admissions, especially in the elderly, at air pollution concentrations below normal health guidelines. Relevance to clinical and professional practice: Elderly populations in Australia need to be protected from air pollution arising from outdoor sources to reduce cardiovascular disease.

Wittgenstein, medicine and neuropsychiatry.

PubMed

Teive, Hélio A G; Silva, Guilherme Ghizoni; Munhoz, Renato P

2011-08-01

A historical review is presented of the link between Ludwig Wittgenstein, considered the most important philosopher of the 20th century, and medicine, particularly neurology and psychiatry. Wittgenstein worked as a porter at Guy's Hospital in London, and then as a technician at the Royal Victoria Infirmary in Newcastle. He wrote about his important insights into language, and neuroscience. It has been suggested that he had Asperger syndrome and a possible movement disorder (mannerisms).

Promotor Regions Determining Over-Expression of Metalloproteinase Genes in Breast Cancer

DTIC Science & Technology

1999-06-01

G., Ph.D. 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS( ES ) 8. PERFORMING ORGANIZATION REPORT NUMBER Royal Prince Alfred Hospital Camperdown, NSW...2050, Australia 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS( ES ) 10. SPONSORING / MONITORING AGENCY REPORT NUMBER U.S. Army Medical Research...BioTechniques 3 Research Reports satec , Adelaidetusralia) per reaction. Plasmids ItL of phosphate-buffered saline (PBS)When included,- co petor

Late results of the Royal Free Hospital prospective controlled trial of prednisolone therapy in hepatitis B surface antigen negative chronic active hepatitis.

PubMed Central

Kirk, A P; Jain, S; Pocock, S; Thomas, H C; Sherlock, S

1980-01-01

A long-term follow-up of at least 10 years or until death of 44 patients taking part in a controlled prospective trial of prednisolone therapy in hepatitis B antigen negative chronic active hepatitis (lupoid hepatitis) has been performed at the Royal Free Hospital, London. Patients presenting between 1963 and 1967 were randomly allocated into control and treatment groups. Ten year life table survival curves showed a significantly improved survival in the treatment group where 63% of patients were alive at 10 years compared with only 27% in the control group (log rank test, P = 0.03). The median survival in the treatment group was 12.2 years compared with 3.3 years in the control group. The mean duration of treatment was 4.5 years. Age, presence of antinuclear factor, cirrhosis, or level of serum transaminases at presentation did not appear to affect survival. Male patients if untreated had a poorer prognosis than females (P = 0.02). The natural history of chronic active hepatitis appeared from clinical, biochemical, and histological findings to be from an active hepatitis or cirrhosis to inactive macronodular cirrhosis. Prednisolone therapy significantly improved survival by reducing mortality in the early active phase of the disease. PMID:6988304

77 FR 27115 - Drawbridge Operation Regulations; Raritan River, Perth Amboy, NJ

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-09

... the draw may remain in the closed position for four days to facilitate mechanical maintenance. Vessels... scheduled mechanical maintenance at the bridge. In order to perform the bridge maintenance the bridge must...

2. Historic American Buildings Survey Everitt K. Taylor, Photographer September ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. Historic American Buildings Survey Everitt K. Taylor, Photographer September 15, 1936 EXTERIOR - EAST ELEVATION FROM OLD PRINT IN POSSESSION OF OWNER - Governor's House, 149 Kearny Avenue, Perth Amboy, Middlesex County, NJ

Invisible partners: the Royal Australian Army Nursing Corps pathway to the Malayan Emergency.

PubMed

McLeod, Margaret; Francis, Karen

2007-12-01

This paper highlights the role of women from the Royal Australian Army Nursing Corps who served in the Malayan Emergency. The British administrators of Malaya declared an Emergency in 1948 in response to threats posed by Chinese Communist Terrorists. Australia was slow to support Britain, but in 1955 Australian ground troops, accompanied by six Army nurses were deployed to Malaya. The nurses worked in British Military Hospitals, continuing the traditions of their antecedents; yet their contributions remain hidden from view. The exact number of Australian nurses who served in the Emergency is unknown, because of the poor record-keeping of the Southeast Asian conflicts. However, it is estimated that 33 Australian Army nurses served in Malaya from 1955, with some continuing their service into the early 1960s. The experiences of four of these nurses are revealed in this paper: they are no longer invisible partners.

[Wouter van Doeveren (1730-1783) professor of practical medicine, obstetrics and pathology].

PubMed

Van Heiningen, Teunis Willem

2012-01-01

Between September 1752 and July 1753, Wouter van Doeveren, a student of Gaubius, Albinus and Winter at Leyden University, studied, together with a couple of friends at various Paris hospitals in order to improve his skills in the fields of surgery and obstetrics. After his return to Leyden, he took his doctor's degree in medicine and started his practice in that town. In 1754 he was appointed professor of medicine at Groningen University. In 1770 he was appointed professor of theoretical and practical medicine at Leyden University. He held that office until his death on 31 December 1783. He was a most appreciated foreign member of the Société Royale de Médecine (Paris) and of the Royal Society of Medicine (Edinburgh). He succeeded in improving his medical skills, by doing thorough research in the fields of pathological anatomy and teratology. He laid the foundations for national healthcare regulations for the United Provinces.

Profile: Vanessa Cameron – 36 years at the Royal College of Psychiatrists

PubMed Central

Poole, Rob; Robinson, Catherine A.

2016-01-01

On 16 December 2016, Vanessa Cameron retires as Chief Executive of the Royal College of Psychiatrists. She started working there in September 1980 and in 1984 she became Secretary of the College, the role that preceded chief executive. The College was formed in 1971, so Vanessa has been present for most of its lifetime. It has been a period of continuous change that has seen psychiatry leave the old mental hospitals, expand considerably in the late 1990s and early part of the 21st century, and come under huge pressure more recently. Although she has never worked within mental health services, Vanessa has been at the heart of British psychiatry for 36 years. She was awarded an MBE in the 2013 New Year's Honours list for services to psychiatry. We interviewed Vanessa at 21 Prescot Street on 3 August 2016. PMID:28377815

Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia.

PubMed

Crebbin, Wendy; Campbell, Graeme; Hillis, David A; Watters, David A

2015-12-01

The topic of discrimination, bullying and sexual harassment in surgery was raised in the Australian media earlier in 2015. This led the Royal Australasian College of Surgeons (RACS) to commission an Expert Advisory Group to investigate and advise the College on their prevalence in surgery in Australia and New Zealand. This paper reports the findings with respect to prevalence of these inappropriate behaviours. The data in this paper were drawn from the published results of two quantitative surveys. One was an online survey sent to all RACS members. The other was an invited survey of hospitals, medical institutions and other related professional organizations including surgical societies. The prevalence survey achieved a 47.8% response rate, representing 3516 individuals. Almost half of the respondents 1516 (49.2%) indicated that they had experienced one or more of the behaviours. This proportion was consistent across every specialty. Male surgical consultants were identified as the most likely perpetrators. More than 70% of the hospitals reported that they had instances in their organization of discrimination, bullying or sexual harassment by a surgeon within the last 5 years. Surgical directors or surgical consultants were by far the most frequently reported perpetrators (in 50% of hospitals). Discrimination, bullying and sexual harassment are common in surgical practice and training in Australia and New Zealand. RACS needs to urgently address these behaviours in surgery. This will involve a change in culture, more education for fellows and trainees, and better processes around complaints including support for those who have suffered. © 2015 Royal Australasian College of Surgeons.

Measuring the effectiveness of in-hospital and on-base Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) programs on reducing alcohol related harms in naval trainees: P.A.R.T.Y. Defence study protocol.

PubMed

Watterson, Jason; Gabbe, Belinda; Dietze, Paul; Thompson, Jennifer; Oborn, Michael; Rosenfeld, Jeffrey V

2017-05-02

Reducing alcohol related harms in Australian Defence Force (ADF) trainees has been identified as a priority, but there are few evidence-based prevention programs available for the military setting. The study aims to test whether the P.A.R.T.Y. program delivered in-hospital or on-base, can reduce harmful alcohol consumption among ADF trainees. The study is a 3-arm randomized controlled trial, involving 953 Royal Australian Navy trainees from a single base. Trainees, aged 18 to 30 years, will be randomly assigned to the study arms: i. in-hospital P.A.R.T.Y.; ii. On-base P.A.R.T.Y.; and iii. All groups will receive the routine ADF annual alcohol awareness training. The primary outcome is the proportion of participants reporting an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or above at 12 months' post-intervention. The secondary outcome is the number of alcohol related incidents reported to the Royal Australian Navy (RAN) in the 12 months' post-intervention. This is the first trial of the use of the P.A.R.T.Y. program in the military. If the proposed intervention proves efficacious, it may be a useful program in the early education of RAN trainees. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001332617 , date of registration: 18/12/2014 'retrospectively registered'.

An audit of the E.N.T. casualty service at the Royal Victoria Eye and Ear Hospital.

PubMed

O'Driscoll, K; Donnelly, M J; McShane, D P; Burns, H

1993-11-01

The only specialised Accident and Emergency unit for ENT in Ireland is at The Royal Victoria Eye and Ear Hospital, Dublin. This provides a service for the entire Republic, operating on a 9 am to 5 pm, Monday to Friday, basis. The aim of the present study was to define the role of this specialised unit. A prospective study of the service over a one month period was conducted. During this time 779 patients were seen of which 350 (45%) were new patients and 429 (55%) were return patients. Fifty two per cent were self referred, 35% were referred by their General Practitioners, 8% by other hospitals and 5% from other sources. The most common diagnosis was otitis externa (21% of new patients and 63% of returns), followed by ear wax (15% of new patients), and epistaxis (9% of new patients). Five per cent of patients required removal of foreign bodies from their ear, nose or oesophagus, and 3% received treatment for trauma to these regions. Of note during this period six new cases of head and neck cancer were detected. From these figures it is the authors' opinion that many of the problems seen could have been dealt with by General Practitioners or as non-emergency referrals to the out-patient department. This indicates the need for further training for primary care physicians and expansion of the present outpatients services. The specialised casualty service should continue to exist to provide a genuine emergency service and valuable training in the speciality.

Lawn mower injuries in children: a 30-year experience.

PubMed

Nguyen, Anh; Raymond, Simon; Morgan, Vanessa; Peters, Julian; Macgill, Kirstie; Johnstone, Bruce

2008-09-01

Lawn mowers cause severe injuries that are particularly devastating to children. This study analyses the patterns and trends in lawn mower injuries involving children referred to Victoria's principal children's hospital. A retrospective review of the patient medical records at the Royal Children's Hospital (Melbourne) Victoria, Australia was carried out. The series included all patients admitted for lawn mower injury during the 30-year period spanning 1975-2004. Lawn mower injuries treated at Royal Children's Hospital were severe and included partially amputated limbs. Overall, admissions for lawn mower injury generally decreased over time from n = 26 in the 1975-1979 interval to n = 14 in the 2000-2004 interval. However, the frequency of admission for injuries caused by ride-on mowers contradicted the overall trend and generally increased over time from n = 5 in the 1975-1979 interval to n = 11 in the 2000-2004 interval. This is of particular concern. Ride-on lawn mowers caused significantly more severe injuries requiring longer periods of admission and more operations during admission in comparison to standard mowers. Rural location at the time of injury was a risk factor associated with requiring longer periods of admission and more operations during admission. Children injured while operating mowers were generally older than children injured as bystanders. Lawn mower injuries are a significant cause of morbidity. These injuries are particularly devastating to children. The tragedy is keenly felt in the realization that these devastating injuries to children could all be prevented. Strategic preventative measures should be developed through partnership between the medical profession, the media, industry specialists and the wider community.

1. Historic American Buildings Survey Everitt K. Taylor, Photographer September ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Historic American Buildings Survey Everitt K. Taylor, Photographer September 15, 1936 EXTERIOR - GENERAL VIEW EAST ELEVATION FROM OLD PRINT IN POSSESSION OF OWNER - Governor's House, 149 Kearny Avenue, Perth Amboy, Middlesex County, NJ

Leg lengthening - series (image)

MedlinePlus

... as Legg-Perthes disease Previous injuries or bone fractures that may stimulate excessive bone growth Abnormal spinal ... in the bone to be lengthened; usually the lower leg bone (tibia) or upper ... small steps, usually over the course of several months.

[Legg-Calvé-Perthes disease (LCPD). Principles of diagnosis and treatment].

PubMed

Manig, M

2013-10-01

The clinical course of Legg-Calvé-Perthes disease (LCPD) is variable. Diagnosis, nonsurgical and surgical methods of treatment have evolved over many decades, from abduction casts and braces to advanced surgical containment methods which are now the mainstay of treatment. This article presents a general view and a critical evaluation of the literature. The main prognostic factors are patient age at the onset of LCPD, the range of motion and the extent of the necrotic process according to the classification of Herring and Catterall. The main aims of surgical and nonsurgical treatment of LCPD are to prevent prearthrotic deformity of the femoral head, relief of symptoms, containment of the femoral head and restoration of congruence of the hip joint. Each patient needs to be evaluated individually. Every child must receive an adapted treatment and continued follow-up at regular intervals.

The Assessment of Emotional Reactivity Across Negative and Positive Emotions: Development and Validation of the Perth Emotional Reactivity Scale (PERS).

PubMed

Becerra, Rodrigo; Preece, David; Campitelli, Guillermo; Scott-Pillow, Glen

2017-02-01

The Perth Emotional Reactivity Scale (PERS) is a newly developed 30-item self-report measure of emotional reactivity (affective style). The PERS measures the typical ease of activation, intensity, and duration of one's emotional responses, and importantly does so for negative and positive emotions separately. We examined the psychometric properties of the PERS in an adult community sample ( N = 183). Confirmatory and exploratory factor analyses supported the capacity of the PERS to measure separate negative and positive reactivity factors, and to distinguish between the activation, intensity, and duration aspects of reactivity. All items of the PERS had strong loadings on their intended factor. Concurrent validity was supported via congruent correlations with other emotion measures, and internal reliability was good to excellent for all PERS scales and subscales. Overall, the PERS appears to have good psychometric properties, and thus has promising utility for research and clinical settings.

Psychogeriatrics in England: Its Route to Recognition by the Government as a Distinct Medical Specialty, c.1970-89.

PubMed

Hilton, Claire

2016-04-01

Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. 'General psychiatrists', nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London.

Psychogeriatrics in England: Its Route to Recognition by the Government as a Distinct Medical Specialty, c.1970–89

PubMed Central

Hilton, Claire

2016-01-01

Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. ‘General psychiatrists’, nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London. PMID:26971597

B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial.

PubMed

2010-09-01

Epidemiological studies suggest that raised plasma concentrations of total homocysteine might be a risk factor for major vascular events. Whether lowering total homocysteine with B vitamins prevents major vascular events in patients with previous stroke or transient ischaemic attack is unknown. We aimed to assess whether the addition of once-daily supplements of B vitamins to usual medical care would lower total homocysteine and reduce the combined incidence of non-fatal stroke, non-fatal myocardial infarction, and death attributable to vascular causes in patients with recent stroke or transient ischaemic attack of the brain or eye. In this randomised, double-blind, parallel, placebo-controlled trial, we assigned patients with recent stroke or transient ischaemic attack (within the past 7 months) from 123 medical centres in 20 countries to receive one tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B6, and 0.5 mg vitamin B12). Patients were randomly allocated by means of a central 24-h telephone service or an interactive website, and allocation was by use of random permuted blocks stratified by hospital. Participants, clinicians, carers, and investigators who assessed outcomes were masked to the assigned intervention. The primary endpoint was the composite of stroke, myocardial infarction, or vascular death. All patients randomly allocated to a group were included in the analysis of the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT00097669, and Current Controlled Trials, ISRCTN74743444. Between Nov 19, 1998, and Dec 31, 2008, 8164 patients were randomly assigned to receive B vitamins (n=4089) or placebo (n=4075). Patients were followed up for a median duration of 3.4 years (IQR 2.0-5.5). 616 (15%) patients assigned to B vitamins and 678 (17%) assigned to placebo reached the primary endpoint (risk ratio [RR] 0.91, 95% CI 0.82 to 1.00, p=0.05; absolute risk reduction 1.56%, -0.01 to 3.16). There were no unexpected serious adverse reactions and no significant differences in common adverse effects between the treatment groups. Daily administration of folic acid, vitamin B6, and vitamin B12 to patients with recent stroke or transient ischaemic attack was safe but did not seem to be more effective than placebo in reducing the incidence of major vascular events. These results do not support the use of B vitamins to prevent recurrent stroke. The results of ongoing trials and an individual patient data meta-analysis will add statistical power and precision to present estimates of the effect of B vitamins. Australia National Health and Medical Research Council, UK Medical Research Council, Singapore Biomedical Research Council, Singapore National Medical Research Council, Australia National Heart Foundation, Royal Perth Hospital Medical Research Foundation, and Health Department of Western Australia. Copyright 2010 Elsevier Ltd. All rights reserved.

Carotenaemia in children is common and benign: most can stay at home.

PubMed

McGowan, R; Beattie, J; Galloway, P

2004-08-01

We identified children with elevated plasma carotene levels who attended the Royal Hospital for Sick Children, Glasgow, between July 1998 and April 2001 and carried out a retrospective case record review. Thirty-one children were identified (7 boys; 14 girls) with a median age at presentation of 13 months (range 7m- 11yrs). Twenty-seven (87%) children had simple diet-related carotenaemia and were well. In four cases the hypercarotenaemia reflected nutritional problems with associated failure to thrive. In only one case did the family doctor recognise the condition before referral. Many who attended hospital had laboratory confirmation of the benign diagnosis despite a clear dietary origin. Some had repeat laboratory tests to confirm resolution. Diet-related carotenaemia appears common in our community. The condition appears poorly recognised within primary care and hospital investigations may be over-enthusiastic.

Staff rotation: implications for occupational therapy.

PubMed

Taylor, A; Andriuk, M L; Langlois, P; Provost, E

1995-10-01

Occupational therapy departments of tertiary care hospitals can provide staff with opportunities to gain diverse clinical experience if they rotate through the various services such as surgery, medicine, geriatrics, plastic surgery and orthopaedics. The system of rotation offers both advantages and disadvantages for the staff and the institution. The Royal Victoria Hospital in Montreal, a large university teaching hospital, had traditionally offered staff the opportunity to rotate. Changes in staffing and their needs however, resulted in rotation becoming an important issue within the department. This article presents the pros and the cons of rotation and non-rotation systems as identified by therapists and administrators across Canada. Staff rotation was found to have an effect on job satisfaction and a therapist's career orientation. Given these findings, administrators may want to reconsider the role of the generalist and specialist in their facilities.

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

PubMed Central

Dunnigan, Matthew G; Pollock, Allyson M

2003-01-01

Objectives To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Design Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Main outcome measures Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. Results By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). Conclusion The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1. What is already known on this topicThe full business cases for the 15 first wave private finance initiative (PFI) hospitals in England and Scotland projected reductions in acute beds of about 30% in the five years before the opening of the new replacement hospitalsThe new PFI Royal Infirmary of Edinburgh, which will fully open in 2003, is the cornerstone of Lothian Health Board's healthcare plan for its acute hospitalsWhat this study addsCompared with other Scottish NHS hospitals, service delivery has been reduced across Lothian associated with PFI developmentThe planning targets and increase in clinical activity in acute specialties in Lothian hospitals had not been achieved by 2000-1There is evidence of an independent “PFI effect” on hospital downsizing and bed reductions, which in Lothian has resulted in severe capacity constraints across all acute specialties with a need for immediate expansion in acute and community provisionFurther hospital and community service downsizing may be required to meet the financial deficit, which is principally due to the high costs of PFI PMID:12714469

Compliance to clinical pathways in the management of suspected pulmonary embolus: are there cost implications?

PubMed

Rehman, Ata; Yelf, Eric; Pearson, Jacqueline; Yeo, Wilf

2017-04-01

This study investigated the cost implications of poor compliance to established guidelines for management of suspected pulmonary embolism (PE) in two NSW public hospitals. A retrospective audit showed that the prevalence of PE overall was 9.9% (4.3% in the low-risk groups) in 436 patients. An estimated total of $32 454 (14%) was spent on unnecessary tests. © 2017 Royal Australasian College of Physicians.

The volume and type of unhealthy bus shelter advertising around schools in Perth, Western Australia: Results from an explorative study.

PubMed

Parnell, Ashleigh; Edmunds, Melinda; Pierce, Hannah; Stoneham, Melissa J

2018-03-05

Exposure to advertising for unhealthy food, alcohol and gambling has been shown to influence children and adolescents' behaviours and attitudes. This exploratory study aimed to assess the volume and type of unhealthy bus shelter advertisements near schools in five local government areas in Perth, Western Australia and to monitor whether the volume of unhealthy advertisements varied seasonally. The 29 local governments in the Perth metropolitan region were contacted seeking information regarding the locations of bus shelters featuring advertisements in their local government area. Five local governments provided sufficient information for an audit of the bus shelter advertisements in their area to be conducted. Every bus shelter within 500 m of a school was photographed and the type of advertisement recorded. The advertisements in the food, non-alcoholic beverage, alcohol, or gambling categories were then classified as being healthy, moderate, or unhealthy. This process was carried out in June, September, December 2016, and March 2017 to ascertain whether the type of advertisements displayed changed depending on the season. Of the 293 advertisements recorded over the four audits, 31% featured unhealthy products, 3% moderate, and <1% healthy. Only two of the 293 advertisements were classified as being healthy. Seasonal variation in the volume of unhealthy advertisements was not identified. SO WHAT?: Western Australian school students are regularly exposed to unhealthy bus shelter advertisements. Stricter regulation of outdoor advertising is needed to ensure that young people are protected from the influence of unhealthy industries. © 2018 Australian Health Promotion Association.

The provision of mental health services in England for people over 65 years of age, 1970-78.

PubMed

Hilton, Claire

2008-09-01

The twentieth century saw an increasing number of people living into old age, and consequently a higher prevalence of age-related chronic degenerative brain disorders. By 1971 the mental hospitals were almost half full with people over 65 years of age. Thus plans to close the mental hospitals meant that the development of community mental health services for older people was a necessity. Although there was a multi-disciplinary focus on the care of older people, the lead in service development was largely taken by psychiatrists, both individually and through the Group for the Psychiatry of Old Age at the Royal College of Psychiatrists.

Nursing workforce planning: insights from seven Malaysian hospitals.

PubMed

Drake, Robert

In 2010, the Royal College of Nursing asked: 'What is the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible?' This question implies there is a relationship between staffing levels, quality of care and financial efficiency. This paper examines the relationship between the staff budget, the number of staff required to achieve a target level of care and the actual number of staff employed in seven hospitals in Malaysia. It seeks to critically evaluate local challenges arising from staff budgeting/planning procedures, identify general issues that apply beyond Malaysian healthcare institutions and, finally, to propose a model that combines finance, staffing and level of care.

Impacts of Vegetation Change on the Water Balance of Superficial, Coastal Aquifers: a Comparative Study of Pre-clearing and Post-clearing Recharge Under Native Vegetation, and Pine Plantations

NASA Astrophysics Data System (ADS)

Bekele, E. B.; Salama, R. B.

2003-12-01

Replacing native vegetation with pasture across the northern Perth Basin in Western Australia has profoundly altered the water balance and led to dramatic increases in recharge and groundwater levels from about the mid-1960's, whereas replacing native vegetation with pine plantations and market gardens further south in the Gnangara groundwater Mound together with declining rainfall has caused continuous declines in recharge and water levels. Long-term monitoring of water levels in the Parmelia Formation, a superficial, semi-confined aquifer of predominantly weathered sand in the northern Perth Basin, indicates maximum rates of water level rise on the order of 40 to 55 cm/yr within the past decade. In the Gnangara Mound, water levels are falling by 10 to 20 cm/yr in the unconfined aquifer. Quantifying groundwater capture due to the removal of native vegetation is crucial for predicting the extent of groundwater development in the northern Perth Basin, whereas in the Gnangara Mound, it is necessary to limit the total water use to the declining resource to arrest the trend in falling water levels. Estimates of groundwater recharge before the removal of native vegetation in the northern Perth Basin determined from chloride tracer measurements in the soil water beneath native bushland and from groundwater samples ranged from 12 to 16 mm/yr, while estimates from soil water flux at the water table are approximately 5 mm/yr. In contrast, recharge estimates under cleared conditions since 1970 are between 24 and 50 mm/yr, based on hydrograph analyses of different bores. CFC and chloride analyses of water sampled from piezometers screened at the water table gave recharge estimates of 20 to 30 mm/yr and less than 10 mm/yr, respectively. In the Gnangara Mound recharge varies between 70 to 200 mm/year; the lowest recharge values were under the pines and the highest in the urban areas. Due to increasing demand on the groundwater resources and the declining water levels, additional resources can be provided only by removing the pine plantations, proper management of the Banksia woodland areas and capture of fresh groundwater discharging to the sea.

Effect of prophylactic trochanteric epiphyseodesis in older children with Perthes' disease.

PubMed

Shah, Hitesh; Siddesh, Nandi D; Joseph, Benjamin; Nair, Sreekumaran N

2009-12-01

To evaluate the effect of prophylactic epiphyseodesis of the greater trochanter in Perthes' disease, 62 children with unilateral Perthes' disease who underwent trochanteric epiphyseodesis combined with varus osteotomy of the femur during the active stage of the disease (mean age at surgery: 8.4 y) and 20 controls were followed up until skeletal maturity. On radiographs taken at skeletal maturity, the articulo-trochanteric distance, the center-trochanteric distance, the length of the abductor lever arm, the neck-shaft angle, the radius of the femoral head, and the Reimer's migration index of normal and affected hips were measured. The shape of the femoral head was assessed according to the criteria of Mose. The range of hip motion, the strength of hip abduction, and limb lengths were measured and the Trendelenburg sign was elicited. The mean values of articulo-trochanteric distance and center-trochanteric distance were greater and the frequency of a positive Trendelenburg sign was less in children who had undergone trochanteric epiphyseodesis than in children who had no surgery (P<0.01). Trochanteric epiphyseodesis achieved optimal trochanteric growth arrest in 60% of operated children; the procedure was not effective in 30%, and in 10% of children there was overcorrection. Logistic regression analysis showed that the size of the femoral head at healing and the age at surgery were variables that significantly influenced the effectiveness of trochanteric growth arrest. At skeletal maturity, the mean shortening of the affected limb in operated children was 0.44 cm (SD 0.68 cm), whereas that of non-operated children was 0.86 cm (SD 0.78 cm) (P<0.05). The range of motion of the hip was excellent and there were no significant differences in the range of motion among children with optimal correction, under-correction, and overcorrection. A probability curve plotted on the basis of a logistic regression model suggests that effective trochanteric arrest may be achieved in a high proportion of children operated at or before 8.5 years of age and in half the children operated between the age of 8.5 years and 10 years. On the basis of this study, we recommend prophylactic epiphyseodesis of the greater trochanter as a means of minimizing trochanteric overgrowth and resultant Trendelenburg gait in older child with Perthes' disease.

Per capita increase in hospital presentations and admissions among children since the 1990s.

PubMed

Hardy, Andrew; Fuller, David G; Forrester, Mike; Anderson, Kym P; Cooper, Chris; Jenner, Bernard; Marshall, Isaac; Mccloskey, Kate; Sanderson, Christine; Standish, Jane; Vuillermin, Peter

2016-10-01

Data regarding temporal trends in per capita paediatric hospital presentations and admissions are required to inform health system and workforce planning. Emergency Department (ED) presentations and admissions to the University Hospital Geelong among patients aged 0 to 16 years over a 12-month period (2012-2013) were determined by review of hospital records and then compared with similar data collected during 1996/1997. 1 During each period, the Geelong region was serviced by a single ED, enabling us to estimate per capita presentation and admission rates. Since 1996/1997, per capita paediatric presentations to the ED increased from 643 to 1837 per 10 000 (186%; 95% confidence interval 181% to 191%). Moreover, the proportion of paediatric ED presentations resulting in hospital admission increased from 12.3% to 18.3% (49%; 95% confidence interval 39% to 59%). There has been a substantial absolute and per capita increase in paediatric ED presentations and hospital admissions since the 1990s. These trends place an increasing burden on the public hospital system, and strategies are required to promote paediatric acute care in the ambulatory setting. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Introduction of clerking pro forma for surgical spinal patients at the Royal National Orthopaedic Hospital NHS Trust (London): an audit cycle.

PubMed

Pace, Valerio; Farooqi, Omar; Kennedy, James; Park, Chang; Cowan, Joseph

2018-05-01

As a tertiary referral centre of spinal surgery, the Royal National Orthopaedic Hospital (RNOH) handles hundreds of spinal cases a year, often with complex pathology and complex care needs. Despite this, issues were raised at the RNOH following lack of sufficient documentation of preoperative and postoperative clinical findings in spinal patients undergoing major surgery. This is not in keeping with guidelines provided by the Royal College of Surgeons. The authors believe that a standardised clerking pro forma for surgical spinal patients admitted to RNOH would improve the quality of care provided. Therefore, the use of a standard clerking pro forma for all surgical spinal patients could be a useful tool enabling improvements in patients care and safety in keeping with General Medical Council/National Institute for Health and Care Excellence guidelines. An audit (with closure of loop) looking into the quality of the preoperative and postoperative clinical documentation for surgical spinal patients was carried out at the RNOH in 2016 (retrospective case note audit comparing preintervention and postintervention documentation standards). Our standardised pro forma allows clinicians to best utilise their time and standardises examination to be compared in a temporal manner during the patients admission and care. It is the authors understanding that this work is a unique study looking at the quality of the admission clerking for surgical spinal patients. Evidently, there remains work to be done for the widespread utilisation of the pro forma. Early results suggest that such a pro forma can significantly improve the documentation in admission clerking with improvements in the quality of care for patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Masters Degree in Medical Physics at Queensland University of Technology--14 years on.

PubMed

Thomas, B W; Thomas, B J; Treffene, R J

1990-03-01

In 1975, the Masters Degree in Medical Physics was first made available at the Queensland Institute of Technology (now Queensland University of Technology, QUT), and is offered on both a part time and full time basis. An option for a Graduate Diploma award after completion of the in-house course work stage is available. The research project may be undertaken either in Brisbane or elsewhere. Such projects have been undertaken in Perth, Hong Kong, Sydney, etc. It is a broad based program, embracing activities of current professional importance while including aspects which have potential importance. Recognition that medical physics is a dynamic speciality ensures that the content of the program is kept under continuous review, and changes made as required. It is of interest to observe that of graduates from the course, approximately 50% have moved into the hospitals and private medical research, 11% into government health departments, 16% into the mining industry, 9% into tertiary education, and 14% into non medical or sales areas. Many have gained senior positions in their selected vocations. The success of the program in providing a useful professional person is due in no small measure to the collaboration of many dedicated professionals in the field. This collaboration relates to informal and formal contact between academic staff and students within the Physics Department, and personnel in hospitals, public health establishments and industry.

Inpatient antibiotic consumption in a regional secondary hospital in New Zealand.

PubMed

Hopkins, C J

2014-02-01

Reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres. The study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres. Hospital population-level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient-days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres. Total consumption was lower, but that of high-risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months. Our secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking. © 2014 The Author; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

ClinicalTrials.gov

2016-10-06

Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

77 FR 37439 - Notice of Lodging of Proposed Consent Decree Under the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... City of Perth Amboy, New Jersey a Municipal Corporation, and the State of New Jersey, Civil Action No... inspection and engineering assessment that will result in a corrective action plan that will include...

Part-time general surgical training in South Australia: its success and future implications (or: pinnacles, pitfalls and lessons for the future).

PubMed

Neuhaus, Susan; Igras, Emma; Fosh, Beverley; Benson, Sarah

2012-12-01

Flexible training options are sought by an increasing number of Australasian surgical trainees. Reasons include increased participation of women in the surgical workforce, postgraduate training and changing attitudes to family responsibilities. Despite endorsement of flexible training by the Royal Australasian College of Surgeons and Board in General Surgery, part-time (PT) training in General Surgery in Australia and New Zealand is not well established. A permanent 'stand-alone' PT training position was established at the Royal Adelaide Hospital in 2007 under the Surgical Education and Training Program. This position offered 12 months of General Surgical training on a 0.5 full-time (FT) equivalent basis with pro rata emergency and on-call commitments and was accredited for 6 months of General Surgical training. This paper reviews the PT training experience in South Australia. De-identified logbook data were obtained from the South Australian Regional Subcommittee of the Board in General Surgery with consent of each of the trainees. Totals of operative cases were compared against matched FT trainees working on the same unit. Overall, PT trainees achieved comparable operative caseloads compared with their FT colleagues. All trainees included in this review have subsequently passed the Royal Australasian College of Surgeons Fellowship Examination in General Surgery and returned to FT workforce positions. This paper presents two validated models of PT training. Training, resource and regulatory requirements and individual and institutional barriers to flexible training are substantial. Successful PT models offer positive and beneficial training alternatives for General Surgical trainees and contribute to workforce flexibility. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Cataract surgery audit at an Australian urban teaching hospital.

PubMed

Kahawita, Shyalle K; Goggin, Michael

2015-08-01

To provide local data on visual acuity and surgical outcomes for cataract surgery performed in an Australian teaching hospital. Continuous audit over 7 years in a public teaching hospital. A total of 3740 eyes had cataract surgery performed at The Queen Elizabeth Hospital, South Australia, from May 2006 to September 2013. Visual acuity and complication rates were recorded for cataract surgery cases operated on between May 2006 and September 2013 on a digital database with data entry contemporaneous with final follow-up. Visual acuity and surgical complications. Of the patients, 91.4% achieved postoperative best-measured vision better than preoperative best-measured vision. The rate of posterior capsular tear was 2.59%, endophthalmitis was 0.11% and the overall complication rate was 11.7%. This audit is the first to document modern cataract surgery, overwhelmingly dominated by phacoemulsification in an Australian population and can be used to benchmark cataract surgery outcome in an urban Australian population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014.

PubMed

Chang, C C; Ananda-Rajah, M; Belcastro, A; McMullan, B; Reid, A; Dempsey, K; Athan, E; Cheng, A C; Slavin, M A

2014-12-01

Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

The psychiatric inpatient physical health assessment sheet (PIPHAS): a useful tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients

PubMed Central

Pettipher, Alexander; Ovens, Richard

2015-01-01

There is increased morbidity and mortality among patients suffering from mental illness. This is believed to be multi-factorial. Poor access to healthcare, the stigma of mental illness, reduced clinic attendance, lifestyle factors, and side effects of medications are cited as possible contributing factors. It is therefore vital to perform a physical examination to identify previously undiagnosed conditions during the admission of a psychiatric inpatient. The Royal College of Psychiatrists recommends that all patients admitted to a psychiatric hospital should receive a full physical examination on admission, or within twenty-four hours of admission. A snapshot audit was carried out at Prospect Park Hospital in Reading, which highlighted that The Royal College of Psychiatrist's recommendation, along with Trust guidelines regarding physical examination were not being met, with only 78 out of 111 patients (70.3%) undergoing an examination during their admission. In addition to this, examinations were often poorly documented and not covering all examination domains. A psychiatric inpatient physical health assessment sheet (PIPHAS) was designed and introduced, providing a quick and standardised approach to the documentation of a physical examination. After the intervention was put into practice, its impact was assessed by performing a retrospective review of the admission clerking notes of the next 100 admissions to Prospect Park Hospital. Following the introduction of the PIPHAS form there was an increase in the number of patients undergoing physical examination on admission to hospital (75 out of 100 patients, 75%). There was also an increase in the thorough documentation of all examination domains (e.g. respiratory examination) for patients that had a completed PIPHAS form scanned within their medical records. This quality improvement project demonstrates that the PIPHAS form is a useful tool to improve the speed, efficiency, and documentation of a thorough physical examination in new psychiatric inpatients. PMID:26734362

The psychiatric inpatient physical health assessment sheet (PIPHAS): a useful tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients.

PubMed

Pettipher, Alexander; Ovens, Richard

2015-01-01

There is increased morbidity and mortality among patients suffering from mental illness. This is believed to be multi-factorial. Poor access to healthcare, the stigma of mental illness, reduced clinic attendance, lifestyle factors, and side effects of medications are cited as possible contributing factors. It is therefore vital to perform a physical examination to identify previously undiagnosed conditions during the admission of a psychiatric inpatient. The Royal College of Psychiatrists recommends that all patients admitted to a psychiatric hospital should receive a full physical examination on admission, or within twenty-four hours of admission. A snapshot audit was carried out at Prospect Park Hospital in Reading, which highlighted that The Royal College of Psychiatrist's recommendation, along with Trust guidelines regarding physical examination were not being met, with only 78 out of 111 patients (70.3%) undergoing an examination during their admission. In addition to this, examinations were often poorly documented and not covering all examination domains. A psychiatric inpatient physical health assessment sheet (PIPHAS) was designed and introduced, providing a quick and standardised approach to the documentation of a physical examination. After the intervention was put into practice, its impact was assessed by performing a retrospective review of the admission clerking notes of the next 100 admissions to Prospect Park Hospital. Following the introduction of the PIPHAS form there was an increase in the number of patients undergoing physical examination on admission to hospital (75 out of 100 patients, 75%). There was also an increase in the thorough documentation of all examination domains (e.g. respiratory examination) for patients that had a completed PIPHAS form scanned within their medical records. This quality improvement project demonstrates that the PIPHAS form is a useful tool to improve the speed, efficiency, and documentation of a thorough physical examination in new psychiatric inpatients.

High burden of diabetic foot infections in the top end of Australia: An emerging health crisis (DEFINE study)

PubMed Central

Commons, Robert J.; Robinson, Claire H.; Gawler, David; Davis, Joshua S.; Price, Ric N.

2015-01-01

Introduction The risk of diabetes mellitus is increasing worldwide, and is particularly high in Indigenous Australians. Complicated foot infection is one of the most common sequelae of diabetes. We describe the incidence and associations of Indigenous and non-Indigenous inpatients with diabetic foot infections at Royal Darwin Hospital. Methods All adult Royal Darwin Hospital inpatients with diabetic foot infections were enrolled prospectively from September 2012 to November 2013. Incidence, demographics, microbiology, management and clinical outcomes were analysed by Indigenous status, and association with methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa. Results There were 245 separate hospital admissions in 177 patients with an incidence of 79 admissions per 100,000 person years. Patients occupied a mean of 19.4 hospital beds each day. Compared to the non-Indigenous population, Indigenous patients had a greater incidence of admission (Rate Ratio (RR) = 5.1, [95%CI = 3.8, 7.0]), were younger (mean difference of 11.1 years; p < 0.001), and more likely to undergo major and minor amputations (RR = 4.1 [95%CI = 1.6, 10.7], and 6.2 [95%CI = 3.5, 11.1] respectively). Non-multiresistant methicillin resistant S. aureus was present in 44.7% of wounds from Indigenous patients versus 20.6% of non-Indigenous patients (Odds Ratio (OR) = 3.1, [95%CI = 1.5, 6.4]), whereas P. aeruginosa presence was significantly lower (15.8% versus 46.0%; OR = 0.22; [95%CI = 0.11, 0.45]). Methicillin resistant S. aureus or P. aeruginosa infections were associated with longer antibiotic courses and durations of stay. Conclusions This study highlights a rising burden of diabetic foot infections in the Top End of Australia, with a four-fold increase in bed days since 2002 and an overrepresentation in the Indigenous population. PMID:26453263

Frequency of respiratory deterioration after immunisation in preterm infants.

PubMed

Hacking, Douglas F; Davis, Peter G; Wong, Ester; Wheeler, Kevin; McVernon, Jodie

2010-12-01

To determine the relationship between the initiation of respiratory support and the first routine immunisation of neonates at 2 months of age during primary hospitalisation. An historical cohort study design was used to study the neonatal factors associated with the initiation of respiratory support within 7 days of immunisation in a cohort of 7629 preterm and term infants admitted to the Neonatal Unit of the Royal Women's Hospital between 2001 and 2008. The 411 infants who received their first immunisations in hospital were both very preterm and of extremely low birth weight (ELBW, below 1000 g). Twenty-two infants experienced post-immunisation apnoea of sufficient severity to warrant the initiation of either intermittent positive pressure ventilation (two cases) or continuous positive airway pressure (20 cases). Infants exhibiting a respiratory deterioration following immunisation had a higher incidence of previous septicaemia (Odds ratio 2.5, 95% confidence interval 1.0, 6.1; P = 0.04) and received CPAP for a longer period prior to vaccination (P = 0.03). Apnoea following immunisation may be an aetiological factor in the requirement of respiratory support in a small number of preterm, ELBW infants particularly those with significant lung disease and those who have previously experienced septicaemia. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Wireless telemedicine for the delivery of specialist paediatric services to the bedside.

PubMed

Smith, Anthony C; Coulthard, Mark; Clark, Ron; Armfield, Nigel; Taylor, Shauna; Goff, Robyn; Mottarelly, Ian; Youngberry, Karen; Isles, Alan; McCrossin, Robert; Wootton, Richard

2005-01-01

A mobile interactive online health system was used to conduct virtual ward rounds at a regional hospital which had no specialist paediatrician. The system was wireless, which allowed telepaediatric services to be delivered direct to the bedside. Between December 2004 and May 2005, 43 virtual ward rounds were coordinated between specialists based in Brisbane and local staff at the Gladstone Hospital. Eighty-six consultations were provided for 64 patients. The most common conditions included asthma (27%), chest infections (12%), gastroenteritis (10%) and urinary tract infections (10%). In the majority of cases, there were partial (67%) or complete changes (11%) in the clinical management of patients. Specialist services were offered by a team of 13 clinicians at the Royal Children's Hospital: 10 general paediatricians, two physiotherapists and one registered nurse. Feedback from all consultants involved in the service and local staff in Gladstone was extremely positive. In 43 videoconference calls there were three technical problems, probably due to an intermittent mains power supply at the regional hospital. There appears to be potential for other rural and regional hospitals to adopt this model of service delivery.

Return to sender: the need to re-address patient antibiotic allergy labels in Australia and New Zealand.

PubMed

Trubiano, J A; Worth, L J; Urbancic, K; Brown, T M; Paterson, D L; Lucas, M; Phillips, E

2016-11-01

Antibiotic allergies are frequently reported and have significant impacts upon appropriate prescribing and clinical outcomes. We surveyed infectious diseases physicians, allergists, clinical immunologists and hospital pharmacists to evaluate antibiotic allergy knowledge and service delivery in Australia and New Zealand. An online multi-choice questionnaire was developed and endorsed by representatives of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and the Australasian Society of Infectious Diseases (ASID). The 37-item survey was distributed in April 2015 to members of ASCIA, ASID, the Society of Hospital Pharmacists of Australia and the Royal Australasian College of Physicians. Of 277 respondents, 94% currently use or would utilise antibiotic allergy testing (AAT) and reported seeing up to 10 patients/week labelled as antibiotic-allergic. Forty-two per cent were not aware of or did not have AAT available. Most felt that AAT would aid antibiotic selection, antibiotic appropriateness and antimicrobial stewardship (79, 69 and 61% respectively). Patients with the histories of immediate hypersensitivity were more likely to be referred than those with delayed hypersensitivities (76 vs 41%, P = 0.0001). Lack of specialist physicians (20%) and personal experience (17%) were barriers to service delivery. A multidisciplinary approach was a preferred AAT model (53%). Knowledge gaps were identified, with the majority overestimating rates of penicillin/cephalosporin (78%), penicillin/carbapenem (57%) and penicillin/monobactam (39%) cross-reactivity. A high burden of antibiotic allergy labelling and demand for AAT is complicated by a relative lack availability or awareness of AAT services in Australia and New Zealand. Antibiotic allergy education and deployment of AAT, accessible to community and hospital-based clinicians, may improve clinical decisions and reduce antibiotic allergy impacts. A collaborative approach involving infectious diseases physicians, pharmacists and allergists/immunologists is required. © 2016 Royal Australasian College of Physicians.

Development of stable isotope mixing models in ecology - Perth

EPA Science Inventory

More than 40 years ago, stable isotope analysis methods used in geochemistry began to be applied to ecological studies. One common application is using mathematical mixing models to sort out the proportional contributions of various sources to a mixture. Examples include contri...

Self-amputation of the hand: issues in diagnosis and general hospital management.

PubMed

Crawford, Alison; Wand, Anne Pf; Smith, Michelle A

2016-04-01

To detail a diagnostic dilemma of intentional hand amputation in a man with a history of substance misuse and associated psychosis, depression and traumatic brain injury and to highlight issues in joint psychiatric and surgical management of such a complex patient in a general hospital setting. Deliberate limb self-amputation is a rare event with the majority of reported cases occurring during an episode of psychosis. This case illustrates the diagnostic utility of the literature supporting that a person who has self-inflicted amputation of a limb should be treated as psychotic until proven otherwise. The presence of a traumatic brain injury, with associated cognitive and psychosocial sequelae, affected diagnosis and management. Early and ongoing involvement of consultation-liaison psychiatry collaborating with a multidisciplinary general hospital team may improve mental and physical health outcomes for such patients. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Physician involvement enhances coding accuracy to ensure national standards: an initiative to improve awareness among new junior trainees.

PubMed

Nallasivan, S; Gillott, T; Kamath, S; Blow, L; Goddard, V

2011-06-01

Record Keeping Standards is a development led by the Royal College of Physicians of London (RCP) Health Informatics Unit and funded by the National Health Service (NHS) Connecting for Health. A supplementary report produced by the RCP makes a number of recommendations based on a study held at an acute hospital trust. We audited the medical notes and coding to assess the accuracy, documentation by the junior doctors and also to correlate our findings with the RCP audit. Northern Lincolnshire & Goole Hospitals NHS Foundation Trust has 114,000 'finished consultant episodes' per year. A total of 100 consecutive medical (50) and rheumatology (50) discharges from Diana Princess of Wales Hospital from August-October 2009 were reviewed. The results showed an improvement in coding accuracy (10% errors), comparable to the RCP audit but with 5% documentation errors. Physician involvement needs enhancing to improve the effectiveness and to ensure clinical safety.

Providing opportunistic immunisations for at-risk inpatients in a tertiary paediatric hospital.

PubMed

Elia, Sonja; Perrett, Kirsten; Newall, Fiona

2017-01-01

Attaining high immunisation coverage rates for children with medical conditions is vital. The Royal Children's Hospital (RCH) Immunisation Service has the opportunity to check each inpatient's immunisation status and provide opportunistic vaccines and/or bring the Australian Childhood Immunisation Register (ACIR) up-to-date. This paper highlights that during admission, one quarter of children were not up-to-date with routine scheduled immunisations and 42% of those inpatients due or overdue for immunisation were vaccinated. The model of establishing routine checking of immunisation records and reminding hospital staff about immunisation can result in improvements in vaccination coverage. Healthcare providers have a responsibility to check immunisation status and offer vaccines when necessary; however, often there are missed opportunities to immunise. This paper demonstrates that having a dedicated Immunisation Service, a partnership with a relevant government agency, and effective collaboration with inpatient clinical teams, opportunistic immunisation can be achieved for inpatients. © 2017 Wiley Periodicals, Inc.

The management of acute myocardial infarction: guidelines and audit standards. Report of a workshop of the Joint Audit Committee of the British Cardiac Society and the Royal College of Physicians.

PubMed

De Bono, D P; Hopkins, A

1994-01-01

Successful management of acute myocardial infarction depends in the first instance on the patient recognising the symptoms and seeking help as quickly as possible. Once in hospital, fast track admission procedures and protocols for pain relief, early thrombolysis and appropriate ancillary measures (eg aspirin, i.v. betablockers) should be promptly instituted. Specialist advice and, if necessary, transfer to specialist unit should be considered if additional complications arise. Follow-up management after discharge from hospital requires cooperation between primary and secondary care to prolong survival by reducing risk factors, using aspirin, betablockers and angiotensin converting enzyme inhibitors and instituting a suitable rehabilitation programme. Audit measures are included in the report to help general practitioners and hospital doctors review their practice and assess it against the standards set.

How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

PubMed

Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

2005-01-01

Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

The significance of digital citizenship in the well-being of older migrants.

PubMed

Millard, A; Baldassar, L; Wilding, R

2018-05-01

To understand the increasingly important role of digital citizenship (the ability to participate in society online) in supporting the well-being of ageing migrants. Participant observation, social network mapping, ethnographic and life-history interviews. Fifteen in-depth case studies examined the role of online participation in fostering the well-being and care of older migrants in Perth, Western Australia. Participants are members of an 'internet café' that facilitates their shared development of Internet skills. The case studies are derived from ethnographic research conducted between July and October 2016. Older peoples' maintenance of support networks and social engagement, and their access to healthcare services, can be enhanced when they are motivated to increase their digital literacy (the ability to use the Internet for information and communication) through appropriate educational, technological, infrastructure and social support. This support is likely to be more effective when developed through social learning systems that create communities of practice. Improving digital literacy has special implications for the well-being of older migrants because it can enhance their ability to exchange emotional support across distance. Digital literacy for older migrants can dramatically increase their ability to maintain and expand dispersed networks of support. Effective implementation of affordable and age-inclusive information and communication technology (ITC) infrastructure requires integrated support that connects individuals and their homes with social learning systems to ensure that participation continues as mobility declines. As health information and social engagement are increasingly delivered through online platforms, supporting the digital citizenship of older people is becoming an important equity issue. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The Perth Automated Supernova Search

NASA Astrophysics Data System (ADS)

Williams, A. J.

1997-12-01

An automated search for supernovae in late spiral galaxies has been established at Perth Observatory, Western Australia. This automated search uses three low-cost PC-clone computers, a liquid nitrogen cooled CCD camera built locally, and a 61-cm telescope automated for the search. The images are all analysed automatically in real-time by routines in Perth Vista, the image processing system ported to the PC architecture for the search system. The telescope control software written for the project, Teljoy, maintains open-loop position accuracy better than 30" of arc after hundreds of jumps over an entire night. Total capital cost to establish and run this supernova search over the seven years of development and operation was around US$30,000. To date, the system has discovered a total of 6 confirmed supernovae, made an independent detection of a seventh, and detected one unconfirmed event assumed to be a supernova. The various software and hardware components of the search system are described in detail, the analysis of the first three years of data is discussed, and results presented. We find a Type Ib/c rate of 0.43 +/- 0.43 SNu, and a Type IIP rate of 0.86 +/- 0.49 SNu, where SNu are 'supernova units', expressed in supernovae per 10^10 solar blue luminosity galaxy per century. These values are for a Hubble constant of 75 km/s per Mpc, and scale as (H0/75)^2. The small number of discoveries has left large statistical uncertainties, but our strategy of frequent observations has reduced systematic errors - altering detection threshold or peak supernova luminosity by +/- 0.5 mag changes estimated rates by only around 20%. Similarly, adoption of different light curve templates for Type Ia and Type IIP supernovae has a minimal effect on the final statistics (2% and 4% change, respectively).

The natural history of Perthes' disease

PubMed Central

2010-01-01

Background The prognosis in Perthes' disease varies considerably according to certain risk factors, but there is no concensus regarding the relative importance of these factors. We assessed the natural history of the disease and defined prognostic factors of value in deciding the proper treatment. Patients and methods During the 5-year period 1996–2000, a nationwide study on Perthes' disease was performed in Norway. 425 patients were registered. The present study involved the 212 children (mean age 5.1 years, 77% boys) who were affected unilaterally and who had been treated with physiotherapy only (which is considered not to change the natural history). They were followed by taking radiographs at the time of diagnosis and after 1, 3, and 5 years. At the 5-year follow-up, the outcome was evaluated according to a modification of the Stulberg classification: good (spherical femoral head), fair (ovoid femoral head), and poor (flat femoral head). Results The 5-year radiographic results were strongly dependent on 4 risk factors: age 6 years or more at diagnosis, total femoral head necrosis, height of the lateral pillar of the epiphysis less than 50% of normal height, and femoral head cover less than 80%. As the number of risk factors increased from 0 to 4, the proportion of patients with good radiographic 5-year outcome decreased from 79% to 0% and the proportion with poor outcome increased from 3% to 91%. Interpretation Most children under 6 years of age do not need any special treatment. In older children, no special treatment is indicated if the whole femoral head is not necrotic and the femoral head cover is > 80%. In the most severe forms of the disease (i.e. more than 2 risk factors), surgical containment treatment seems advisable. PMID:21067434

The natural history of Perthes' disease.

PubMed

Terjesen, Terje; Wiig, Ola; Svenningsen, Svein

2010-12-01

The prognosis in Perthes' disease varies considerably according to certain risk factors, but there is no concensus regarding the relative importance of these factors. We assessed the natural history of the disease and defined prognostic factors of value in deciding the proper treatment. During the 5-year period 1996-2000, a nationwide study on Perthes' disease was performed in Norway. 425 patients were registered. The present study involved the 212 children (mean age 5.1 years, 77% boys) who were affected unilaterally and who had been treated with physiotherapy only (which is considered not to change the natural history). They were followed by taking radiographs at the time of diagnosis and after 1, 3, and 5 years. At the 5-year follow-up, the outcome was evaluated according to a modification of the Stulberg classification: good (spherical femoral head), fair (ovoid femoral head), and poor (flat femoral head). The 5-year radiographic results were strongly dependent on 4 risk factors: age 6 years or more at diagnosis, total femoral head necrosis, height of the lateral pillar of the epiphysis less than 50% of normal height, and femoral head cover less than 80%. As the number of risk factors increased from 0 to 4, the proportion of patients with good radiographic 5-year outcome decreased from 79% to 0% and the proportion with poor outcome increased from 3% to 91%. Most children under 6 years of age do not need any special treatment. In older children, no special treatment is indicated if the whole femoral head is not necrotic and the femoral head cover is > 80%. In the most severe forms of the disease (i.e. more than 2 risk factors), surgical containment treatment seems advisable.

Radiographic classifications in Perthes disease

PubMed Central

Huhnstock, Stefan; Svenningsen, Svein; Merckoll, Else; Catterall, Anthony; Terjesen, Terje; Wiig, Ola

2017-01-01

Background and purpose Different radiographic classifications have been proposed for prediction of outcome in Perthes disease. We assessed whether the modified lateral pillar classification would provide more reliable interobserver agreement and prognostic value compared with the original lateral pillar classification and the Catterall classification. Patients and methods 42 patients (38 boys) with Perthes disease were included in the interobserver study. Their mean age at diagnosis was 6.5 (3–11) years. 5 observers classified the radiographs in 2 separate sessions according to the Catterall classification, the original and the modified lateral pillar classifications. Interobserver agreement was analysed using weighted kappa statistics. We assessed the associations between the classifications and femoral head sphericity at 5-year follow-up in 37 non-operatively treated patients in a crosstable analysis (Gamma statistics for ordinal variables, γ). Results The original lateral pillar and Catterall classifications showed moderate interobserver agreement (kappa 0.49 and 0.43, respectively) while the modified lateral pillar classification had fair agreement (kappa 0.40). The original lateral pillar classification was strongly associated with the 5-year radiographic outcome, with a mean γ correlation coefficient of 0.75 (95% CI: 0.61–0.95) among the 5 observers. The modified lateral pillar and Catterall classifications showed moderate associations (mean γ correlation coefficient 0.55 [95% CI: 0.38–0.66] and 0.64 [95% CI: 0.57–0.72], respectively). Interpretation The Catterall classification and the original lateral pillar classification had sufficient interobserver agreement and association to late radiographic outcome to be suitable for clinical use. Adding the borderline B/C group did not increase the interobserver agreement or prognostic value of the original lateral pillar classification. PMID:28613966

The Effect of Geographic Location on Circannual Adrenocorticotropic Hormone Plasma Concentrations in Horses in Australia.

PubMed

Secombe, C J; Tan, R H H; Perara, D I; Byrne, D P; Watts, S P; Wearn, J G

2017-09-01

Longitudinal evaluation of plasma endogenous ACTH concentration in clinically normal horses has not been investigated in the Southern Hemisphere. To longitudinally determine monthly upper reference limits for plasma ACTH in 2 disparate Australian geographic locations and to examine whether location affected the circannual rhythm of endogenous ACTH in the 2 groups of horses over a 12-month period. Clinically normal horses <20 years of age from 4 properties (institutional herd and client owned animals) in Perth (n = 40) and Townsville (n = 41) were included in the study. A prospective longitudinal descriptive study to determine the upper reference limit and confidence intervals for plasma ACTH in each geographic location using the ASVCP reference interval (RI) guidelines, for individual months and monthly groupings for 12 consecutive months. Plasma endogenous ACTH concentrations demonstrated a circannual rhythm. The increase in endogenous ACTH was not confined to the autumnal months but was associated with changes in photoperiod. During the quiescent period, plasma ACTH concentrations were lower, ≤43 pg/mL (upper limit of the 90% confidence interval (CI)) in horses from Perth and ≤67 pg/mL (upper limit of the 90% CI) in horses from Townsville, than at the acrophase, ≤94 pg/mL (upper limit of the 90% CI) in horses from Perth, ≤101 pg/mL (upper limit of the 90% CI) in horses from Townsville. Circannual rhythms of endogenous ACTH concentrations vary between geographic locations, this could be due to changes in photoperiod or other unknown factors, and upper reference limits should be determined for specific locations. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

The impact of later trading hours for hotels on levels of impaired driver road crashes and driver breath alcohol levels.

PubMed

Chikritzhs, Tanya; Stockwell, Tim

2006-09-01

To examine the impact of later trading hours for licensed hotels in Perth, Western Australia on levels of associated impaired driver road crashes and driver breath alcohol levels (BALs). Police data on the "last place of drinking" for impaired drivers involved in road crashes and their corresponding BALs were examined to identify those associated with Perth hotels between 1 July 1990 and 30 June 1997. During this period, 43 (23%) of the 186 hotels meeting study criteria were granted an Extended Trading Permit for 1 a.m. closing (ETP hotels), while the rest continued to close at midnight (non-ETP hotels). Time-series analyses employing multiple linear regressions were applied to determine whether an association existed between the introduction of extended trading and (i) monthly levels of impaired driver road crashes associated with ETP hotels and (ii) driver BALs associated with ETP hotels. Trends associated with non-ETP hotels were included as controls and possible confounders were considered. After controlling for the trend in crash rates associated with non-ETP hotels and the introduction of mobile police breath testing stations to Perth freeways, a significant increase in monthly crash rates for ETP hotels was found. This relationship was largely accounted for by higher volumes of high-alcohol content beer, wine and spirits purchased by ETP hotels. No relation was found between driver BALs and the introduction of ETPs. Late trading was associated with increased levels of impaired driver road crashes and alcohol consumption, particularly high-risk alcoholic beverages. Greater numbers of patrons and characteristics specific to clientele of hotels which applied for late trading hours (i.e. younger age, greater propensity to drunk-drive, preference for high-risk beverages) were suggested as having contributed to this increase.

The impact of later trading hours for Australian public houses (hotels) on levels of violence.

PubMed

Chikritzhs, Tanya; Stockwell, Tim

2002-09-01

To examine the impact of later trading hours for licensed hotels (Australian public houses are usually known as "hotels") in Perth, Western Australia, on levels of violent assault on or near these premises. Data on assault offenses reported to police between July 1, 1991, and June 30, 1997, were examined to identify those offenses that occurred on or close to hotels. During this period, 45 (24%) of the 188 hotels meeting study criteria were granted an extended trading permit for 1AM closing ("ETP hotels"), whereas the rest continued to close at midnight ("non-ETP hotels"). A time-series analysis employing linear regression was used to test whether there was a relationship between the introduction of extended trading and monthly rates of assaults associated with ETP hotels, while controlling for the general trend in assault rates among normally trading hotels. Possible confounders and other variables of interest (e.g., levels of alcohol purchases) were also examined. After controlling for the general trend in assaults occurring throughout Perth hotels, there was a significant increase in monthly assault rates for hotels with late trading following the introduction of extended trading permits. This relationship was largely accounted for by higher volumes of high alcohol content beer, wine and distilled spirits purchased by late trading hotels. Late trading was associated with both increased violence in and around Perth hotels and increased levels of alcohol consumption during the study period. It is suggested that greater numbers of patrons and increased levels of intoxication contributed to the observed increase in violence and that systematic planning and evaluation of late trading licenses is required.

Does alcohol outlet density differ by area-level disadvantage in metropolitan Perth?

PubMed

Foster, Sarah; Hooper, Paula; Knuiman, Matthew; Trapp, Georgina; Wood, Lisa

2017-09-01

Research suggests that there are area-level disparities in alcohol outlets, with greater density in disadvantaged areas. In part, this might be explained by the inequitable distribution of retail, attracted by lower rents to disadvantaged neighbourhoods. This ecological study examines the distribution of liquor licences in Perth, Australia, and whether discrepancies in the distribution of retail land-uses could account for a socio-economic gradient. Area disadvantage was determined for each Statistical Area 1 (SA1) using the Australian Bureau of Statistics Index of Relative Socio-economic Disadvantage, and licence locations were mapped in GIS. Negative binomial loglinear models examined whether licence densities within SA1s differed by area disadvantage, controlling for demographics and spatial correlation. Models included an offset term, so the estimated effects of area-level disadvantage were on licences per km 2 , or licences per retail destination. In the area-based analyses, for every unit increase in disadvantage decile (i.e. a reduction in relative disadvantage), general licences reduced by 15% (P = 0.000) and liquor stores reduced by 7% (P = 0.004). These gradients were not apparent when licences were examined as a function of retail; however, for every unit increase in disadvantage decile, the density of on-premise licences per retail destination increased by 14% (P = 0.000). The direction of the socio-economic gradient for general licences and liquor stores in Perth is concerning, as all licences selling packaged alcohol were more abundant in disadvantaged areas. However, the over-representation of packaged liquor in disadvantaged areas may relate to the increased provision of retail. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Impact of tailored falls prevention education for older adults at hospital discharge on engagement in falls prevention strategies postdischarge: protocol for a process evaluation.

PubMed

Naseri, Chiara; McPhail, Steven M; Netto, Julie; Haines, Terrence P; Morris, Meg E; Etherton-Beer, Christopher; Flicker, Leon; Lee, Den-Ching A; Francis-Coad, Jacqueline; Hill, Anne-Marie

2018-04-20

Older adults recently discharged from hospital have greater incidence of adverse events, functional decline, falls and subsequent readmission. Providing education to hospitalised patients on how to prevent falls at home could reduce postdischarge falls. There has been limited research investigating how older adults respond to tailored falls prevention education provided at hospital discharge. The aim of this study is to evaluate how providing tailored falls prevention education to older patients at the point of, and immediately after hospital discharge in addition to usual care, affects engagement in falls prevention strategies in the 6-months postdischarge period, including their capability and motivation to engage in falls prevention strategies. This prospective observational cohort study is a process evaluation of a randomised controlled trial, using an embedded mixed-method design. Participants (n=390) who have been enrolled in the trial are over the age of 60 years, scoring greater than 7/10 on the Abbreviated Mental Test Score. Participants are being discharged from hospital rehabilitation wards in Perth, Western Australia, and followed up for 6 months postdischarge. Primary outcome measures for the process evaluation are engagement in falls prevention strategies, including exercise, home modifications and receiving assistance with activities of daily living. Secondary outcomes will measure capability, motivation and opportunity to engage in falls prevention strategies, based on the constructs of the Capability Opportunity Motivation Behaviour system. Quantitative data are collected at baseline, then at 6 months postdischarge using structured phone interviews. Qualitative data are collected from a purposive sample of the cohort, using semistructured in-depth phone interviews. Quantitative data will be analysed using regression modelling and qualitative data will be analysed using interpretive phenomenological analysis. Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Dental anomalies in children with cleft lip and palate in Western Australia.

PubMed

Nicholls, Wendy

2016-01-01

The purpose of this paper was to describe the prevalence and type of dental anomalies in the primary and permanent dentition in children with a cleft condition at Princess Margaret Hospital in Perth, Western Australia. The details of 162 current dental patients extracted from the main dental database through their year of birth for the period 1998-2001 were selected consecutively. Dental records and X-rays were examined by one examiner (WN) and verified by a second examiner (RB) to determine dental development. The mean age of the subjects was 10.8 years with equal numbers of males and females. Subjects were further divided into cleft type; unilateral cleft lip (UCL) and palate, bilateral cleft lip (BCL) and palate, UCL, BCL, and cleft palate. One hundred sixty-two subjects were grouped into 21 categories of anomaly or abnormality. Prevalence rates for the categories were calculated for the overall group and for gender and cleft type. Overall, 94% of patients were found to have at least one dental anomaly, with fifty-six (34%) patients having more than one anomaly or abnormality.

Testing Drugs and Attesting Cures: Pharmaceutical Monopolies and Military Contracts in Eighteenth-Century France.

PubMed

Rivest, Justin

2017-01-01

This article explores the role of testing in the allocation of royal monopoly privileges for drugs in eighteenth-century France by following the multi-generational fortunes of a single "secret remedy" from 1713 to 1776: the poudre fébrifuge of the Chevalier de Guiller. On at least five occasions, this drug was tested on patients in order to decide whether it should be protected by a privilege and whether or not its vendors should be awarded lucrative contracts to supply it in bulk to the French military. Although efforts were made early in the century to test the drug through large-scale hospital trials and to relegate privilege granting to a bureaucratic commission, the case of the poudre fébrifuge instead suggests that military expediency and relatively small-scale trials administered personally by royal practitioners remained decisive in determining whether or not a drug received a monopoly privilege or a military contract.

[Reasons for the construction of Bispebjerg Hospital--a hospital with light, air and freedom of nature].

PubMed

Permin, Henrik; Wagner, Peter

2009-01-01

Since the 1850ies the city of Copenhagen changed, ramparts were removed or remodelled as parks, industries were established. The new factories and wharfs expanded, labourers were needed; many country people moved into the city to find work and thus the population increased immensely. In Copenhagen a few hospitals only were present around 1850; The Royal Frederik Hospital (now the Museum of applied Arts) was the only hospital in the modern sense of the word. Other institutions with "hospital" as part of their name as e.g. General Hospital (Almindelig Hospital) or Ladegaarden were a mixture of hospital and workhouse and The Royal Maternity Hospital founded in 1750. The wealthy and the upper middle class citizens were nursed or cured at home. At the end of the nineteenth century medical doctors could successfully cure some diseases, and surgeons could after the introduction of the anesthetic and aseptic treatment carry out operations with diminished risks of complications. Copenhagen's first modern hospital, Municipal Hospital (Kommunehospitalet) opened 1863, but in a very short time it was permanently overcrowded. Although two small hospitals Blegdam Hospital (isolation hospital) and the Oresund Hospital (quarantine station) were established a large new hospital was needed. Although the financial situation of the city of Copenhagen was strained due to the expenditures caused by the rapidly growing population within the city itself and the villages incorporated into it, the first social democratic mayor Jens Jensen wanted to secure his voters the same care and treatment as citizens of better means. As this view was accepted by the majority of the city council a hospital in the then modern and functional pavilion system (ascribed to Florence Nightingale) with buildings surrounded by gardens was planned. The architect Martin Nyrop (1849-1921) who had just completed the monumental and beautiful Copenhagen City Hall along with the engineer AC Karsten (1857-1931) and landscape architect Edvard Glaesel (1858-1915) were entrusted with the task to develop the design of the hospital. Bispebjerg Hospital was built in the years 1907-13 on a piece of land of 21 hectares on a slope facing southeast at Bispebjerg Bakke at the lower end bordering on Lersøen, a lake which eventually was filled and drained. The 6 red 2-story brick pavilions are located around an axis along Bispebjerg hill with southeast facing bedrooms over viewing the lush patient gardens. These sick rooms all had large double windows at the southeast providing excellent daylight. On the walls are washable frescoes with motifs from nature. Pavilion buildings are flanked by two avenues with linden trees on both sides and connected by crossroads between the buildings. Underground tunnels link the buildings. On both sides, the two lower pavilions on the same side of the central avenue staircase are linked together by a long covered bridge leading from the first floor of the first building to the ground flour in the next building because of the terrain slope. This bridge connects the two pavilions with a building with operating theatres so that patients can be transferred indoors between operation theatre and sick room. Surrounding the sick pavilions administrative building, rheumatic outpatient department, laundry, kitchen and engine house are placed. Between the buildings, avenues and crossroads gardens designed with benches, beautiful flowerbeds and bouquets were established to the leisure of the patients. The hospital offers a wealth ot fine architectural designs and presents itself as a kind of garden village within the city.

Medical student teaching in the private sector - An overlooked opportunity?

PubMed

Galletly, Cherrie A; Turnbull, Carol; Goldney, Robert

2016-04-01

One in four psychiatric beds in Australia are located in the private sector, and more than half of Australian psychiatrists undertake private work. However, nearly all medical student teaching in psychiatry takes place in public hospitals. This paper explores the learning opportunities in the private sector. We report the South Australian experience; medical students have been taught in Ramsay Health Care (SA) Mental Health facilities for more than 23 years. Our experience demonstrates that clinical teaching in private hospitals is sustainable and well accepted by students, patients and clinicians. The private sector has the capacity to make a much greater contribution to medical student training in psychiatry. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia.

PubMed

Callander, Emily; Fox, Haylee

2018-06-01

Recent health reforms alongside unregulated provider fees have led to increased attention being given to out-of-pocket healthcare costs. This study utilised annual statistics published by the Department of Health for services provided under the Medicare Benefits Schedule (MBS) from 1992/3 to 2016/17 to identify changes in out-of-pocket charges for obstetric items over time, and estimate the change in demand for obstetric items in response to price increases. Since 1992/3 out-of-pocket charges increased by 1035% for out-of-hospital items and 77% for in-hospital items. Demand for obstetric items has reduced with increasing charges. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Nutrition Beliefs of Disadvantaged Parents of Overweight Children

ERIC Educational Resources Information Center

Pescud, Melanie; Pettigrew, Simone; Henley, Nadine

2014-01-01

Objective: To explore low socioeconomic parents' beliefs in relation to children's nutrition. Design: A qualitative, longitudinal study over 12 months involving 37 low socioeconomic parents. Setting: Perth, Western Australia. Method: Parents' nutrition-related beliefs were explored via interviews, focus groups and…

Technological Delivery Systems.

ERIC Educational Resources Information Center

Kennedy, Don; And Others

A section on technological delivery systems, presented as part of the second Australian National Workshop on Distance Education (Perth, 1983), contains four papers on using technological resources to provide educational services to persons in isolated locations. The first paper, by Don Kennedy, covers the use of satellite broadcasting of course…

Get Real 'n' Read.

ERIC Educational Resources Information Center

Ledger, Michelle

1997-01-01

Describes a program called Get Real 'n' Read developed by Perth (Australia) public librarians to offer adolescents a greater incentive to use the library and to improve the image of reading. Topics include demographic characteristics of the area; planning; and advertising, including donations appealing to the target audience. (LRW)

Body size of young Australians aged five to 16 years.

PubMed

Hitchcock, N E; Maller, R A; Gilmour, A I

1986-10-20

In 1983-1984, 4578 Perth primary and secondary schoolchildren were studied. The selected sample was broadly representative of the ethnic groups that make up the Perth population and of the different social ranks within that population. The age, sex, weight, height, country of birth of the child and the parents, and occupation of the father were recorded for each subject. Weight, height and body mass index (BMI) increased with age. Age and sex were the most important determinants of body size. However, children of lower social rank and those with a southern European background were over-represented among the overweight children (greater than the 90th centile for BMI), particularly in adolescence. Children with an Asian background who were 11 years of age and younger were over-represented among the underweight children (less than or equal to the 10th centile for BMI). Results from this study indicate a continuing, though small (1.5 cm to 1.6 cm), secular increase in height over the past 13 to 14 years.

Culture, management and finances as key aspects for healthy workplace initiatives.

PubMed

Waterworth, Pippa; Pescud, Melanie; Chappell, Stacie; Davies, Christina; Roche, Dee; Shilton, Trevor; Ledger, Melissa; Slevin, Terry; Rosenberg, Michael

2018-02-01

The aim of this study was to qualitatively explore the barriers and enablers to implementing healthy workplace initiatives in a sample of workplaces based in Perth, Western Australia. In-depth interviews were conducted with representatives from 31 organizations representing small, medium and large businesses in the Perth metropolitan area which reported having healthy workplace initiatives. In total, 43 factors were mentioned as influencing the implementation of healthy workplace initiatives. Factors appearing to exert the most influence on the implementation of health promoting initiatives in this sample were culture; support from managers and staff; collaboration with industry providers; financial resources circumstances and the physical environment. These factors appeared to be mutually reinforcing and interconnected. Findings suggest there may be merit in applying an organizational development lens to the implementation of workplace health promotion initiatives as this could assist in leveraging enablers and minimizing barriers. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Evolution in diagnosis and treatment of Legg-Calve-Perthes disease

PubMed Central

Mazloumi, Seyed Mahdi; Ebrahimzadeh, Mohammad H.; Kachooei, Amir Reza

2014-01-01

Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD. PMID:25207324

Effect of Processed Honey and Royal Jelly on Cancer-Related Fatigue: A Double-Blind Randomized Clinical Trial

PubMed Central

Mofid, Bahram; Rezaeizadeh, Hossein; Termos, Abdulkarim; Rakhsha, Afshin; Mafi, Ahmad Rezazadeh; Taheripanah, Taiebeh; Ardakani, Mehran Mirabzadeh; Taghavi, Seyed Mohammad Esmaeil; Moravveji, Seyyed Alireza; Kashi, Amir Shahram Yousefi

2016-01-01

Background Cancer-related fatigue (CRF) is experienced by 50% to 90% of cancer patients and can severely affect their quality of life and functional capacity. Several randomized trials have recommended various ways to alleviate the symptoms of CRF with or without recourse to medications. Objective The aim of this study is to evaluate the effectiveness of processed honey and royal jelly on the symptoms of CRF in cancer patients who are undergoing hormone therapy, chemotherapy, chemo-radiation, or radiotherapy. Methods Fifty-two participants from the patients who visited the oncology clinic of Shohada-e-Tajrish hospital in Tehran (Iran) between May 2013 and August 2014 were selected and divided into two groups. The study group (26 patients) received processed honey and royal jelly, while the control group received pure honey. Both groups were instructed to consume their 5mL supplement twice daily for 4 weeks. Both groups were assessed at the beginning of the study, after 2 weeks, and then at the end of 4 weeks of treatment. Fatigue was measured using a visual analogue fatigue scale (VAFS) and fatigue severity scale (FSS). The results were compared between the two arms of study, and equality of probability distributions was assessed using a Kolmogorov–Smirnov test. Results The mean age of the 52 patients was 54.84. After two and four weeks of treatment with processed honey and royal jelly, VAFS and FSS due to treatment was better in the study group than in the control group, and the differences were statistically significant (p<0.001, p<0.001, respectively). Conclusion To the best of our knowledge, our study provided support for the use of processed honey and royal jelly to ameliorate CRF. The positive results of this study warrant further studies in this field. Clinical Trial Registration The study was registered in the Iranian Clinical Trial Registry Center (http://www.irct.ir) with the registration code: IRCT2015081423426N1. Funding The authors received no financial support for the research, authorship, and/or publication of this article. PMID:27504161

Effect of Processed Honey and Royal Jelly on Cancer-Related Fatigue: A Double-Blind Randomized Clinical Trial.

PubMed

Mofid, Bahram; Rezaeizadeh, Hossein; Termos, Abdulkarim; Rakhsha, Afshin; Mafi, Ahmad Rezazadeh; Taheripanah, Taiebeh; Ardakani, Mehran Mirabzadeh; Taghavi, Seyed Mohammad Esmaeil; Moravveji, Seyyed Alireza; Kashi, Amir Shahram Yousefi

2016-06-01

Cancer-related fatigue (CRF) is experienced by 50% to 90% of cancer patients and can severely affect their quality of life and functional capacity. Several randomized trials have recommended various ways to alleviate the symptoms of CRF with or without recourse to medications. The aim of this study is to evaluate the effectiveness of processed honey and royal jelly on the symptoms of CRF in cancer patients who are undergoing hormone therapy, chemotherapy, chemo-radiation, or radiotherapy. Fifty-two participants from the patients who visited the oncology clinic of Shohada-e-Tajrish hospital in Tehran (Iran) between May 2013 and August 2014 were selected and divided into two groups. The study group (26 patients) received processed honey and royal jelly, while the control group received pure honey. Both groups were instructed to consume their 5mL supplement twice daily for 4 weeks. Both groups were assessed at the beginning of the study, after 2 weeks, and then at the end of 4 weeks of treatment. Fatigue was measured using a visual analogue fatigue scale (VAFS) and fatigue severity scale (FSS). The results were compared between the two arms of study, and equality of probability distributions was assessed using a Kolmogorov-Smirnov test. The mean age of the 52 patients was 54.84. After two and four weeks of treatment with processed honey and royal jelly, VAFS and FSS due to treatment was better in the study group than in the control group, and the differences were statistically significant (p<0.001, p<0.001, respectively). To the best of our knowledge, our study provided support for the use of processed honey and royal jelly to ameliorate CRF. The positive results of this study warrant further studies in this field. The study was registered in the Iranian Clinical Trial Registry Center (http://www.irct.ir) with the registration code: IRCT2015081423426N1. The authors received no financial support for the research, authorship, and/or publication of this article.

A review of medical airlifts by a search and rescue squadron on the east coast of England over 18 years.

PubMed Central

Williams, M J

1991-01-01

This paper reviews the medical workload of a Royal Air Force Search and Rescue squadron on the East Coast of England over a period of 18 years and their association with the principal receiving hospitals in that area. It illustrates the effects of improvements in road networks on the workload of the squadron and contrasts the use of military helicopters with established U.K. civilian helicopter schemes. PMID:1888403

Predicting drug interactions in addiction treatment.

PubMed

Lucas, Catherine J; Patel, Joanne; Martin, Jennifer H

2017-08-01

It is not uncommon to be treating people with addiction who also have significant other health problems, including heart, renal or liver failure, diabetes and vascular disease. These conditions require regular medications to be taken. This can be a problem for people living with addiction and difficult social circumstances affecting compliance, among other issues. Our perspective provides a summary of general pharmacological factors affecting medicine taking in people with addiction problems, to provide a guide for hospital doctors in this setting. © 2017 Royal Australasian College of Physicians.

In the beginning, there was general paediatrics ….

PubMed

Gunasekera, Hasantha; Kilham, Henry

2015-01-01

In this article, we address how general paediatrics has evolved and adapted to change over the past 50 years and speculate on its future directions. We compare the state of general paediatrics with that of general adult medicine. We argue that general paediatrics must continue to have a strong role both in paediatric teaching hospitals and the community. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Swimming for the Handicapped Child and Adult: Occasional Papers No. 10.

ERIC Educational Resources Information Center

Neishloss, Lou

Outlined are physiological and psychological values of swimming for the handicapped, basic principles and teaching procedures for instructing physically handicapped persons, and specific suggestions for teaching swimming to persons with the following conditions; amputations, polio, paraplegia, cerebral palsy, spina bifida, Legg-Perthes Disease,…

Professor Lesley Parker: A Science Educator "Writ Large"

ERIC Educational Resources Information Center

Kahle, Jane Butler

2011-01-01

Professor Lesley Parker's career has moved from teaching and advising graduate students at Curtin University of Technology, Perth, Western Australia to leadership roles and advocacy positions in state and national governments and in international organizations. Throughout her distinguished career, she has been committed to social justice,…

Student Leadership Development: A Functional Framework

ERIC Educational Resources Information Center

Hine, Gregory Stephen Colin

2014-01-01

This article presents a longitudinal, qualitative case study of a student leadership program in a Catholic secondary school in Perth, Western Australia. Data were collected over a period of three years through multiple methods, including one-on-one interviewing, focus group interviewing, document searches, field notes, and researcher reflective…

GEMINI-TITAN (GT)-11 - EARTH SKY - OUTER SPACE

NASA Image and Video Library

1966-09-14

S66-54643 (14 Sept. 1966) --- Western half of Australia, including the coastline from Perth to Port Darwin, looking west, as seen from the Gemini-11 spacecraft at a record-high apogee of 740 nautical miles during its 26th revolution of Earth. Photo credit: NASA

Legg-Calve-Perthes disease

MedlinePlus

... 4 through 10 years old. There are many theories about the cause of this disease, but little is actually ... on the child's age and the severity of the disease. Children younger than 6 years old who receive treatment are more likely to end up with a normal hip joint. Children older ...

Creating SunSmart Schools

ERIC Educational Resources Information Center

Giles-Corti, B.; English, D. R.; Costa, C.; Milne, E.; Cross, D.; Johnston, R.

2004-01-01

Kidskin was a sun-protection intervention study involving 1776 children attending 33 primary schools in Perth, Western Australia. There were three study groups: a control group, a moderate intervention group and a high intervention group. In addition to receiving a specially designed curricular intervention (1995-1998), the moderate and high…

What are the similarities and differences in antimicrobial prescribing between Australian public and private hospitals?

PubMed

Cotta, M O; Chen, C; Tacey, M; James, R S; Buising, K L; Marshall, C; Thursky, K A

2016-10-01

Identifying themes associated with inappropriate prescribing in Australian public and private hospitals will help target future antimicrobial stewardship initiatives. To describe current antimicrobial prescribing practices, identify similarities and differences between hospital sectors and provide target areas for improvement specific to each hospital sector. All hospitals included in the study were part of the 2014 national antimicrobial prescribing survey and conducted one of the following: a whole hospital point prevalence survey, serial point prevalence surveys or a sample of randomly selected patients. Data on the types of antibiotics used, their indications for use and the quality of prescription based on compliance with national and local prescribing guidelines were collected. Two hundred and two hospitals (166 public and 36 private) comprising 10 882 patients and 15 967 antimicrobial prescriptions were included. Public hospitals had higher proportions of prescriptions for treatment (81.5% vs 48.4%) and medical prophylaxis (8.8% and 4.6%), whilst private hospitals had significantly higher surgical prophylaxis use (9.6% vs 46.9%) (P < 0.001). In public hospitals, the main reasons for non-compliance of treatment prescriptions were spectrum being too broad (30.5%) while in private it was incorrect dosing. Prolonged duration was the main reason for non-compliance among surgical prophylaxis prescriptions in both types of hospitals. Australian hospitals need to target specific areas to improve antimicrobial use. Specifically, unnecessary broad-spectrum therapy should be a priority area in public hospitals, whilst emphasis on curtailing antimicrobial overuse in surgical prophylaxis needs to be urgently addressed across in the private hospital sector. © 2016 Royal Australasian College of Physicians.

Perceptions of Physical Activity by Older Adults: A Qualitative Study

ERIC Educational Resources Information Center

Jancey, Jonine M.; Clarke, Ann; Howat, Peter; Maycock, Bruce; Lee, Andy H.

2009-01-01

Objective: To identify issues and perceptions concerning physical activity in older adults. Design: Qualitative study. Setting: Perth, Western Australia. Methods: Sixteen adults aged 65 to 74 years were interviewed in their own homes using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology.…

TESOL in Context: Authentic Workplace Learning for Pre-Service Teachers

ERIC Educational Resources Information Center

Thomsett, Janeen; Leggett, Bridget; Ainsworth, Sharon

2011-01-01

The action research project entitled "Engaging pre-service TESOL teachers in authentic workplace learning" aimed to enhance the TESOL practicum experience of pre-service teachers in the Graduate Diploma of Education at Edith Cowan University in Perth, Western Australia. Integrated into the relevant TESOL curriculum unit was the…

Englishes in Asia: Communication, Identity, Power and Education.

ERIC Educational Resources Information Center

Kirkpatrick, Andy, Ed.

This collection of papers comprises proceedings from the 5th English in South East Asia Conference, held in December 2000 at Curtin University of Technology in Perth. The 19 papers include the following: (1) "Global English and Local Language Policies" (Robert Phillipson); (2) "Hong Kong Parents' Preference for English-Medium…

Getting Down and Dirty: Values in Education for Sustainability

ERIC Educational Resources Information Center

Lewis, Elaine; Mansfield, Caroline; Baudains, Catherine

2008-01-01

Values education and environmental education for sustainability are both spheres of education research that have manifested rapid and overlapping development in recent years. An independent primary school located in the Perth metropolitan area of Western Australia participated in research on both values education and environmental education for…

Prospective Associations between Dietary Patterns and Cognitive Performance during Adolescence

ERIC Educational Resources Information Center

Nyaradi, Anett; Foster, Jonathan K.; Hickling, Siobhan; Li, Jianghong; Ambrosini, Gina L.; Jacques, Angela; Oddy, Wendy H.

2014-01-01

Background: The aim of the study was to investigate prospective associations between dietary patterns and cognitive performance during adolescence. Methods: Participants were sourced from the Western Australian Pregnancy Cohort (Raine) Study that includes 2868 children born between 1989 and 1992 in Perth, Western Australia. When the children were…

Feast of Science Sense-Ations

ERIC Educational Resources Information Center

Lewis, Elaine; Bullimore, Hayley; Krupa, Amy; Gaschk, Katherine; Pearson, Jennifer

2014-01-01

Science expositions at the Canning River Eco Education Centre (CREEC), Perth, Western Australia, have been conducted over the last five years (2009-2013) during National Science Week. These expos aimed to enhance science understanding in the community, foster partnerships for science and promote science careers by providing a scientific feast for…

Turtle Watch: Community Engagement and Action

ERIC Educational Resources Information Center

Lewis, Elaine; Baudains, Catherine

2015-01-01

Many threats face the freshwater turtle, Chelodina colliei, also known as the oblong turtle. A community education project, Turtle Watch, focused on this target species and enabled effective conservation action to be implemented. Turtle Watch was conducted in the Perth Metropolitan Area of Western Australia, as the oblong turtle inhabits the…

Overview of shorthand medical glossary (OMG) study.

PubMed

Politis, J; Lau, S; Yeoh, J; Brand, C; Russell, D; Liew, D

2015-04-01

Shorthand is commonplace in clinical notation. While many abbreviations are standard and widely accepted, an increasing number are non-standard and/or unrecognisable. We sought to describe the frequency of inappropriate and ambiguous shorthand in discharge summaries. Eighty electronic discharge summaries from the four General Medical Units at the Royal Melbourne Hospital were randomly extracted from the hospital's electronic records. Extraction was stratified by the four units and by the four quarters between July 2012 and June 2013. All abbreviations were assigned into one of four categories according to appropriateness: 1. 'Universally accepted and understood even without context'; 2. 'Understood when in context'; 3. 'Understood but inappropriate and/or ambiguous'; and 4. 'Unknown'. These categories were determined by the authors, which included junior and senior medical staff. The 80 discharge summaries contained 840 different abbreviations used on 6269 occasions. Of all words, 20.1% were abbreviations. Of the 6269 occasions of shorthand, 6.8% were categorised as 'Understood but inappropriate and/or ambiguous' or 'Unknown' (category 3 or 4), equating to 1.4% of all words, and an average of 5.4 words per discharge summary. Abbreviations are common in electronic discharge summaries, occurring at a frequency of one in five words. While the majority of shorthand used seems to be appropriate, the use of inappropriate, ambiguous or unknown shorthand is still frequent. This has implications for safe and effective patient care and highlights the need for better awareness and education regarding use of shorthand in clinical notation. © 2015 Royal Australasian College of Physicians.

Gunpowder, the Prince of Wales's feathers and the origins of modern military surgery.

PubMed

Pearn, John

2012-04-01

The history of military surgery claims many forebears. The first surgeon-soldiers were Homer's Machaon and Podalirius, followed a thousand years later by the Roman surgeons-general, Antonius Musa and Euphorbus; and later, e.g. Ambrose Paré, John Hunter and Sir John Pringle; and the 19th century innovators, Dominique-Jean Larrey (France), Friedrich von Esmarch (Prussia) and the Russian, Nikolai Pirogoff. The singular feature that distinguished modern military surgery from its earlier practice was the use of gunpowder. It was one of two inventions (the other was printing) that by the empowerment of individuals, lifted Western humankind from the medieval to the modern era. Research of primary and secondary archives. Gunpowder was first used in European warfare at Algeceras (1344-1368). Hitherto, the destruction of tissue had been the result of (relative) low-energy wounding with tissue damage caused by incisional or crushing wounds. The founder of modern surgery, Master John of Arderne (1307-1380), wrote of his experience gained as a military surgeon on the battlefield at Crecy (1346). Following Crecy, Arderne was the only chronicler who described the origins of the Prince of Wales's feathers as a royal and later commercial symbol, and the motto 'Ich Dien', 'I serve', as that of hospitals in the Western World. Later advances in military surgery incorporated both clinical experimentation and the innovation of new systems of pre-hospital battlefield care. © 2012 The Author. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Cataract surgery in the United Kingdom: a postal survey.

PubMed

Olali, Carpi A; Priya, Anita; Gupta, Mohit; Ahmed, Sohail

2010-01-01

A postal questionnaire study to evaluate the current practice of cataract surgery delivery in the United Kingdom including strategies for postoperative review was performed. A cataract questionnaire was sent to all hospital departments delivering ophthalmic services in the United Kingdom based on a list from the Royal College of Ophthalmologists. It included questions about the staffing level, number of cases operated on per list, and the different strategies employed postoperatively. The results were statistically analyzed. A total of 248 questionnaires were sent and 106 (43%) replies were received. The mean number of consultant teams was 11 (2-20). The average number of cases per list was 6-7 (range 4-9). In 65 hospitals, all patients are reviewed postoperatively in the hospital and some consultant teams review patients postoperatively in 18 hospitals. In 15 hospitals, patients were seen by the community optician. Most hospitals review their patients postoperatively within the first 3 weeks with more hospitals seeing them at 2-3 weeks. A wide variety of health professionals review the postoperative cases and they include doctors, nurses, and opticians (in house and community). There are varied practices for cataract surgery in the United Kingdom including the number of cases on the list and postoperative review protocols. There is room for better service organization in some hospitals in terms of patient flow and better use of medical staff time to improve output.

Patients' satisfaction with fast-track surgery in gynaecological oncology.

PubMed

Philp, S; Carter, J; Pather, S; Barnett, C; D'Abrew, N; White, K

2015-07-01

This study investigates the experience and satisfaction with care of fast-tracked gynaecological patients. The Sydney Gynaecological Oncology Group, New South Wales, Australia, has previously shown the benefits of a fast-track surgery programme for gynaecology patients with both complex benign gynaecological pathology and gynaecological malignancy. The question of whether these benefits translate into a positive experience for fast-tracked patients, in the context of their hospital stay and healthcare team care, has not been previously explored in detail. A self-administered satisfaction questionnaire incorporating the European Organisation for Research and Treatment of Cancer (EORTC) cancer in-patient satisfaction with care measure (INPATSAT-32) questionnaire with additional questions was administered to 106 gynaecology participants at Royal Prince Alfred Hospital. Participants reported high levels of satisfaction with patient care and support received from doctors, ward nurses and the hospital as a service and care organisation, within the context of a fast-track surgical programme. Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction. © 2014 John Wiley & Sons Ltd.

The future of hospital laboratories. Position statement from the Royal Belgian Society of Clinical Chemistry (RBSCC).

PubMed

Langlois, Michel R; Wallemacq, Pierre

2009-01-01

To face the economic pressures arising from the current socio-economic conjuncture, hospital laboratories are endangered by an increasing trend towards the outsourcing of clinical laboratory tests to external (mega-) laboratories. This should allow hospitals to meet their economic requirements, but with an increased risk of loss of medical quality and, mid- to long-term, loss of cost effectiveness of healthcare at the national level. To anticipate current developments (economical and technological) that inevitably will affect the future of laboratory medicine, hospital laboratories should be proactive and enhance efficiency, reduce costs by consolidation, integrate into regional networks, and form alliances or partnerships. To create additional value, the core competency of laboratory professionals must be refocused to provide medical knowledge services (consultative support to clinicians) related to in vitro diagnostic testing. To integrate cost-efficiency with medical quality, implementation of a matricial organization - operational vs. biomedical level - could be an interesting approach. This integrated structure should create total quality of laboratory testing, managing the entire medical diagnostic cycle from the pre-preanalytical to post-postanalytical phase.

Scrub typhus in the northern provinces of Vietnam: an observational study of admissions to a national referral hospital.

PubMed

Nadjm, Behzad; Thuy, Pham T; Trang, Van D; Ha, Le Dang; Kinh, Nguyen V; Wertheim, Heiman F

2014-11-01

Scrub typhus is a common cause of fever in parts of South East and Southern Asia. Little is known about the disease burden in Vietnam. A 2-year observational study of scrub typhus at a tertiary referral hospital in northern Vietnam was carried out. Diagnosis was based on a single serological test in patients with suggestive clinical symptoms. Scrub typhus was diagnosed in 3.5% (251/7226) of admissions. Cases occurred throughout the year, with incidence highest in the summer. Although complications were common, mortality was low (1.2%; 3/251). These data suggest that scrub typhus is common, with a seasonal distribution in northern Vietnam. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Why group & save? Blood transfusion at low-risk elective caesarean section.

PubMed

Stock, Owen; Beckmann, Michael

2014-06-01

Women undergoing elective caesarean section (CS) routinely have a group and save ordered as part of their preoperative assessment, whereas women with expected vaginal birth do not. Our aim was therefore to determine the rate of blood transfusion at elective CS compared with vaginal birth in a large Australian maternity hospital. A retrospective cohort study was performed using routinely collected de-identified data of 35 477 women, over 4 years, who delivered at the Mater Mothers' Hospital, Brisbane, Australia. After excluding women with established risk factors for transfusion, the likelihood of blood transfusion following elective CS was significantly lower compared to vaginal birth (aOR 0.47 (0.29, 0.77)). © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The quality of operative note taking: an audit using the Royal College of Surgeons Guidelines as the gold standard.

PubMed

Shayah, A; Agada, F O; Gunasekaran, S; Jassar, P; England, R J A

2007-04-01

To assess the quality of operative note keeping and compare the results with the Royal College of Surgeons (RCS) of England guidelines 'Good Surgical Practice' as the gold standard. ENT Department at Hull Royal Infirmary, University Hospital. A hundred consecutive operative notes were selected between November 2005 and January 2006. The documentation of the operative notes in each case was compared with the RCS of England guidelines. All surgeons were made aware of the results of the first cycle and the guidelines were made available in all ENT theatres in the form of a printed aide-memoir. A second audit cycle was then carried out prospectively between April and June 2006. The results demonstrated a change in practice in key areas. The 1st cycle results showed the documentation of patient identification (94%), name of surgeon (98%) and clearly written postoperative instructions (94%). However, surgeons performed suboptimally at recording the name of assistant (82%), operative diagnosis (46%), the incision type (87%) and the type of wound closure (83%). After introducing the aide-memoir, the second cycle demonstrated a change in practice with 100% documentation in most of the assessed parameters except that the time of surgery and the type of surgery (emergency or elective) were not adequately recorded. We recommend that all surgical departments should have the RCS guidelines as an aide-memoir in theatres to enhance the quality and standardise operative note recording.

A mixed-method outcome evaluation of a specialist Alcohol Hospital Liaison Team.

PubMed

McGeechan, Grant J; Wilkinson, Kirsty G; Martin, Neil; Wilson, Lynn; O'Neill, Gillian; Newbury-Birch, Dorothy

2016-11-01

To evaluate the effectiveness of an Alcohol Hospital Liaison Team at reducing alcohol-specific hospital attendances and admissions. In a mixed-method evaluation, 96 patients who accessed the team were monitored using data for alcohol-specific hospital attendances and Accident and Emergency (A&E) admissions before, during, and after engaging with the team. A feedback survey was sent to patients and a focus group was held with staff from the team to identify barriers and facilitators to the successful delivery of this service. No differences were observed when looking at alcohol admissions or A&E attendances before patients engaged with the service to those after discharge. While hospital admissions decreased slightly and A&E attendances increased slightly, these differences were not significant. Hospital admissions and A&E attendances increased significantly during engagement with the service. The focus group identified confusion over who should be delivering brief interventions and that the team was holding onto patients for too long. The results of this evaluation demonstrated that this team was not effective at reducing alcohol attendances or admissions due to a number of factors. Policy makers should make note of the barriers to effectiveness highlighted in this article, before commissioning alcohol care teams in the future. © Royal Society for Public Health 2016.

Characterization of major allergens of royal jelly Apis mellifera.

PubMed

Rosmilah, M; Shahnaz, M; Patel, G; Lock, J; Rahman, D; Masita, A; Noormalin, A

2008-12-01

Royal jelly is widely consumed in the community and has perceived benefits ranging from promoting growth in children and improvement of general health status to enhancement of longevity for the elderly. However, royal jelly consumption has been linked to contact dermatitis, acute asthma, anaphylaxis and death. High prevalence of positive skin tests to royal jelly have been reported among atopic populations in countries with a high rate of royal jelly consumption. The present study is aimed to identify the major allergens of royal jelly. Royal jelly extract was separated by sodium dodecyl polyacrylamide gel electrophoresis (SDS-PAGE) and 2-dimensional electrophoresis (2-D). Immunoblotting of the SDS-PAGE and 2-D profiles were performed to identify the allergenic spots. Spots were then excised from the 2-D gel, digested with trypsin and analyzed by mass spectrometry. The SDS-PAGE of royal jelly extract revealed 18 bands between 10 to 167 kD. Western blot of the fractionated proteins detected 15 IgE-binding bands between 14 to 127 kD with seven major allergens of 32, 40, 42, 49, 55, 60 and 67 kD using serum from 53 subjects with royal jelly allergy. The 2-D gel fractionated the royal jelly proteins to more than 50 different protein spots. Out of these, 30 spots demonstrated specific IgE affinity to the sera tested. Eight spots of the major royal jelly allergens were selected for mass-spectrometry analysis. Digested tryptic peptides of the spots were compared to the amino acid sequence search in protein databases which identified the fragments of royal jelly homologus to major royal jelly protein 1 (MRJ1) and major royal jelly protein 2 (MRJ2). In conclusion, the major allergens of royal jelly are MRJ1 and MRJ2 in our patients' population.

[Nahabed Roussignan, the first professor of deontology at the Royal School of Medicine].

PubMed

Yildirim, N

1995-01-01

This study based on researches utilizing the American and Ottoman sources, deals with the claim upon the lectures given by Roussignan (Rusinyan Efendi), especially at the Royal School of Medicine and describes his medical career as follows. Nahabed Roussignan who graduated from Paris School of Medicine in 1849, returned to Istanbul in 1851 and was appointed as the private physician to Fuad Pasha, upon the request of Dr. Serviçen. In the meantime he worked at the Bab-i Seraskeri Hastanesi (the Hospital of the Military Ministry) until 1860 and also started to work at the Military High School as a doctor of medicine. As to the Royal School of Medicine, he taught pathological anatomy between 1864-1872. There are not any records to prove his being a faculty member during this year. He was probably in financial shortage because of unemployment during that year, as stated by Artin Mezbour. The following year he was employed at in the School of Medicine again, through his friends' support. this time he taught logic and French composition between 1874-1876 and instructed deontology for a little while in 1876. He collected his lectures on logic as a Textbook of Philosophy. He passed away in the same week, so this book was published posthumously (Istanbul 1879). Since he died on November 29th 1876, at the end of the year, his name was included in the State Yearbook of 1877, but was misspelled as "Rüsteban". To sum up, deontology as an independant discipline at the Royal School of Medicine began to be lectured for the first time by N. Roussignan in 1876, and succeeding his death these lectures were taken over by Dr. Hovsep Nouridjan (Nurican Efendi). Istepan Arslanian, who was claimed to be the lecturer of these courses after Roussignan, was in Rumelie during 1875-1876 and employed in Austria in 1877; therefore he could never have taught deontology during this period.

The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

PubMed

Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

2016-04-01

People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. © 2016 Royal College of Physicians.

An aggression policy that works.

PubMed

Kitchener, Denby A; Sykes, Sharon R; McEwan, Allan G

2004-12-13

In 1999, a survey of the clinical staff in Royal Darwin Hospital showed that most instances of aggressive and abusive behaviour by patients or visitors occurring in the hospital went unreported because staff believed there would not be any follow-up investigation or action taken by management, Australia. In response, a hospital working party was formed to develop and implement an aggression management policy with practical effective strategies. The principal tool used was an Action Plan that delineated an immediate response to the aggression, as well as long-term strategies such as negotiated care and behaviour modification programs. An advocate is provided for the patient and debriefing for staff members. If the aggressive behaviour continues, early discharge of the patient could be initiated. The fundamental principle of the policy is to prevent fostering a culture of acceptance of aggressive behaviour through appropriate early intervention. In 2002, a follow-up survey showed that 82% of aggressive incidents were being reported and dealt with by management in a timely manner -- a significant improvement.

Fast determination of royal jelly freshness by a chromogenic reaction.

PubMed

Zheng, Huo-Qing; Wei, Wen-Ting; Wu, Li-Ming; Hu, Fu-Liang; Dietemann, Vincent

2012-06-01

Royal jelly is one of the most important products of honeybees. Given its role in development of bee brood into fertile individuals of the royal caste it is also used in health products for human consumption. Royal jelly spoils and loses its health-promoting properties depending on storage duration and conditions. To ensure product quality before selling, it is therefore necessary to assess royal jelly freshness. Many indexes of freshness have been suggested, but they all lack reliability or require complex and time-consuming analyses. Here we describe a method to detect royal jelly freshness based on a chromogenic reaction between royal jelly and HCl. We demonstrate that analyses based on color parameters allow for the discrimination of royal jelly samples based on the duration of their storage. Color parameters of royal jelly stored at -18 and 4 °C for 28 d remained comparable to that of fresh samples, which supports the reliability of the method. The method of freshness determination described is practical, cheap, and fast and can thus be used in real-time when trading royal jelly. The method developed can be used to assess royal jelly freshness. It is practical, cheap, and fast and can thus be used in real-time when trading royal jelly. © 2012 Institute of Food Technologists®

Variation of laparoscopic hernia repair in Scotland: a postcode lottery?

PubMed

Stevenson, A D; Nixon, S J; Paterson-Brown, S

2010-06-01

The laparoscopic approach is now recommended by NICE as the preferred technique for repair of bilateral and recurrent inguinal hernia and an accepted option for unilateral hernia. This study was set up to examine whether patients across Scotland had equal access to this method of treatment. Information was collected on laparoscopic hernia repairs in adults at all acute general NHS hospitals in Scotland between the financial years 1997/8 and 2007/8. Private hospitals were excluded due to lack of data. The data were derived from SMR01 data of inpatient and daycase discharges from non-paediatric general acute NHS hospitals in Scotland as collected by the Information Services Division (ISD) of NHS National Services Scotland. Of 6821 repairs in 2007/8, only 890 (13.0%) were performed laparoscopically, a small increase from 294 (4.5%) in 1997/8. The highest incidence of laparoscopic hernia repair in 2007/8 was in NHS Lothian, where 435 (41.1%) of all repairs were performed using the laparoscopic technique. Excluding NHS Lothian, the number of laparoscopic hernia repairs in the rest of Scotland showed a much smaller rise, from 184 (3.3%) to 455 (7.9%). NHS Lothian, (which has 20% of the Scottish population) performed 54.5% of laparoscopic repairs in Scotland between 1997/8 and 2007/8. In the most recent year available, 2007/8, 63.1% of bilateral primary, 53.7% of bilateral recurrent and 26.8% of unilateral recurrent hernia operations in Lothian were laparoscopic. This compares to only 9.9%, 7.0% and 7.1%, respectively, for other Scottish hospitals. Despite the fact that laparoscopic hernia repair has several proven advantages over open techniques, particularly in bilateral and recurrent hernias, activity remains at a low level in Scotland with the exception of NHS Lothian. In Scotland, laparoscopic techniques are not being used as recommended by NICE guidelines and there appears to be a "postcode lottery" in the provision of this method of treatment. Possible reasons are discussed and action plans are suggested. Copyright (c) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

The Child-Friendly Healthcare Initiative (CFHI): Healthcare provision in accordance with the UN Convention on the Rights of the Child. Child Advocacy International. Department of Child and Adolescent Health and Development of the World Health Organization (WHO). Royal College of Nursing (UK). Royal College of Paediatrics and Child Health (UK). United Nations Children's Fund (UNICEF).

PubMed

Southall, D P; Burr, S; Smith, R D; Bull, D N; Radford, A; Williams, A; Nicholson, S

2000-11-01

Although modern medical technology and treatment regimens in well-resourced countries have improved the survival of sick or injured children, most of the world's families do not have access to adequate health care. Many hospitals in poorly resourced countries do not have basic water and sanitation, a reliable electricity supply, or even minimal security. The staff, both clinical and nonclinical, are often underpaid and sometimes undervalued by their communities. In many countries there continues to be minimal, if any, pain control, and the indiscriminate use of powerful antibiotics leads to a proliferation of multiresistant pathogens. Even in well-resourced countries, advances in health care have not always been accompanied by commensurate attention to the child's wider well-being and sufficient concerns about their anxieties, fears, and suffering. In accordance with the United Nations Convention on the Rights of the Child,(1) the proposals set out in this article aim to develop a system of care that will focus on the physical, psychological, and emotional well-being of children attending health care facilities, particularly as inpatients. To develop in consultation with local health care professionals and international organizations, globally applicable standards that will help to ensure that practices in hospitals and health centers everywhere respect children's rights, not only to survival and avoidance of morbidity, but also to their protection from unnecessary suffering and their informed participation in treatment. Child Advocacy International will liase closely with the Department of Child and Adolescent Health and Development of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in the implementation of the pilot scheme in 6 countries. In hospitals providing maternity and newborn infant care, the program will be closely linked with the Baby Friendly Hospital Initiative of WHO/UNICEF that aims to strengthen support for breastfeeding. United Nations Children's Fund, United Nations Convention on the Rights of the Child, child protection, breastfeeding, pain control, palliative care, child abuse.

Rapid update on childhood immune thrombocytopenic purpure.

PubMed

Cole, Catherine H

2012-05-01

Most childhood immune thrombocytopenic purpure is benign, self-limiting and requires no therapy. However, questions remain: (i) to treat or not; (ii) bone marrow examination or not; and (iii) admit to hospital or not. These questions have dominated the literature and we still need a prospective large multi-centre study of these issues to determine a useful bleeding score, quality of life measure and a measure of parental anxiety. © 2011 The Author. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Course Evaluation on the Web: Facilitating Student and Teacher Reflection to Improve Learning

ERIC Educational Resources Information Center

Tucker, Beatrice; Jones, Sue; Straker, Leon; Cole, Joan

2003-01-01

The School of Physiotherapy at Curtin University of Technology in Perth, Western Australia, recognizes that learning is influenced by many variables. Therefore, evaluation of teaching and learning should focus on changes in knowledge, skills, attitudes, and behavior. In 1999, physiotherapy faculty at Curtin University developed Course Evaluation…

Geoff Giles and Geometry

ERIC Educational Resources Information Center

Fielker, David

2007-01-01

Geoff Giles died suddenly in 2005. He was a highly original thinker in the field of geometry teaching. As early as 1964, when teaching at Strathallen School in Perth, he was writing in "MT27" about constructing tessellations by modifying the sides of triangles and (irregular) quadrilaterals to produce what he called "trisides" and "quadrisides".…

The Relationship of Gender, Sex Role, and Law-and-Order Attitudes to Nuclear Opinions.

ERIC Educational Resources Information Center

Peterson, Candida C.; And Others

1990-01-01

Examines the effect of gender, sex role orientation, and political orientation on attitudes among 46 male and 62 female first-year university students in Perth, Australia, concerning nuclear weapons. Females were found to be more opposed to their development and use. Discusses practical implications for political behavior. (DM)

An Australian Story: School Sustainability Education in the Lucky Country

ERIC Educational Resources Information Center

Salter, Zarin; Venville, Grady; Longnecker, Nancy

2011-01-01

This paper documents a case study involving a Perth primary school accompanied on its sustainability journey by Millennium Kids Inc, a local not-for-profit community organisation. Tension between the school's sustainability focus, its prestige as an elite private school and a "lucky country" mentality frames the Australian-ness of this…

33 CFR 165.170 - Safety Zone; Military Munitions Recovery, Raritan River, Raritan, NJ.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Safety Zone; Military Munitions... § 165.170 Safety Zone; Military Munitions Recovery, Raritan River, Raritan, NJ. (a) Location. The following area is a safety zone: All navigable waters of the Raritan River upstream of the Perth Amboy...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Platt, F.N. Jr.

This article examines the treatment of a Superfund site, the Runyon Watershed just outside of Perth Amboy, New Jersey, for volatile organic compounds. The beginning of treatment was the result of a 20-year legal battle begun in 1971 and resolved after the city's consulting engineering firm designed and implemented a specialized approach to identify and develop key critical issues.

40 CFR 52.1581 - Control strategy: Carbon monoxide.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implementation plan for Camden County and the Nine not-classified areas (the city of Trenton, the City of Burlington, the Borough of Penns Grove (part), the Borough of Freehold, the City of Morristown, the City of Perth Amboy, the City of Toms River, the Borough of Somerville, and the City of Atlantic City). This...

Difficulties in Initiating and Sustaining Peer Friendships: Perspectives on Students Diagnosed with AD/HD

ERIC Educational Resources Information Center

Taylor, Myra; Houghton, Stephen

2008-01-01

In this article, Myra Taylor, research fellow, and Professor Stephen Houghton of the Centre for Child and Adolescent Related Disorders at the University of Western Australia, report theory generated from interviews with teachers, students and mothers residing in Perth, Western Australia, on how children with attention-deficit/hyperactivity…

Annual Science Education Conference (9th, Murdoch University, Perth, Western Australia, September 23, 1983).

ERIC Educational Resources Information Center

Western Australia Science Education Association.

This proceedings contains the texts of 14 science education research studies which were presented at the 1983 Western Australia Science Education Conference. They include: "Students' Understanding of Chemical Equilibrium: A Report of Research in Progress" (Patrick J. Garnett, Mark W. Hackling); "Measuring the Learning Environment in…

Effects of Variability Associated with the Antarctic Circumpolar Current on Sound Propagation in the Ocean

DTIC Science & Technology

2008-09-01

showing shot locations (circles) and IMS hydrophone station locations ( triangles ), superimposed on a map of group velocities derived using average fall...E. McDonald (1991). Perth- Bermuda sound propagation (1960): Adiabatic mode interpretation, J. Acoust. Soc. Am. 90: 2586–2594. Jensen, F. B., W. A

Framing and Frame Shifting in a Higher Education Merger

ERIC Educational Resources Information Center

Pick, David

2003-01-01

Late in 1996, Kalgoorlie College and the Western Australian School of Mines in Western Australia were merged to form an expanded campus of Curtin University, based in the state capital city of Perth. This paper uses a frame analytical approach to examining how differing and competing interpretations and commitments affected how the merger was…

Peer Assisted Study Sessions (PASS): Does Gender Matter?

ERIC Educational Resources Information Center

Geerlings, Peter M.; Cole, Helen; Batt, Sharryn; Martin-Lynch, Pamela

2016-01-01

Peer-learning is an effective way to assist students to acquire study skills and content knowledge, especially in university courses that students find difficult, and it is an effective adjunct to improve student retention. In 2014, Murdoch University in Perth, Western Australia, commenced Peer Assisted Study Sessions (PASS) in two first-year…

Q & A with Ed Tech Leaders: Interview with Jan Herrington

ERIC Educational Resources Information Center

Fulgham, Susan M.; Shaughnessy, Michael F.

2014-01-01

Jan Herrington is a Professor of Education at Murdoch University in Perth, Western Australia, where she teaches educational technology in the School of Education, including a compulsory first year unit called "Living and Learning with Technology." She has been active in the promotion and support of the effective use of educational…

Dioxins, Furans and PCBs in Recycled Water for Indirect Potable Reuse

PubMed Central

Rodriguez, Clemencia; Cook, Angus; Devine, Brian; Van Buynder, Paul; Lugg, Richard; Linge, Kathryn; Weinstein, Philip

2008-01-01

An assessment of potential health impacts of dioxin and dioxin-like compounds in recycled water for indirect potable reuse was conducted. Toxic equivalency factors (TEFs) for 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (PCBs) congeners have been developed by the World Health Organization to simplify the risk assessment of complex mixtures. Samples of secondary treated wastewater in Perth, Australia were examined pre-and post-tertiary treatment in one full-scale and one pilot water reclamation plant. Risk quotients (RQs) were estimated by expressing the middle-bound toxic equivalent (TEQ) and the upper-bound TEQ concentration in each sampling point as a function of the estimated health target value. The results indicate that reverse osmosis (RO) is able to reduce the concentration of PCDD, PCDF and dioxin-like PCBs and produce water of high quality (RQ after RO=0.15). No increased human health risk from dioxin and dioxin-like compounds is anticipated if highly treated recycled water is used to augment drinking water supplies in Perth. Recommendations for a verification monitoring program are offered. PMID:19151430

An evaluation of various methods of treatment for Legg-Calvé-Perthes disease.

PubMed

Wang, L; Bowen, J R; Puniak, M A; Guille, J T; Glutting, J

1995-05-01

An analysis of 5 methods of treatment for Legg-Calvé-Perthes disease was done on 124 patients with 141 affected hips. Before treatment, all groups were statistically similar concerning initial Mose measurement, age at onset of the disease, gender, and Catterall class. Treatments included the Scottish Rite orthosis (41 hips), nonweight bearing and exercises (41 hips), Petrie cast (29 hips), femoral varus osteotomy (15 hips), or Salter osteotomy (15 hips). Hips treated by the Scottish Rite orthosis had a significantly worse Mose measurement across time interaction (repeated measures analysis of variance, post hoc analyses, p < 0.05). For the other 4 treatment methods, there was no statistically different change. At followup, the Mose measurements for hips treated with the Scottish Rite orthosis were significantly worse than those for hips treated by nonweight bearing and exercises, Petrie cast, varus osteotomy, or Salter osteotomy (repeated measures analysis of variance, post hoc analyses, p < 0.05). There was, however, no significant difference in the distribution of hips according to the Stulberg et al classification at the last followup.

Impacts of wave energy conversion devices on local wave climate: observations and modelling from the Perth Wave Energy Project

NASA Astrophysics Data System (ADS)

Hoeke, Ron; Hemer, Mark; Contardo, Stephanie; Symonds, Graham; Mcinnes, Kathy

2016-04-01

As demonstrated by the Australian Wave Energy Atlas (AWavEA), the southern and western margins of the country possess considerable wave energy resources. The Australia Government has made notable investments in pre-commercial wave energy developments in these areas, however little is known about how this technology may impact local wave climate and subsequently affect neighbouring coastal environments, e.g. altering sediment transport, causing shoreline erosion or accretion. In this study, a network of in-situ wave measurement devices have been deployed surrounding the 3 wave energy converters of the Carnegie Wave Energy Limited's Perth Wave Energy Project. This data is being used to develop, calibrate and validate numerical simulations of the project site. Early stage results will be presented and potential simulation strategies for scaling-up the findings to larger arrays of wave energy converters will be discussed. The intended project outcomes are to establish zones of impact defined in terms of changes in local wave energy spectra and to initiate best practice guidelines for the establishment of wave energy conversion sites.

Periphyton indicate effects of wastewater discharge in the near-coastal zone, Perth (Western Australia)

NASA Astrophysics Data System (ADS)

Cosgrove, Jeffrey; Walker, Di; Morrison, Peter; Hillman, Karen

2004-10-01

Periphyton communities on artificial substrata were successfully utilised as a biological indicator of the potential eutrophic effects of wastewater discharge into coastal waters off Perth, Western Australia. Biomass and percentage carbonate content measurements of periphyton communities grown in situ indicated that the periphyton primary production (organic weight) was enhanced in the vicinity of the discharge outlets, with a significant negative correlation between distance north of the northern outlet in Whitfords Lagoon and periphyton organic weight (OW) observed in autumn at a depth of 4 m ( r = -0.704, P < 0.001). However, this response was primarily limited to the relatively calm autumn season and substrata at depths of 2 m and 4 m. Thus, in favourable conditions phytoplankton and high relief reef communities are more likely to exhibit a eutrophic influence (in the form of enhanced primary production) of the treated wastewater discharge. Laboratory studies confirmed that treated wastewater, diluted 100-fold to estimate surface concentrations above the wastewater outfalls in the field, stimulates periphyton growth above levels recorded in unpolluted seawater ( F = 12.485; P = 0.0073).

How receptive are patients to medical students in Australian hospitals? A cross-sectional survey of a public and a private hospital.

PubMed

Tiong, M K; Levinson, M R; Oldroyd, J C; Staples, M P

2013-04-01

Medical student numbers in Australian universities have more than doubled since 2000. There are concerns about the ability for existing clinical training sites to accommodate this increase in student numbers, and there have been calls to increase training in private hospitals. The receptiveness of patients in private hospitals will influence the success of such placements. We aimed to evaluate whether patients in a private hospital are as receptive to medical students as patients in a public hospital. Cross-sectional survey of patients conducted at a private and a public teaching hospital in Melbourne, Australia. Main outcome measures were willingness to allow a medical student to participate in an interview, physical examination and procedures (electrocardiogram, venepuncture and digital rectal examination), and patient attitudes towards medical students as assessed by a series of 20 attitude statements and a summative attitude score. Patients at the private hospital were more willing than patients at the public hospital to allow a medical student to take their history unsupervised (112/146, 76.7% vs 90/141, 63.8%; P = 0.02). The distribution of patient willingness did not otherwise differ between hospitals for physical examination or procedures. There was no difference in the mean attitude score between hospitals (15.3 ± 0.8 private vs 15.4 ± 1.2 public, P = 0.38), and responses differed between hospitals for only four of the 20 attitude statements. Our findings suggest that patients in a private hospital are at least as receptive to medical students as patients in a public hospital. © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

Application of a new genetic classification and semi-automated geomorphic mapping approach in the Perth submarine canyon, Australia

NASA Astrophysics Data System (ADS)

Picard, K.; Nanson, R.; Huang, Z.; Nichol, S.; McCulloch, M.

2017-12-01

The acquisition of high resolution marine geophysical data has intensified in recent years (e.g. multibeam echo-sounding, sub-bottom profiling). This progress provides the opportunity to classify and map the seafloor in greater detail, using new methods that preserve the links between processes and morphology. Geoscience Australia has developed a new genetic classification approach, nested within the Harris et al (2014) global seafloor mapping framework. The approach divides parent units into sub-features based on established classification schemes and feature descriptors defined by Bradwell et al. (2016: http://nora.nerc.ac.uk/), the International Hydrographic Organization (https://www.iho.int) and the Coastal Marine and Ecological Classification Standard (https://www.cmecscatalog.org). Owing to the ecological significance of submarine canyon systems in particular, much recent attention has focused on defining their variation in form and process, whereby they can be classified using a range of topographic metrics, fluvial dis/connection and shelf-incising status. The Perth Canyon is incised into the continental slope and shelf of southwest Australia, covering an area of >1500 km2 and extending from 4700 m water depth to the shelf break in 170 m. The canyon sits within a Marine Protected Area, incorporating a Marine National Park and Habitat Protection Zone in recognition of its benthic and pelagic biodiversity values. However, detailed information of the spatial patterns of the seabed habitats that influence this biodiversity is lacking. Here we use 20 m resolution bathymetry and acoustic backscatter data acquired in 2015 by the Schmidt Ocean Institute plus sub-bottom datasets and sediment samples collected Geoscience Australia in 2005 to apply the new geomorphic classification system to the Perth Canyon. This presentation will show the results of the geomorphic feature mapping of the canyon and its application to better defining potential benthic habitats.

[Perthes disease--results of a containment-oriented therapy concept].

PubMed

Rühmann, O; Lazović, D; Wirth, C J; Gossé, F; Franke, J

1997-01-01

In a retrospective study a treatment concept for Perthes' disease dependent on the containment was applied. 49 hips of 41 children (9 female, 32 male) were treated between 01. 01. 1990 and 31. 12. 1995. In our concept of treatment a varus femoral osteotomy was performed in 28 cases with not contained hips or less than 4/5 coverage of the femoral head (X-ray/MRI). The other 21 well contained hips with 4/5 coverage or more were treated conservatively with physiotherapy and in case of joint effusion and pain additionally with the use of crutches (partial weight bearing) and anti-inflammatory medication. The average age in the non-operative group at the time of first investigation was 4 years and 9 months (3 y./1 m. to 7 y./1 m.) and 6 years and 3 months (4 y/2 m. to 10 y/0 m.) at our last examination (mean follow up 17.7 months, range of 6 to 72 months). At the time of indication for a varus femoral osteotomy the patients had an average age 6 years and 1 month (3 y./6 m. to 10 y./2 m.), the mean age at the last postoperative examination was 7 years and 11 months (4 y./8 m. to 12 y./5 m.) with an average follow up of 21.5 months (6 to 77 months). For the conservatively treated children we achieved good results (still well contained hips with 4/5 coverage, no decrease of function, no increase of pain) in 85.7% (18 of 21 cases). In 85.7% (24 of 28 cases) we found good results (well contained hips, increase of coverage, no decrease of function, no increase of pain) in the operation group. The presented concept of therapy in Perthes' disease was practicable for all patients and included the possibility of decision for operative or non-operative treatment. In both groups we achieved good results in 85.7% of the cases.

[ATD index in Perthes disease].

PubMed

Grzegorzewski, Andrzej; Synder, Marek; Szymczak, Wiesław; Kowalewski, Maciej; Kozłowski, Piotr

2003-01-01

Authors present an estimation of articulo-trochanteric-distance (ATD) and ATD index in patients with Perthes disease and if there is any correlation between ATD and ATD index and age at the onset, gender, type of treatment, Herring and Stulberg classification. The study population consisted of 242 patients (35 female and 207 male) who had reached skeletal maturity at last follow up. The mean age at the onset of symptoms was 7 years and 4 months. All patients were treated by containment methods (bed rest and traction in abduction, brace, Petri cast, varus osteotomy, Salter osteotomy and shelf operation). ATD was estimated according to the Edgren methods and ATD index was calculated as relation ATD on Perthes site to ATD in normal joint. The late results were classified according to the Stulberg classification. Statistical analysis did not revealed any correlation between the age at the onset, gender and ATD index and ATD during last follow up. Both parameters decreased with poor results according to the Stulberg classifications. ATD index and ATD were statistically significant less after surgical treatment than after non-operative treatment. The same relations were seen between patients with leg length discrepancy (LLD) and without LLD. Patients in Herring group A had statistically significant bigger both parameters than patients in group B, C and patients in Herring group B than C. Articulo-trochanteric-distance and ATD index decreased during follow up and ATD decreased also in normal joint. In our opinion ATD index is a more reliable radiological parameter than ATD. ATD index decreases with bigger necrosis of the femoral head and poor result according to the Stulberg classification. This parameter is an evidence of the dysfunction proximal femoral growth plate in patients with LLD. The most decreased ATD index was observed after surgical treatment. There was no correlation between the age at the onset, gender and ATD index at last follow up.

Investigation of alcohol-related social norms among youth aged 14–17 years in Perth, Western Australia: protocol for a respondent-driven sampling study

PubMed Central

Hildebrand, Janina; Maycock, Bruce; Howat, Peter; Burns, Sharyn; Allsop, Steve; Dhaliwal, Satvinder; Lobo, Roanna

2013-01-01

Introduction Alcohol use among young people is a major public health concern in Australia and internationally. Research elucidating social norms influencing alcohol use supports the desire to conform to peers. However, there is a lack of evidence on how social norms are transmitted from the community to young people and between family members and peers, as previous studies are limited to mainly school and university environments. This article describes the proposed process to investigate common alcohol-related norms held by 14-year-olds to 17-year-olds in Perth, Western Australia, and to clarify the process and pathways through which proalcohol norms are transmitted to adolescents. Methods and analysis This cross-sectional quantitative study will use respondent-driven sampling (RDS) to recruit a sample of 672 adolescents from sporting groups, youth programmes and the community in Perth. Data will be collected with a previously developed and validated multidimensional online survey instrument. A variety of strategies will be explored to aid participation including face-to-face recruitment and survey administration, web-based RDS and a ‘mature minor’ consent assessment protocol. Data analysis will include descriptive statistics of demographic characteristics, as well as social network and dyadic analyses, to explore the connections between shared understanding of norms and behaviours among individuals and how these translate into reported practices. Ethics and dissemination This research is expected to extend our understanding of normative development pathways to inform future interventions, and will be widely disseminated through conference presentations, peer-reviewed papers, media channels and community seminars. A study reference group of key health industry stakeholders will be established to encourage integration of study findings into policy and practice, and results will guide the development of community interventions. The Curtin University Human Research Ethics Committee has granted approval for this research. PMID:24154519

The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010.

PubMed

Hobday, Michelle; Chikritzhs, Tanya; Liang, Wenbin; Meuleners, Lynn

2015-12-01

Few studies have investigated the combined effects of alcohol sales, outlet numbers and trading hours on alcohol-related harms. This study aimed to test whether associations: (i) exist between alcohol-related emergency department (ED) injuries and alcohol sales and counts of outlets; (ii) vary between on- and off-premises outlets; and (iii) vary by trading hours conditions [extended trading permits (ETP) versus standard hours]. Panel study using 117 postcodes over 8 years (2002-10): 936 data points. Perth, Australia. ED injury presentations, aggregated to postcode-level. Alcohol-related injuries were identified using time-based surrogate measures: night injuries (n=51,241) and weekend night injuries (n=30,682). Measures of alcohol availability included number of outlets with standard and extended trading hours and mean sales per postcode. Negative binomial regression modelling with random effects was used to examine associations between availability and alcohol-related injury, controlling for socio-demographic characteristics. (i) Night injuries were associated significantly with counts of on-premises outlets [incident rate ratio (IRR)=1.046; 95% confidence interval (CI)=1.014-1.078] and sales per off-premises outlet (IRR=1.019; 95% CI=1.004-1.035); (ii) counts of on-premises outlets were positively associated with alcohol-related injury while counts of off-premises outlets indicated a negative association; and (iii) weekend night injuries increased by about 5% per on-premises outlet with an ETP (IRR=1.049; 95% CI=1.015-1.084) and by less than 1% for outlets with standard trading hours (IRR=1.008; 95% CI=1.004-1.013). Regions of Perth, Australia with greater off-premises alcohol sales and counts of on-premises alcohol outlets, particularly those with extended trading hours, appear to have higher levels of alcohol-related injuries. © 2015 Society for the Study of Addiction.

Chronology of Quaternary coastal aeolianite deposition and the drowned shorelines of southwestern Western Australia - a reappraisal

NASA Astrophysics Data System (ADS)

Brooke, B. P.; Olley, J. M.; Pietsch, T.; Playford, P. E.; Haines, P. W.; Murray-Wallace, C. V.; Woodroffe, C. D.

2014-06-01

Aeolianite successions of low-gradient continental margins commonly show complex records of coastal dune deposition linked to a wide range of sea-level positions and climatic periods of the middle and late Pleistocene, recording both regional and broader-scale drivers of sediment production, coastal dune development and landform preservation. To better characterise the general pattern of sedimentation that occurs over Quaternary glacial-interglacial cycles on low-gradient, temperate carbonate continental shelves we examine the morphology, stratigraphy and age of aeolianite deposits in the Perth region, Western Australia. This includes an analysis of well-defined drowned coastal landforms preserved on the adjacent shelf. New and previously published optical ages provide a preliminary timeframe for the deposition of aeolianite in the Perth region and on Rottnest Island, 17 km offshore. An extensive aeolianite ridge near Perth, representing a former barrier, has Optically Stimulated Luminesence (OSL) ages that range from 120 ± 12 to 103 ± 10 ka (MIS 5e-5a in the context of associated age uncertainties). OSL ages for an exposure in the same ridge 2.5 km inland, record the onlap of much older aeolianite, OSL age 415 ± 70 ka, by shell-rich estuarine beds, OSL age 290 ± 30 ka. A further 5.5 km inland from the coast, two thick aeolianite units, separated by a well-developed palaeosol, have stratigraphically consistent OSL ages of 310 ± 30 and 155 ± 20 ka. In contrast, aeolianite units that form the northern coast of Rottnest Island have OSL ages of 77 ± 12 ka and 27 ± 5 ka. The new OSL ages and previously reported TL and U/Th ages indicate that the bulk of the island comprises dunes deposited around the end of the Last Interglacial sensu lato (MIS 5a-4) and during the Last Glacial (MIS 4-2), accumulating over a Last Interglacial coral reef and basal calcarenite. Drowned barrier and dune landforms preserved on the adjacent continental shelf reveal that barriers were formed during periods of intermediate sea level (e.g. MIS 3) and significant dune mobility occurred when the shelf was subaerially exposed. The pattern of shelf sedimentation discernible in the Perth region - large-scale coastal carbonate dune deposition during periods of high and intermediate sea level and reactivation during glacial lowstands - is largely consistent with published stratigraphic and age data for large-scale aeolianite deposits on other low-gradient carbonate shelves. Based on these data, a general model is proposed for the cycle of Quaternary sedimentation and landform evolution that occurs on these shelves, which are dynamic sedimentary environments with coastal landforms and sedimentary successions that are very sensitive to erosion and sediment reworking.

Using computerised decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance

PubMed Central

Patkar, Vivek; Acosta, Dionisio; Davidson, Tim; Jones, Alison; Fox, John

2012-01-01

Objectives The cancer multidisciplinary team (MDT) meeting (MDM) is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDMs are often overburdened with many different agendas and hence struggle to achieve their full potential. The authors developed an interactive clinical decision support system called MATE (Multidisciplinary meeting Assistant and Treatment sElector) to facilitate explicit evidence-based decision making in the breast MDMs. Design Audit study and a questionnaire survey. Setting Breast multidisciplinary unit in a large secondary care teaching hospital. Participants All members of the breast MDT at the Royal Free Hospital, London, were consulted during the process of MATE development and implementation. The emphasis was on acknowledging the clinical needs and practical constraints of the MDT and fitting the system around the team's workflow rather than the other way around. Delegates, who attended MATE workshop at the England Cancer Networks' Development Programme conference in March 2010, participated in the questionnaire survey. Outcome measures The measures included evidence-compliant care, measured by adherence to clinical practice guidelines, and promoting research, measured by the patient identification rate for ongoing clinical trials. Results MATE identified 61% more patients who were potentially eligible for recruitment into clinical trials than the MDT, and MATE recommendations demonstrated better concordance with clinical practice guideline than MDT recommendations (97% of MATE vs 93.2% of MDT; N=984). MATE is in routine use in breast MDMs at the Royal Free Hospital, London, and wider evaluations are being considered. Conclusions Sophisticated decision support systems can enhance the conduct of MDMs in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness and measure the impact on patient outcomes. The decision support technology used in MATE is generic and if found useful can be applied across medicine. PMID:22734113

A prospective survey of cases of complications of induced abortion presenting to Goroka Hospital, Papua New Guinea, 2011.

PubMed

Asa, Isaac; de Costa, Caroline; Mola, Glen

2012-10-01

Induced abortion on demand or for socio-economic indications is illegal in Papua New Guinea under the 1974 Criminal Code. Nevertheless, the procedure is known to be widely practised. This prospective study examines the demographic and medical features of women presenting with complications of induced abortion to Goroka Hospital in a 6-month period. It was noted that abortion was most commonly induced using the synthetic prostaglandin analogue misoprostol. Although illegal induced abortion cannot be condoned, it appears that misoprostol, much safer in this context than mechanical or traditional herbal methods, is now being widely used for the purpose of induced abortion in Papua New Guinea, as it is in other developing countries. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Drug substitution associated with a hospital stay in Belgium: a retrospective analysis of a claims database.

PubMed

Simoens, Steven; Dubois, Cécile; Spinewine, Anne; Foulon, Veerle; Paulus, Dominique

2014-04-01

This study measures the extent of drug substitution associated with a hospital stay in Belgium. Data were extracted from the 2006-2007 dataset of the Belgian Agency of Health Insurance Funds on drug use of patients hospitalized in acute hospitals. Reimbursed drugs received in ambulatory care during the 3 months prior to hospitalization were compared with drugs received during the 3 months following hospital discharge. Both a narrow definition and a broad definition were used for drug substitution. Narrow substitution (switches between generic and originator drugs) was computed for 14 drug classes for chronic conditions with the highest public expenditure. Broad substitution (changes between chemical substances within the drug class at ATC level 4, changes in brand name) was calculated for statins and proton-pump inhibitors only. The database included 17 764 patients (mean age 66 ± 17 years; 60% female). In 71% of cases an originator drug was received prior to and following hospitalization. A generic drug was received prior to and following hospitalization in 25% of cases. Some form of narrow substitution occurred in 4% of cases: a generic drug was replaced by an originator drug in 2% of cases and an originator drug was replaced by a generic drug in 2% of cases. Some form of broad substitution occurred in 25% of cases for proton-pump inhibitors and 13% of cases for statins. Hospitalization was not a trigger for changes between originator and generic versions of a drug. Broad substitution associated with a hospital stay was relatively limited for statins and proton-pump inhibitors. © 2013 Royal Pharmaceutical Society.

Dental anomalies in children with cleft lip and palate in Western Australia

PubMed Central

Nicholls, Wendy

2016-01-01

Objective: The purpose of this paper was to describe the prevalence and type of dental anomalies in the primary and permanent dentition in children with a cleft condition at Princess Margaret Hospital in Perth, Western Australia. Materials and Methods: The details of 162 current dental patients extracted from the main dental database through their year of birth for the period 1998–2001 were selected consecutively. Dental records and X-rays were examined by one examiner (WN) and verified by a second examiner (RB) to determine dental development. The mean age of the subjects was 10.8 years with equal numbers of males and females. Subjects were further divided into cleft type; unilateral cleft lip (UCL) and palate, bilateral cleft lip (BCL) and palate, UCL, BCL, and cleft palate. Results: One hundred sixty-two subjects were grouped into 21 categories of anomaly or abnormality. Prevalence rates for the categories were calculated for the overall group and for gender and cleft type. Conclusion: Overall, 94% of patients were found to have at least one dental anomaly, with fifty-six (34%) patients having more than one anomaly or abnormality. PMID:27095907

Randomised controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of third stage of labour.

PubMed Central

McDonald, S J; Prendiville, W J; Blair, E

1993-01-01

OBJECTIVE--To compare intramuscular oxytocin alone and intramuscular oxytocin with ergometrine (Syntometrine) for their effect in reducing the risk of postpartum haemorrhage when both are used as part of the active management of the third stage of labour. DESIGN--Double blind, randomised controlled trial. SETTING--Two metropolitan teaching hospitals in Perth, Western Australia. SUBJECTS--All women who expected a vaginal birth during the period of the trial. Informed consent was obtained. MAIN OUTCOME MEASURES--Postpartum haemorrhage, nausea, vomiting, and increased blood pressure. RESULTS--3497 women were randomly allocated to receive oxytocin-ergometrine (n = 1730) or oxytocin (n = 1753). Rates of postpartum haemorrhage (> or = 500 ml or > or = 1000 ml) were similar in both arms (odds ratio 0.90 (0.82); 95% confidence interval 0.75 to 1.07 (0.59 to 1.14) at 500 ml (1000 ml) threshold). The use of oxytocin-ergometrine was associated with nausea, vomiting, and increased blood pressure. CONCLUSIONS--There are few advantages but several disadvantages for the routine use of oxytoxinergometrine when prophylactic active management of the third stage of labour is practised. Further investigation of dose-response for oxytocin may be warranted. PMID:8251842

A retrospective audit of bacterial culture results of donated human milk in Perth, Western Australia.

PubMed

Almutawif, Yahya; Hartmann, Benjamin; Lloyd, Megan; Erber, Wendy; Geddes, Donna

2017-02-01

The bacterial content of donated human milk is either endogenous or introduced via contamination. Defining milk bank bacterial content will allow researchers to devise appropriate tests for significant and commonly encountered organisms. A retrospective audit was conducted on data recorded from the Perron Rotary Express Milk Bank, King Edward Memorial Hospital, Subiaco, Western Australia. This aimed to describe the incidence of bacterial species detected in donated human milk and to identify potentially pathogenic bacteria. The data comprised of 2890 batches donated by 448 women between 2007 and 2011. Coagulase negative Staphylococcus (CoNS) represented the highest prevalence of bacteria in donated milk, isolated from 85.5% of batches (range: 20 to 650,000CFU/mL) followed by Acinetobacter species in 8.1% of batches (range: 100 to 180,000CFU/mL). Staphylococcus aureus was the most prevalent potentially pathogenic bacteria in 5% of batches (range: 40 to 100,000CFU/mL). Further investigation is warranted to better define the risks posed by the presence of toxin-producing S. aureus in raw and pasteurized human milk which may allow minimization of risk to the preterm infants. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of paediatric nursing-sensitive outcomes in an Australian population using linked administrative hospital data.

PubMed

Wilson, Sally; Bremner, Alexandra P; Hauck, Yvonne; Finn, Judith

2013-10-08

Research into nursing-sensitive outcomes using administrative health data has focussed on hospitalised adults. However, we developed algorithms for the identification of 13 paediatric nursing-sensitive outcomes, which we seek to examine for clinical utility. The aims were to determine the rates of paediatric nursing-sensitive outcomes in a Western Australian hospital and ascertain sociodemographic and clinical characteristics associated with a greater risk of developing nursing-sensitive outcomes in hospitalised children. A retrospective cohort study used linked administrative data of all Western Australian children ≤18 years admitted to the only tertiary paediatric hospital in Perth between 1999 and 2009. Rates per 1,000 hospital separations and per 10,000 patient days were calculated for the following nursing-sensitive outcomes: lower respiratory tract infection (LRTI), gastrointestinal (GI) infection, pneumonia, sepsis, arrest/shock/respiratory failure, central nervous system complication, central venous line infection, infectious disease, pressure ulcer, failure to rescue, surgical wound infection, physiologic/metabolic derangement, and postoperative cardiopulmonary complications. Poisson multiple regression models were fitted to estimate rate ratios (RR) and 95% confidence intervals (CI) for suspected risk factors. Linked records of 129,719 hospital separations were analysed. Rates ranged from 0.5/1,000 for pressure ulcer to 14.0/1,000 hospital separations for GI infections. Age was significantly associated with the risk of a nursing-sensitive outcome: compared with adolescents, toddlers had greater risk of GI infection (RR 9.89; 95% CI 6.24, 15.69); infants had 7.74 times greater risk of LRTI (95% CI 5.11, 11.75), while neonates had lower risks for sepsis (RR 0.26; 95% CI 0.08, 0.90) and physiologic/metabolic derangement (RR 0.12; 95% CI 0.04, 0.35). The risk of surgical wound infection was 7.78 times greater (95% CI 5.10, 11.86) for emergency admissions than elective admissions. Seven of the 13 defined nursing-sensitive outcomes occurred with sufficient frequency (>100 events over the 10 year study period) to be potentially useful for monitoring the quality of nursing care. These nursing-sensitive outcomes are: LRTI, GI infection, pneumonia, surgical wound infection, physiologic/metabolic derangement, sepsis and postoperative cardiopulmonary complications. When used for quality improvement or to benchmark with other agencies, data need to be adjusted for, or stratified by age and admission type, to ensure equitable comparisons.

Nonenzymatic Browning and Protein Aggregation in Royal Jelly during Room-Temperature Storage.

PubMed

Qiao, Jiangtao; Wang, Xueyu; Liu, Liqiang; Zhang, Hongcheng

2018-02-28

Royal jelly possesses numerous functional properties. Improper storage usually causes bioactivity loss, especially queen differentiation activity. To determine changes in royal jelly, we investigated nonenzymatic browning and protein changes in royal jelly during room-temperature storage from 1 to 6 months. Our results indicate that royal jelly experiences nonenzymatic browning and protein aggregation. The products of nonenzymatic browning dramatically increased, especially N ε -carboxymethyl lysine (CML) with growth of approximately 7-fold. We speculate that CML may be recognized as a freshness marker for royal jelly. Our results also demonstrate that the major royal jelly protein 1 (MRJP1) monomer gradually aggregated with MRJP1 oligomers into new oligomers of about 440 and 700 kDa. This suggests that the reduction of MRJP1 monomer may be attributable to aggregation. We provide the novel explanation that the differentiation loss of royal jelly may be due to the aggregation of MRJP1 limiting the honeybees' ability to digest and absorb royal jelly.

Factors affecting the views and attitudes of Scottish pharmacists to continuing professional development.

PubMed

Power, Ailsa; Grammatiki, Aikaterini; Bates, Ian; Mc Kellar, Susan; Johnson, B Julienne; Diack, H Lesley; Stewart, Derek; Hudson, Steve A

2011-12-01

To explore factors associated with Scottish pharmacists' views and attitudes to continuing professional development (CPD). A retrospective principal component analysis of 552 (22.8%) questionnaires returned from a sample of 2420 Scottish pharmacists randomly selected from the 4300 pharmacists registered with the Royal Pharmaceutical Society of Great Britain and with a Scottish address. Principal component analysis of questionnaire items (n = 19) revealed four factors associated with Scottish pharmacists' views and attitudes to CPD: having positive support in the workplace, having access to resources and meeting learning needs, having confidence in the CPD process and motivation to participate in the CPD process. Community pharmacists were identified as the subgroup of pharmacists that needed most support for CPD regarding all four factors, while pharmacists working in primary care felt that they had most support in the workplace in comparison to other sectors (P < 0.05) and better access to resources and meeting learning needs when compared to community (P < 0.001) and hospital (P = 0.008) colleagues. Pharmacists working in primary care also felt more motivated to participate in the CPD process than those in the community (P < 0.001), and hospital pharmacists reported having more confidence in the CPD process compared to community pharmacists (P < 0.05). Using principal component analysis has identified four factors associated with Scottish pharmacists' views and attitudes to CPD. This may provide an approach to facilitate comparison of CPD views and attitudes with intra and inter professional groupings. Further study may allow identification of good practice and solutions to common CPD issues. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

SMS text messaging improves outpatient attendance.

PubMed

Downer, Sean R; Meara, John G; Da Costa, Annette C; Sethuraman, Kannan

2006-08-01

To evaluate the operational and financial efficacy of sending short message service (SMS) text message reminders to the mobile telephones of patients with scheduled outpatient clinic appointments. Cohort study with historical control. Royal Children's Hospital, Melbourne, Victoria. Patients who gave a mobile telephone contact number and were scheduled to attend an outpatient clinic at the Royal Children's Hospital, Melbourne in October, November and December 2004 (trial group) or in October, November and December 2003 (historical control group). Failure-to-attend (FTA) rate compared between the trial group, whose members were sent a reminder, and the historical control group, whose members were not sent a reminder. Financial benefits versus cost of sending reminders. 22,658 patients with a mobile telephone contact number scheduled to attend an outpatient clinic appointment in October, November and December 2004 were sent an SMS reminder; 20,448 (90.2%) of these patients attended their appointment. The control group included 22,452 patients with a mobile telephone contact number scheduled to attend an appointment, with 18,073 (80.5%) patients attending. The FTA rate was significantly lower in the trial group than in the historical control group (9.8% v 19.5%; P < 0.001). The cost of sending the SMS reminders was small compared with the increase in patient revenue and associated benefits generated as a result of improved attendance. The observed reduction in FTA rate was in line with that found using traditional reminder methods and a prior pilot study using SMS. The FTA reduction coupled with the increase in patient revenue suggests that reminding patients using SMS is a very cost effective approach for improving patient attendance.

Gunshot injuries in Benghazi-Libya in 2011: the Libyan conflict and beyond.

PubMed

Bodalal, Zuhir; Mansor, Salah

2013-10-01

Since independence, Libya has never experienced personal ownership of arms. That changed during the Libyan conflict where weapons became widespread in the society. As a result gunshot injuries became a concern for surgeons at our principal surgical hospital (Al-Jalaa). This study aims at analyzing the gunshot injuries that took place during 2011 and highlighting the peculiarities in the Libyan scenario. Patient records were obtained and gunshot injuries were analyzed for various parameters. Statistical analyses were made taking into consideration situations faced by neighbouring countries. In 2011, 1761 patients were admitted with over 95% being male and over 97% were Libyan. The average age of a GSI patient was 28.32 ± 10.01 years. Patients aged 18-35 formed over 70% of the cases with half of all cases being treated by the orthopedics department. Sixty-eight percent of cases were injured in the extremities followed by chest (12.5%) and abdomen injuries (7.8%). The mortality rate for GSI's was found to be 5.6% overall with young age, site of injury (i.e. chest and head) and cause of injury (i.e. war or civilian fighting) being important risk factors. Taking into consideration the difficult operating conditions and limited resources, surgeons at our hospital were able to maintain a low mortality rate. Disarmament needs to begin as soon as possible because these injuries will continue to occur so long firearms are available in society. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Firework-related injury in the Top End: a 16-year review.

PubMed

Read, David J; Bradbury, Richard; Yeboah, Edward

2017-12-01

On July 1st on 'Territory Day', the public in the Northern Territory are permitted to purchase and operate consumer fireworks without a licence. Serious permanent injuries from fireworks are well described, leading to their banning in many other jurisdictions. This study describes those seriously injured by fireworks in the Top End of the Northern Territory, with the aim of identifying opportunities for prevention and harm minimization. This is a retrospective audit of all admitted patients with an injury from fireworks at the Royal Darwin Hospital between 2000 and 2015. The variables collected included demographic data and the circumstances around injury (operator versus bystander, alcohol involvement and day of device operation). The consequences such as injuries, operating theatre visits, length of stay and outpatient visits are described. Fifty-five patients (including 17 children) suffered 67 injuries over the study period, resulting in 68 operating theatre visits, 322 hospital days and 380 outpatient appointments. Burns, hand and eye injuries predominate. Females (P = 0.000) and children (P = 0.029) were more likely to be injured as bystanders. Injuries on a day other than Territory Day were more likely to have alcohol involvement (P = 0.01), and occur in the operator (P = 0.017). Consumer firework usage results in a small number of life altering injuries annually. Previous prevention campaigns focusing on device user safety should be expanded to include the safety of bystanders and children and reduce firework usage outside of the Territory Day. © 2017 Royal Australasian College of Surgeons.

Neonatal exchange transfusions in tertiary and non-tertiary hospital settings, New South Wales, 2001-2012.

PubMed

Chessman, Julia C; Bowen, Jennifer R; Ford, Jane B

2017-05-01

To describe neonatal exchange transfusions in New South Wales (NSW) before and after release in January 2007 of a NSW Health guideline regarding exchange transfusions in tertiary and non-tertiary hospitals. The study population included neonates receiving exchange transfusion in NSW hospitals, 2001-2012. Linked birth and hospital data for mothers and babies were used to describe birth characteristics and maternal and neonatal conditions. Exchange transfusions were identified in hospital data and compared for 2001-2006 and 2007-2012. Maternal and neonatal characteristics were compared with χ 2 and Wilcoxon signed-rank tests. Between 2001 and 2012, there were 286 exchange transfusions performed for 281 neonates in NSW hospitals. The number of exchange transfusions decreased from 187 in 184 neonates for 2001-2006 to 99 in 97 neonates 2007-2012 (P < 0.001). The percentage of exchange transfusions performed at tertiary hospitals increased from 85% in 2001-2006 to 91% in 2007-2012, although this was not statistically significant (P = 0.16). Most neonates requiring exchange transfusion were born in tertiary hospitals: 62% for 2001-2006 and 69% for 2007-2012. Among those born in a non-tertiary hospital, the percentage transferred or admitted to a tertiary hospital for exchange transfusion was 63% in 2001-2006 and 77% in 2007-2012. Between 2001 and 2012, there was a decrease in neonatal exchange transfusions in NSW. After the 2007 guideline there was a non-significant increase in the proportion of exchange transfusions performed at tertiary hospitals. Although rare, exchange transfusions are still expected to occur occasionally in non-tertiary hospitals, requiring continuing support for this procedure in these settings. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

PubMed

Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients.

PubMed

Pietrantonio, Filomena; Orlandini, Francesco; Moriconi, Luca; La Regina, Micaela

2015-12-01

Chronic diseases are the major cause of death (59%) and disability worldwide, representing 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards. The Hospital Acute Care Hub will bring together the clinical areas of the MD that focus on the management of acute medical patients. The Chronic Care Model (CCM) places the patient at the center of the care system enhancing the community's social and health support, pathways and structures to keep chronic, frail, poly-pathological people at home or out of the hospital. The management of such patients in the hospital still needs to be solved. Hereby, we propose an innovative model for the management of the hospital's acute complex patients, which is the hospital counterpart of the CCM. The target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring high technology resources. The mission is to improve the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patient-centered approach. The ACCM leader is an internal medicine specialist (IMS) who summarizes health problems, establishes priorities, and restores health balance in AICPPs. The epidemiological transition leading to a progressive increase in "chronically unstable" and complex patients needing frequent hospital treatment, inevitably enhances the role of hospital IMS in the coordination and delivery of care. ACCM represents a practical response to this epochal change of roles. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Proceedings of the Annual Conference of the Western Australian Science Education Association (23rd, Perth, Western Australia, November 13, 1998).

ERIC Educational Resources Information Center

Rennie, Leonie, Ed.

These proceedings contain reviewed and edited papers from the 23rd annual meeting of the Western Australian Science Education Association (WASEA). Papers include: (1) Using Quantitative and Qualitative Approaches to Validate a Questionnaire to Describe Science Teacher Behavior in Taiwan and Australia (Darrell Fisher, David Henderson, and…

An Industrial Building Converted into a Girls School in Australia

ERIC Educational Resources Information Center

Broderick, Eamon

2003-01-01

This article describes how an industrial building in Perth, Western Australia, has been converted into a secondary school to suit the particular needs of girls with educational and social difficulties. The aim of the building project was to provide a small school for approximately 30 students that caters to the needs of adolescent girls who are…

Rethinking Flexible Learning in a Distributed Learning Environment: A University-Wide Initiative

ERIC Educational Resources Information Center

Phillips, Rob; Cummings, Rick; Lowe, Kate; Jonas-Dwyer, Diana

2004-01-01

This paper is a case study of the impact of ICT on the teaching and learning environment at Murdoch University in Perth, Western Australia, where the convergence of distance and campus-based education is changing the teaching environment in ways impossible prior to the development of ICT. Specifically, the paper will explore issues which have…

Learning My Way. Papers from the National Conference on Adult Aboriginal Learning (Perth, Western Australia, September 1988). A Special Edition of Wikaru 16.

ERIC Educational Resources Information Center

Harvey, Barbara, Comp.; McGinty, Suzanne, Comp.

These 31 papers dealing with adult aboriginal learning are divided into three sections. The keynote speakers' papers appear first in each section. Section 1, Learning Our Way, contains these papers: "The Invasion of Aboriginal Education" (Christie); "The Drover's Daughter" (Bedford); "Nyungar Women Returning to…

Masculinities and Violence: Interruption of Hegemonic Discourses in an English Classroom

ERIC Educational Resources Information Center

Hatchell, Helen

2006-01-01

In this paper I explore ways in which adolescent male students perceive war and violence and related gender discourses. My research is situated in a Year 10 English classroom in a private boys' school in Perth, Australia. Interviews with students and their teacher provide opportunities to explore perceptions and ideas on issues relating to war and…

Proceedings of the Annual Conference of the Western Australian Science Education Association (19th, Perth, Western Australia, Australia, November 18, 1994).

ERIC Educational Resources Information Center

Rennie, Leonie J., Ed.

The Western Australian Science Education Association is an informal group which meets annually for a conference. This document contains the proceedings of the 1994 conference. Papers included were: (1) "Relationship Between Cognitive Style and Students' Proportional Reasoning Ability" (Ayo Akatugba); (2) "Alternative Modes of…

The "M" in SMEC: A Short History of the Mathematics Education Presence

ERIC Educational Resources Information Center

Malone, John A.

2011-01-01

In this paper I examine the history of the integration of mathematics education into the Science Education Centre, which had been established by physicist, John de Laeter, within the School of Science and Engineering at Curtin University in Perth, Australia. De Laeter's vision for science education was that teachers should have access to…

Digital exploration via Skype: connecting your classroom with the experts

NASA Astrophysics Data System (ADS)

Hay, Rachel

2014-05-01

This presentation describes experiences of using Skype in the classroom to connect learners with scientists and explorers all over the world in order to deepen learners' knowledge and understanding of course material, develop their enquiry skills, and broaden their perspectives on life beyond the classroom walls. In a session organised by the Royal Scottish Geographical Society (RSGS) in partnership with Digital Explorer, twenty-five Perth High School students who were studying coral reefs took part in an exciting live Skype chat with researchers on Australia's Great Barrier Reef. Students spoke to a marine biologist and a geographer who were on-board their research vessel some 15,000km away. They learned about the Catlin Survey's cutting-edge research, which was set up to study conditions on the reef, take 50,000 images, and create a baseline for future comparisons. In addition, the scientists aimed to develop an underwater equivalent of Google Streetview, called Seaview, which will allow people everywhere to engage with this incredible ecosystem. We heard about the divers' encounter with Tiger sharks earlier that same day, and had a tour of the research vessel, as well as asking the experts questions about their research findings and career paths. Feedback from the students was extremely positive, and it was clear that the experience had greatly enhanced their studies. For myself and the other teachers involved, it was an exciting (and surreal!) experience, and helped to update our knowledge of our subjects. Between July and December 2013 I volunteered as Community Manager for Digital Explorer in their partnership with Skype in the classroom. Digital Explorer is an educational social enterprise dedicated to engaging young people in global issues, and preparing them to tackle environmental and technological changes in the 21st century. We offered seventeen lessons as part of Skype in the classroom's Exploring Oceans event in October and November, which aimed to educate and enthuse young people about the world's oceans. It was fascinating to connect with other teachers and with the guest speakers, and there is huge potential for future events on different themes. This presentation will outline what I think are the main benefits of, and challenges to, embedding the use of Skype in more classrooms, and offer some tips for successful Skype lessons. Value is added when Skype lessons are incorporated into a well-planned scheme of work that utilises high-quality, innovative resources, such as those produced by Digital Explorer. The use of this technology in schools increases student engagement in course material, as well as in local and global issues, thus facilitating the development of successful learners and informed global citizens. In addition, it provides opportunities for learners to take responsibility for, and direct, their own learning and skill development. I hope that more teachers will develop their confidence in using Skype with their students, as it offers exciting opportunities for creating interactive lessons and bringing the world into your classroom. Acknowledgements: Jamie Buchanan-Dunlop - Director, Digital Explorer http://digitalexplorer.com @de_updates Charlotte Moore - Made By Many/Skype in the Classroom https://education.skype.com/ @SkypeClassroom Dr Joyce Gilbert - Education Officer, Royal Scottish Geographical Society http://www.rsgs.org/ @RoyalScotGeoSoc

Communication between hospitals and isolated aboriginal community health clinics.

PubMed

Mackenzie, G; Currie, B J

1999-04-01

This study described the communication dynamics, identified problems and recommended changes to improve patient follow-up and communication between Royal Darwin Hospital (RDH) and isolated Aboriginal community health clinics (CHC) in the Northern Territory (NT). In 1995, staff interviews were conducted and an audit of isolated Aboriginal patients' RDH discharge summaries (DS). Eighteen per cent of RDH DSs never arrived in CHCs. DSs were often prepared late and more likely to be in CHC records if written on time and if the referral source was specified. Interviews revealed discontent between CHCs and RDH regarding: communication, DS documentation, the supply of discharge medication, as well as different hospital and community perceptions of Aboriginies' reliability to carry a DS and CHC desire for patients to be given DSs at discharge. Aboriginal patients should be given a DS at discharge and resident medical officers should be educated as to the function and importance of the DS. In 18 months following this study, RDH appointed unit-based Aboriginal health workers and a policy was produced for written communication between hospital and CHCs, as well as a discharge planning manual for Aboriginal communities. Projects investigating communication between hospitals and isolated Aboriginal clinics and patient follow-up may result in significant policy changes concerning these processes.

Body temperature of trauma patients on admission to hospital: a comparison of anaesthetised and non-anaesthetised patients.

PubMed

Langhelle, Audun; Lockey, David; Harris, Tim; Davies, Gareth

2012-03-01

Hypothermia at hospital admission has been found to independently predict increased mortality in trauma patients. Objectives To establish if patients anaesthetised in the prehospital phase of care had a higher rate of hypothermia than non-anaesthetised patients on admission to hospital. Retrospective review of admission body temperature in 1292 consecutive prehospital trauma patients attended by a physician-led prehospital trauma service admitted to The Royal London Hospital between 1 July 2005 and 31 December 2008. 38% had a temperature recorded on admission. There was a significant difference in body temperature between the anaesthetised group (N=207) and the non-anaesthetised group (N=287): mean (SD) 35.0 (2.1) vs 36.2 (1.0)°C, respectively (p<0.001). No significant seasonal body temperature variation was demonstrated. This study confirmed that patients anaesthetised in the prehospital phase of care had a significantly lower admission body temperature. This has led to a change in the author's prehospital practice. Anaesthetised patients are now actively surface heated and have whole body insulation to prevent further heat loss in an attempt to conserve body temperature and improve outcome. This is an example of best in-hospital anaesthetic practice being carried out in the prehospital phase.

Topical royal jelly alleviates symptoms of pruritus in a murine model of allergic contact dermatitis.

PubMed

Yamaura, Katsunori; Tomono, Ayana; Suwa, Eriko; Ueno, Koichi

2013-01-01

Royal jelly is widely used as a health tonic, especially in Asia. Royal jelly is commonly used in cosmetics as well as in dietary supplements and beverages. Little is known, however, about the pharmacologic efficacy of topical royal jelly. Therefore, we investigated the antipruritic activity of topical royal jelly on chronic pruritus in experimental allergic contact dermatitis in mice. HAIRLESS MICE (HOS: HR-1), with chronic allergic contact dermatitis induced by 5 weeks of repeated application of 2,4,6-trinitro-1-chlorobenzene (TNCB) to the entire back skin were treated topically with royal jelly (0.01% or 1%) for 5 weeks after sensitization with TNCB. The effects of royal jelly on pruritus and inflammation were evaluated by measurement of scratching behavior and skin inflammation score, respectively. Repeated application of TNCB to the back skin of mice elicited frequent scratching behavior immediately and 24h after challenge. Topical royal jelly (0.01% or 1%) and betamethasone (0.01%) significantly ameliorated this chronic pruritus throughout the experimental period. The level of nerve growth factor mRNA in back skin was increased in the mice with dermatitis and reduced by betamethasone, but not by royal jelly. The inhibitory effect of royal jelly on chronic pruritus may occur through different mechanisms from those of betamethasone. Topical application of royal jelly, as used in cosmetics, might be beneficial for the alleviation of chronic pruritus.

Innovating undergraduate pathology education through public engagement.

PubMed

Mukundu Nagesh, Navin; Chiva Giurca, Bogdan; Lishman, Suzy

2018-05-01

The trends in modern undergraduate medical education focus on a patient-centred approach through problem-based learning over the traditional modular curriculum. Integrating pathology into this style of learning has resulted in the dilution of core scientific principles which may have contributed to reduced understanding and interest in the subject. We aim to innovate pathology education by utilising National Pathology Week which is organised by the Royal College of Pathologists to develop the public engagement model which empowers students to learn pathology by teaching the public. Through this model, we hope to generate a greater interest in pathology at both undergraduate and postgraduate stages of education. We obtained funding from the Royal College of Pathologists to organise National Pathology Week at Exeter Medical School and the Royal Devon & Exeter Hospital. We involved 125 undergraduate student volunteers from health-related courses. We designed a curriculum aiming to educate both students and public on current topics such as cancer screening programmes, antibiotic resistance, diagnosis of inflammatory bowel disease and the role of pathologists. We hosted 15 pathologists, biomedical scientists and microbiologists to engage with students, share experiences and offer an insight into their careers. Through this project, we interacted with over 500 members of the public and 150 school students. The medical student volunteers developed a range of skills including competent use of microscopes to visualise pathology slides, effective communication with lay audiences to teach pathology and understanding of the clinical application of pathology. We believe the public engagement model of teaching undergraduate students has the potential to develop a greater interest in pathology whilst benefitting the wider community.

[Assessment of the impact of the new health legislation on illegal immigrants in Spain: the case of human immunodeficiency virus infection].

PubMed

Pérez-Molina, José A; Pulido Ortega, Federico

2012-10-01

The immigrant population in Spain, whether legal or not, has been entitled to healthcare under the same conditions as the Spanish population since the year 2000. The entry into vigour of the Royal Decree-Law 12/2012 of 20 April has significantly restricted this right, so that unauthorized or non-resident foreigners may now only receive emergency care, if they are under 18 or pregnant women. Out of an estimated 459,909 illegal immigrants in our country, 2,700 to 4,600 are probably infected with HIV; 1,800 to 3,220 know that they are infected, and 80% of the latter could receive antiretroviral treatment. The Royal Decree-Law is likely to cause many undesirable consequences in this population infected with HIV: increasing mortality, promoting the emergence of opportunistic diseases, increasing hospital admissions, increasing infections in the population (by HIV and other pathogens), or contributing to mother to child transmission of HIV. The expected increase in morbidity and mortality will be a greater cost in patient care, a cost which will be significantly higher in the more immunosuppressed patients. Therefore, the enforcement of the Royal Decree-Law will be much less cost-effective in the short term than was expected, and will negatively affect our country's public health, especially for those patients infected with HIV who will not be covered, thus increasing healthcare medium to long term costs, and moving away from the international health goals that were established. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Delusional parasitosis on the psychiatric consultation service – a longitudinal perspective: case study

PubMed Central

Pansare, Neha; Tobia, Anthony; Bisen, Viwek; Kaufman, Kenneth R.

2017-01-01

Background Delusional parasitosis is infrequently seen in hospital-based consultation–liaison psychiatry. Aims Although there are many publications on delusional parasitosis, this report reviews a unique case that was diagnosed during a hospital admission and treated over the next 36 months. Method Case report and literature review. Results This case report describes a 65-year-old man who was diagnosed with delusional parasitosis during a hospital admission for congestive heart failure and acute kidney injury. A longitudinal description of the patient’s condition during the hospital stay and in the 36 months following discharge, during which time he was treated by a consultation psychiatrist, is provided. Conclusions In discussing the treatment of a challenging presentation, this case demonstrates the opportunity for consultation psychiatrists to initiate care in patients who might not otherwise seek psychiatric services. Patients with somatic delusions represent one group of patients who are unlikely to independently seek psychiatric treatment. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28630746

Trying to understand routine stroke outcome data: the need for adequate casemix adjustment and some practical considerations.

PubMed

Weir, N U; Signorini, D F; Dennis, M S; Murdoch, P S

2000-07-01

To determine how far the difference in published stroke case fatality between the Western General Hospital (WGH), Edinburgh and the Falkirk and District Royal Infirmary (FDRI) for the period 1990-93 can be explained by adjusting more fully for casemix. The cases were ascertained and followed prospectively at the WGH and retrospectively at the FDRI; casemix correction was performed using a validated logistic regression model. The WGH is a teaching hospital and the FDRI a district general hospital. Four hundred and thirty seven patients with a verified acute stroke at the WGH; 471 patients assigned a cerebrovascular disease discharge diagnostic code at the FDRI. Thirty day case fatality. About half of the difference in the two hospitals' published stroke case fatality could be accounted for by variation in measured casemix. The residual difference in adjusted case fatality might have been due to differences in the structure of stroke care or simply to remaining differences in casemix. Full investigation of the cause was prevented by the destruction of the deceased patients records. Comparisons of routinely collected stroke outcomes will remain difficult to interpret unless casemix is properly accounted for and deceased patients' records stored for several years.

CareTrack Kids—part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review

PubMed Central

Hibbert, Peter D; Hallahan, Andrew R; Muething, Stephen E; Lachman, Peter; Hooper, Tamara D; Wiles, Louise K; Jaffe, Adam; White, Les; Wheaton, Gavin R; Runciman, William B; Dalton, Sarah; Williams, Helena M; Braithwaite, Jeffrey

2015-01-01

Introduction A high-quality health system should deliver care that is free from harm. Few large-scale studies of adverse events have been undertaken in children's healthcare internationally, and none in Australia. The aim of this study is to measure the frequency and types of adverse events encountered in Australian paediatric care in a range of healthcare settings. Methods and analysis A form of retrospective medical record review, the Institute of Healthcare Improvement's Global Trigger Tool, will be modified to collect data. Records of children aged <16 years managed during 2012 and 2013 will be reviewed. We aim to review 6000–8000 records from a sample of healthcare practices (hospitals, general practices and specialists). Ethics and dissemination Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Hospital Network in South Australia. An application is under review with the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers. PMID:25854978

Delays in accessing electroconvulsive therapy: a comparison between two urban and two rural populations in Australia.

PubMed

Johnston, Natalie E

2015-10-01

A comparison of the timing, rates and characteristics of electroconvulsive therapy use between urban and rural populations. The medical records of patients who received an acute course of electroconvulsive therapy at two rural and two urban psychiatric hospitals in New South Wales (NSW), Australia, in 2010 were reviewed retrospectively. Main outcome measures were the time from symptom onset, diagnosis and admission to commencing electroconvulsive therapy. Rates of use of electroconvulsive therapy were also compared between rural and urban hospitals using NSW statewide data. There was a significant delay in the time it took for rural patients to receive electroconvulsive therapy compared with urban patients when measured both from the time of symptom onset and from when they received a diagnosis. There were corresponding delays in the time taken for rural patients to be admitted to hospital compared with urban patients. There was no difference in the time it took to commence electroconvulsive therapy once a patient was admitted to hospital. NSW statewide urban-rural comparisons showed rates of electroconvulsive therapy treatment were significantly higher in urban hospitals. Patients in rural areas receive electroconvulsive therapy later in their acute illness due to delays in being admitted to hospital. The rate of use of electroconvulsive therapy also differs geographically. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Can hospital-based doctors change their working hours? Evidence from Australia.

PubMed

Norman, R; Hall, J

2014-07-01

To explore factors predicting hospital-based doctors' desire to work less, and then their success in making that change. Consecutive waves of an Australian longitudinal survey of doctors (Medicine in Australia-Balancing Employment and Life). There were 6285 and 6337 hospital-based completers in the two waves, consisting of specialists, hospital-based non-specialists and specialist registrars. Forty-eight per cent stated a preference to reduce hours. Predictive characteristics were being female and working more than 40 h/week (both P < 0.01). An inverted U-shape relationship was observed for age, with younger and older doctors less likely to state the preference. Factors associated with not wanting to reduce working hours were being in excellent health and being satisfied with work (both P < 0.01). Of those who wanted to reduce working hours, only 32% successfully managed to do so in the subsequent year (defined by a reduction of at least 5 h/week). Predictors of successfully reducing hours were being older, female and working more than 40 h/week (all P < 0.01). Several factors predict the desire of hospital-based doctors to reduce hours and then their subsequent success in doing so. Designing policies that seek to reduce attrition may alleviate some of the ongoing pressures in the Australian hospital system. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Coronary heart disease events in Aboriginal Australians: incidence in an urban population.

PubMed

Bradshaw, Pamela J; Alfonso, Helman S; Finn, Judith C; Owen, Julie; Thompson, Peter L

2009-05-18

To determine the incidence of coronary heart disease (CHD) events in an urban Aboriginal population. Cohort study of 906 Aboriginal people without CHD from 998 who had undergone risk-factor assessment in the Perth Aboriginal Atherosclerosis Risk Study (PAARS) in 1998-1999. PAARS cohort data were electronically linked to a range of databases that included Western Australian hospital morbidity data and death registry data. We analysed data from January 1980 to December 2006 to identify previous admissions for CHD from 1980 to baseline (1998-1999) and new events from baseline to 2006. First CHD event (hospital admission or death). There were 891 linked records for the 906 participants without previous CHD. The event rate was 12.6/1000 person-years (95% CI, 10.2-15.6/1000 person-years). Annual CHD event rates ranged from 8 to 18/1000 person-years. After adjustment for age (sex was not associated with the risk factors assessed), factors associated with risk of a CHD event in the PAARS cohort were a history of diabetes, overweight or obesity (indicated by body mass index), smoking, and hypertension, but not waist circumference. People with these risk factors were 1.9-2.7 times more likely to experience a CHD event. Compared with previously published information from a remote Aboriginal community in the Northern Territory, the incidence of CHD events among urban-dwelling Aboriginal people was not significantly different (P > 0.05 overall and for subgroups defined by age and sex). City-dwelling Aboriginal Australians have an incidence of CHD events comparable to that of Aboriginal people living in remote northern Australia.

The contribution of passengers versus mobile phone use to motor vehicle crashes resulting in hospital attendance by the driver.

PubMed

McEvoy, Suzanne P; Stevenson, Mark R; Woodward, Mark

2007-11-01

There is evidence that mobile phone use while driving (including hands-free) is associated with motor vehicle crashes. However, whether the effects of mobile phone use differ from that of passengers in the vehicle remains unclear. The aim of this research was to estimate the risk of crash associated with passenger carriage and compare that with mobile phone use. A case-control study ('passenger study') was performed in Perth, Western Australia in 2003 and 2004. Cases were 274 drivers who attended hospital following a motor vehicle crash and controls were 1096 drivers (1:4 matching) recruited at service stations matched to the location and time and day of week of the crash. The results were compared with those of a case-crossover study ('mobile phone study') undertaken concurrently (n=456); 152 cases were common to both studies. Passenger carriage increased the likelihood of a crash (adjusted odds ratio (adj. OR), 95% confidence interval (95% CI), 1.6, 1.1-2.2). Drivers carrying two or more passengers were twice as likely to crash as unaccompanied drivers (adj. OR 2.2, 95% CI 1.3-3.8). By comparison, driver's use of a mobile phone within 5 min before a crash was associated with a fourfold increased likelihood of crashing (OR 4.1, 95% CI 2.2-7.7). Passenger carriage and increasing numbers of passengers are associated with an increased likelihood of crash, though not to the same extent as mobile phone use. Further research is needed to investigate the factors underlying the increased risks.

Evaluation of the impact of fetal fibronectin test implementation on hospital admissions for preterm labour in Ontario: a multiple baseline time-series design.

PubMed

Fell, D B; Sprague, A E; Grimshaw, J M; Yasseen, A S; Coyle, D; Dunn, S I; Perkins, S L; Peterson, W E; Johnson, M; Bunting, P S; Walker, M C

2014-03-01

To determine the impact of a health system-wide fetal fibronectin (fFN) testing programme on the rates of hospital admission for preterm labour (PTL). Multiple baseline time-series design. Canadian province of Ontario. A retrospective population-based cohort of antepartum and delivered obstetrical admissions in all Ontario hospitals between 1 April 2002 and 31 March 2010. International Classification of Diseases codes in a health system-wide hospital administrative database were used to identify the study population and define the outcome measure. An aggregate time series of monthly rates of hospital admissions for PTL was analysed using segmented regression models after aligning the fFN test implementation date for each institution. Rate of obstetrical hospital admission for PTL. Estimated rates of hospital admission for PTL following fFN implementation were lower than predicted had pre-implementation trends prevailed. The reduction in the rate was modest, but statistically significant, when estimated at 12 months following fFN implementation (-0.96 hospital admissions for PTL per 100 preterm births; 95% confidence interval [CI], -1.02 to -0.90, P = 0.04). The statistically significant reduction was sustained at 24 and 36 months following implementation. Using a robust quasi-experimental study design to overcome confounding as a result of underlying secular trends or concurrent interventions, we found evidence of a small but statistically significant reduction in the health system-level rate of hospital admissions for PTL following implementation of fFN testing in a large Canadian province. © 2013 Royal College of Obstetricians and Gynaecologists.

Oral allergy syndrome in a child provoked by royal jelly.

PubMed

Paola, Fantini; Pantalea, Delle Donne; Gianfranco, Calogiuri; Antonio, Ferrannini; Angelo, Vacca; Eustachio, Nettis; Elisabetta, Di Leo

2014-01-01

Royal jelly has been demonstrated to have several physiological activities. However, in the literature, different reactions induced by royal jelly are reported. We describe a case of seven-year-old child that was referred to our observation for two episodes of oral allergy syndrome (OAS) that appeared ten minutes after ingestion of royal jelly. Skin prick test with standard panel of inhalant and food allergens, a prick-to-prick test using the royal jelly's extract responsible for patient's reactions, and royal jelly patch test with extemporaneous preparation were performed. The specific IgE by ImmunoCAP System method versus Hymenoptera venom, inhalant allergens, food allergens, and lipid transfer proteins was dosed. According to the positive reactions to royal jelly both by prick-by-prick test and by a first reading patch test, royal jelly immediate hypersensitivity was diagnosed. According to the positive response for almond in both in vivo and in vitro tests we can think of the royal jelly contamination with almond pollen as possible cause of patient's reaction. Moreover, from the results of specific IgE titers versus Compositae pollens, we have argued the possibility that this case of royal jelly allergy could be explained also by the mechanism of cross-reaction with Compositae pollens.

Oral Allergy Syndrome in a Child Provoked by Royal Jelly

PubMed Central

Paola, Fantini; Pantalea, Delle Donne; Gianfranco, Calogiuri; Antonio, Ferrannini; Angelo, Vacca; Eustachio, Nettis; Elisabetta, Di Leo

2014-01-01

Royal jelly has been demonstrated to have several physiological activities. However, in the literature, different reactions induced by royal jelly are reported. We describe a case of seven-year-old child that was referred to our observation for two episodes of oral allergy syndrome (OAS) that appeared ten minutes after ingestion of royal jelly. Skin prick test with standard panel of inhalant and food allergens, a prick-to-prick test using the royal jelly's extract responsible for patient's reactions, and royal jelly patch test with extemporaneous preparation were performed. The specific IgE by ImmunoCAP System method versus Hymenoptera venom, inhalant allergens, food allergens, and lipid transfer proteins was dosed. According to the positive reactions to royal jelly both by prick-by-prick test and by a first reading patch test, royal jelly immediate hypersensitivity was diagnosed. According to the positive response for almond in both in vivo and in vitro tests we can think of the royal jelly contamination with almond pollen as possible cause of patient's reaction. Moreover, from the results of specific IgE titers versus Compositae pollens, we have argued the possibility that this case of royal jelly allergy could be explained also by the mechanism of cross-reaction with Compositae pollens. PMID:24799914

Topical royal jelly alleviates symptoms of pruritus in a murine model of allergic contact dermatitis

PubMed Central

Yamaura, Katsunori; Tomono, Ayana; Suwa, Eriko; Ueno, Koichi

2013-01-01

Background: Royal jelly is widely used as a health tonic, especially in Asia. Royal jelly is commonly used in cosmetics as well as in dietary supplements and beverages. Little is known, however, about the pharmacologic efficacy of topical royal jelly. Therefore, we investigated the antipruritic activity of topical royal jelly on chronic pruritus in experimental allergic contact dermatitis in mice. Materials and Methods: Hairless mice (HOS: HR-1), with chronic allergic contact dermatitis induced by 5 weeks of repeated application of 2,4,6-trinitro-1-chlorobenzene (TNCB) to the entire back skin were treated topically with royal jelly (0.01% or 1%) for 5 weeks after sensitization with TNCB. The effects of royal jelly on pruritus and inflammation were evaluated by measurement of scratching behavior and skin inflammation score, respectively. Results: Repeated application of TNCB to the back skin of mice elicited frequent scratching behavior immediately and 24h after challenge. Topical royal jelly (0.01% or 1%) and betamethasone (0.01%) significantly ameliorated this chronic pruritus throughout the experimental period. The level of nerve growth factor mRNA in back skin was increased in the mice with dermatitis and reduced by betamethasone, but not by royal jelly. Conclusion: The inhibitory effect of royal jelly on chronic pruritus may occur through different mechanisms from those of betamethasone. Topical application of royal jelly, as used in cosmetics, might be beneficial for the alleviation of chronic pruritus. PMID:23661987

The use of antigravity suits in the treatment of idiopathic orthostatic hypotension

NASA Technical Reports Server (NTRS)

Landmark, K.; Kravik, S.

1980-01-01

Idiopathic orthostatic hypotension is an uncommon disease characterized by a drop in blood pressure when going from a recumbent to a standing position. Treatment by medication generally produces poor results. Three patients at the Royal Hospital in Oslo were treated with antigravity suits and all were able to maintain adequate blood pressures in the standing position. One patient improved dramatically and was able to take short walks while wearing the suit. The two other patients, however, felt that wearing the suits eventually became uncomfortable. This treatment represents a useful treatment alternative for intractable cases.

Efficacy of OK-432 Therapy for the Incisionless Treatment of Head and Neck Cystic Masses

PubMed Central

Hasan, Hesham Y. A.; Rizwan, Muhammad A.

2018-01-01

Head and neck masses can present in different pathologies that usually vary according to the age of the patient. We report five cases of benign head or neck masses occurring among patients of different ages who were managed at the Bahrain Defence Force Royal Medical Services Hospital, Ar-Rifaa, Bahrain, between 2005–2014. All of the patients were treated using the sclerotherapeutic agent OK-432. Although surgical removal is usually considered optimal treatment in the management of such cases, OK-432 appears to be a promising alternative. PMID:29666687

SOMA: A Proposed Framework for Trend Mining in Large UK Diabetic Retinopathy Temporal Databases

NASA Astrophysics Data System (ADS)

Somaraki, Vassiliki; Harding, Simon; Broadbent, Deborah; Coenen, Frans

In this paper, we present SOMA, a new trend mining framework; and Aretaeus, the associated trend mining algorithm. The proposed framework is able to detect different kinds of trends within longitudinal datasets. The prototype trends are defined mathematically so that they can be mapped onto the temporal patterns. Trends are defined and generated in terms of the frequency of occurrence of pattern changes over time. To evaluate the proposed framework the process was applied to a large collection of medical records, forming part of the diabetic retinopathy screening programme at the Royal Liverpool University Hospital.

Discussion on wound care in the 21st century.

PubMed

Harrison, Mary

In June of this year, Liverpool John Moores University was the venue for the Advancing Wound Care conference. Experts in wound healing from both the university and from the Royal Liverpool and Broadgreen University Hospital NHS Trust gave keynote speeches aimed at informing, improving and advancing healthcare knowledge on such topics as: wound healing in the 21st century; evidence-based practice for superficial burns; infected and complex wounds; and the use of silver in wound care. This paper introduced the conference and considered some of the complex issues involved in clinical decision making for wound management.

Crucible of fire: the Boer War and the birth of the Canadian Army Medical Corps.

PubMed Central

McCulloch, I

1995-01-01

Although Canada's military physicians didn't come to prominence until WW I and WW II, the Canadian Army Medical Corps (CAMC), the forerunner of the Royal Canadian Army Medical Corps and the current Canadian Forces Medical Service, actually had its origins in the Boer War. During that turn-of-the-century conflict, field hospitals accompanied Canadian troops to South Africa. Ian McCulloch discusses that early type of medical service and the steps that led to the creation of the CAMC. Images p1495-a p1496-a PMID:7585380

Sidaway v. Bethlem Royal Hospital.

PubMed

1984-02-23

England's appellate court upheld a ruling that a surgeon who had performed an operation resulting in severe spinal cord damage, without having advised the patient of the risk of such an occurrence, was not liable. The physician's duty of care is discharged by revealing enough information to enable the patient to make a rational decision, with the extent of disclosure to be based on accepted medical practice. The judges rejected, as not in accord with English law, the American doctrine of informed consent based on the patient's right to disclosure of all material risks of significance to a "prudent patient."

A complete audit cycle of management of third/fourth degree perineal tears.

PubMed

Panigrahy, R; Welsh, J; MacKenzie, F; Owen, P

2008-04-01

We present a complete audit cycle of the management of third/fourth degree perineal tears in the three Glasgow maternity hospitals measured against the recommendations of the Royal College of Obstetricians and Gynaecologists (RCOG) Guideline No. 29 (www.rcog.org.uk). Following an initial 6-month data collection period, shortcomings in the practice were identified, circulated and an operative proforma was designed and introduced. A re-audit demonstrated improved compliance with the RCOG guidelines. We recommend the introduction of an operative proforma to aid management and documentation of third/fourth degree tear repairs.

Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.

PubMed

Crabtree, Nathan; Mo, Shirley; Ong, Leon; Jegathees, Thuvarahan; Wei, Daniel; Fahey, David; Liu, Jia Jenny

2017-04-01

Introduction Comprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events. Hypothesis Patient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements. A retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA). Between 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were more likely to require advanced treatment, health professional review, and were more likely to be discharged to hospital or home rather than discharged back to the event. Extremes of temperature were associated with a lower crowd size and higher patient presentation rate (PPR), but had no impact on transfer or referral rates to hospital. This study demonstrated that analyses of patient presentations at an agricultural show provide unique insights on weather, attendance, and demographic features that correlated with treatment and disposition. These data can help guide organizers with information on how to better staff and train health care providers at future mass-gathering events of this type. Crabtree N , Mo S , Ong L , Jegathees T , Wei D , Fahey D , Liu J . Retrospective analysis of patient presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014. Prehosp Disaster Med. 2017;32(2)187-194.

[Two cases of royal jelly allergy provoked the symptoms at the time of their first intake].

PubMed

Harada, Susumu; Moriyama, Tatsuya; Tanaka, Akira

2011-06-01

Two young women were suffered from several symptoms after the intake of royal jelly at their first time. According to the positive skin prick test reactions of raw royal jelly, royal jelly allergy was diagnosed. As the reasons why the symptoms appeared at the time of their first intake, we guessed the possibility that 1) they had been sensitized for royal jelly formerly, or 2) their symptoms were induced by the cross-reactivity between royal jelly and other allergens such as bee, honey and pollens. As to our cases, no related allergens were found in one case, but in another case co-existence of mugwort allergy was suspected from the results of both skin prick test and specific IgE titers. Originally royal jelly allergy has been regarded as class 1 allergic reaction developed by the sensitization of itself. But we speculated the possibility that there can also be cases of class 2 royal jelly allergy by the mechanism of cross-reaction with pollens.

The outcomes and treatment burden of childhood acute myeloid leukaemia in Australia, 1997-2008: A report from the Australian Paediatric Cancer Registry.

PubMed

Foresto, Steven A; Youlden, Danny R; Baade, Peter D; Hallahan, Andrew R; Aitken, Joanne F; Moore, Andrew S

2015-09-01

Childhood acute myeloid leukaemia (AML) requires intensive therapy and is associated with survival rates that are substantially inferior to many other childhood malignancies. We undertook a retrospective analysis of Australian Paediatric Cancer Registry data from 1997 to 2008 together with a single-centre audit during the same period assessing burden on service delivery at a tertiary children's hospital (Royal Children's Hospital, Brisbane). Although survival improved from 54.3% (1997-2002) to 69.2% (2003-2008), childhood AML caused a disproportionate number of childhood cancer deaths, accounting for 5.5% of all childhood cancer diagnoses yet 7.9% of all childhood cancer mortality. Furthermore, treatment was associated with significant toxicity requiring intensive use of local health resources. Novel therapeutic strategies aimed at improving survival and reducing toxicity are urgently required. © 2015 Wiley Periodicals, Inc.

Mobile surgical skills education unit: a new concept in surgical training.

PubMed

Shaikh, Faisal M; Hseino, Hazem; Hill, Arnold D K; Kavanagh, Eamon; Traynor, Oscar

2011-08-01

Basic surgical skills are an integral part of surgical training. Simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a nonpatient, nonstressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations. A new program is designed by the Royal College of Surgeons in Ireland (RCSI), in an approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings. In this article, authors describe the program and students response to the mobile surgical skills being delivered in the region of their training hospitals and by their own regional consultant trainers.

Physical restraint and the protection of the human rights of immigration detainees in hospitals.

PubMed

Pickles, Hilary; Norton, Emma; Ginn, Emma; Schleicher, Theresa

2015-08-01

Immigration detainees, like prisoners, are entitled to the same standard of healthcare as non-detained patients. When hospital attendance or admission is required, the priority for custodial staff (who for purposes of this article we refer to as 'escorts') is to prevent absconding. For that reason, they may wish to use physical restraints, such as handcuffs, and remain with the detainee at all times. This can be degrading for the patient and breach their human rights. Clinicians have professional obligations to all their patients and must object to any restraint methods that risk damaging the patient's right to confidentiality, treatment, health or the therapeutic relationship itself. The starting presumption is that restraints ought not to be used during treatment and only in the most exceptional cases ought escorts to be present during clinical examination or treatment. © Royal College of Physicians 2015. All rights reserved.

Brownfields Redevelopment, Preferences and Public Involvement: A Case Study of an Ethnically Mixed Neighborhood.

ERIC Educational Resources Information Center

Greenberg, Michael; Lewis, M. Jane

2000-01-01

A survey of over 200 residents of a largely Hispanic census tract in Perth Amboy, NJ found that residents preferred recreation, cultural, and other community facilities be the aim of brownfield re-development. They were less interested in industry and business, the promoted aim of such re-development. Three-quarters of respondents indicated a…

The Use of Ethical Frameworks for Implementing Science as a Human Endeavour in Year 10 Biology

ERIC Educational Resources Information Center

Yap, Siew Fong; Dawson, Vaille

2014-01-01

This research focuses on the use of ethical frameworks as a pedagogical model for socio-scientific education in implementing the "Science as a Human Endeavour" (SHE) strand of the Australian Curriculum: Science in a Year 10 biology class in a Christian college in metropolitan Perth, Western Australia. Using a case study approach, a mixed…

Biopedagogies and Indigenous Knowledge: Examining Sport for Development and Peace for Urban Indigenous Young Women in Canada and Australia

ERIC Educational Resources Information Center

Hayhurst, Lyndsay M. C.; Giles, Audrey R.; Wright, Jan

2016-01-01

This paper uses transnational postcolonial feminist participatory action research (TPFPAR) to examine two sport for development and peace (SDP) initiatives that focus on Indigenous young women residing in urban areas, one in Vancouver, Canada, and one in Perth, Australia. We examine how SDP programs that target urban Indigenous young women and…

Cohort Size, Sex and Socio-Economic Status as Predictors of Success in Year 12 Physics in Perth, 1987-1997

ERIC Educational Resources Information Center

Geelan, David; Louden, William; Wildy, Helen

2013-01-01

A variety of factors are associated with students' achievement in secondary school physics, including cohort size--the total number of students studying Physics in the school--and socioeconomic status. Earlier studies also showed boys achieving better in Physics, while more recent research has shown better results for girls. Statistical analysis…

Coping With Curriculum. Papers and Proceedings of the National Workshop on Distance Education (2nd, Perth, Western Australia, July 13-15, 1983).

ERIC Educational Resources Information Center

Western Australia Education Dept., Perth.

The proceedings of the 3-day Australian National Workshop on Distance Education, whose theme was "Coping with Curriculum," include 18 papers, 2 workshop reports, and appendices that list participants and state, territory, and New Zealand representatives. The 36 recommendations developed by the workshop groups include recommendations to…

Understanding Parent Perceptions of a 1:1 Laptop Program in Western Australia

ERIC Educational Resources Information Center

Bate, Frank; MacNish, Jean; Males, Steven

2012-01-01

This paper provides some initial findings from a current longitudinal study that examines the implementation of a student-owned 1:1 laptop program in a school for boys in Perth, Western Australia. This research tracks 196 students, their families and associated teachers for a 3-year period (2010-2012). Underpinning this research is a mixed methods…

Teaching for understanding and/or teaching for the examination in high school physics

NASA Astrophysics Data System (ADS)

Geelan, David R.; Wildy, Helen; Louden, William; Wallace, John

2004-04-01

Literature on the related notions of 'teaching for understanding' and 'exemplary teaching' tends to be interpreted as prescribing certain classroom approaches. These are usually the strategies often identified with constructivist teaching, which involve a redefinition of the teacher's role: rather than being seen as a source of knowledge and control, the teacher is described as the facilitator of a largely student-directed search for understanding. More 'transmissive', teacher-centred approaches are held to lead to poor student understanding, low cognitive engagement and rote learning. This paper reports a case study of physics teaching in a government high school in Perth, Western Australia. This case study is part of a larger project spanning 5 years and eight case investigations in Perth schools. While the pedagogical style of the teacher studied could be labelled as 'transmissive', we tentatively assert that his practice exemplified high-quality physics teaching and led to high-quality understanding on the part of the students. The study suggests that prescriptions for quality teaching must be sensitive to issues of context and content, and that further study in a variety of school contexts is required to expand our understanding of what constitutes good teaching and learning in physics.

The potential for convection and implications for geothermal energy in the Perth Basin, Western Australia

NASA Astrophysics Data System (ADS)

Sheldon, Heather A.; Florio, Brendan; Trefry, Michael G.; Reid, Lynn B.; Ricard, Ludovic P.; Ghori, K. Ameed R.

2012-11-01

Convection of groundwater in aquifers can create areas of anomalously high temperature at shallow depths which could be exploited for geothermal energy. Temperature measurements in the Perth Basin (Western Australia) reveal thermal patterns that are consistent with convection in the Yarragadee Aquifer. This observation is supported by Rayleigh number calculations, which show that convection is possible within the range of aquifer thickness, geothermal gradient, salinity gradient and permeability encountered in the Yarragadee Aquifer, assuming that the aquifer can be treated as a homogeneous anisotropic layer. Numerical simulations of convection in a simplified model of the Yarragadee Aquifer show that: (1) the spacing of convective upwellings can be predicted from aquifer thickness and permeability anisotropy; (2) convective upwellings may be circular or elongate in plan view; (3) convective upwellings create significant temperature enhancements relative to the conductive profile; (4) convective flow rates are similar to regional groundwater flow rates; and (5) convection homogenises salinity within the aquifer. Further work is required to constrain the average horizontal and vertical permeability of the Yarragadee Aquifer, to assess the validity of treating the aquifer as a homogeneous anisotropic layer, and to determine the impact of realistic aquifer geometry and advection on convection.

Premature femoral neck physeal closure in Perthes' disease.

PubMed

Bowen, J R; Schreiber, F C; Foster, B K; Wein, B K

1982-01-01

One hundred premature femoral neck physeal closures in 430 hips with Perthes' disease have occurred in two patterns central and lateral. Abnormal physeal growth can be demonstrated early by a narrowed physeal plate with overlying avascular epiphysis and marked metaphyseal reaction below. Subsequently, a bony bridge forms between the metaphysis and epiphysis. If the physeal closure is central, the mature hip will have a short femoral neck, a relatively round femoral head, a trochanter that has overgrown the femoral head, a short leg, and a mildly deformed acetabulum. If the physeal closure is lateral, the mature hip will have a femoral head that is externally tilted as the medial neck lengthens and the lateral neck remains short, a trochanter that has overgrown the femoral head, an oval femoral head, a short leg, and a deformed acetabulum. A physeal arrest is a contraindication for a varus osteotomy because it accentuates the deformity, especially in the greater trochanter. The leg-length discrepancy may be treated by epiphysiodesis of the contralateral femur, when necessary, and the abductor muscle insufficiency may be treated by an exercise program or distal and lateral transfer of the greater trochanter.

Life-cycle assessment of diesel, natural gas and hydrogen fuel cell bus transportation systems

NASA Astrophysics Data System (ADS)

Ally, Jamie; Pryor, Trevor

The Sustainable Transport Energy Programme (STEP) is an initiative of the Government of Western Australia, to explore hydrogen fuel cell technology as an alternative to the existing diesel and natural gas public transit infrastructure in Perth. This project includes three buses manufactured by DaimlerChrysler with Ballard fuel cell power sources operating in regular service alongside the existing natural gas and diesel bus fleets. The life-cycle assessment (LCA) of the fuel cell bus trial in Perth determines the overall environmental footprint and energy demand by studying all phases of the complete transportation system, including the hydrogen infrastructure, bus manufacturing, operation, and end-of-life disposal. The LCAs of the existing diesel and natural gas transportation systems are developed in parallel. The findings show that the trial is competitive with the diesel and natural gas bus systems in terms of global warming potential and eutrophication. Emissions that contribute to acidification and photochemical ozone are greater for the fuel cell buses. Scenario analysis quantifies the improvements that can be expected in future generations of fuel cell vehicles and shows that a reduction of greater than 50% is achievable in the greenhouse gas, photochemical ozone creation and primary energy demand impact categories.

A two-degree-of-freedom hip exoskeleton device for an immature animal model of exercise-induced Legg-Calvé-Perthes disease.

PubMed

Zhang, J F; Yang, C J; Wu, T; Li, J H; Xu, Z S; Chen, Y

2009-11-01

Legg-Calvé-Perthes disease (LCPD) is a significant problem in healthcare because it so commonly affects young adults and immature athletes, primarily gymnasts. In this paper, a two-degree-of-freedom (2-DOF) hip exoskeleton device was developed for study on an immature animal model of exercise-induced LCPD. The exoskeleton device can reproduce the repetitive actions and forceful centrality impingements on the coxafemoral head that occur in sports such as gymnastics and acrobatics. It initiated a new method rather than the traditional medical or physiological operation method to establish an animal model of LCPD and allowed for the development and testing of new treatments. Ten immature New Zealand white rabbits were selected for the experiment. Their right legs were driven to achieve repetitive extension/ flexion and abduction/adduction beyond the normal range of motion, with centrality impingements at the maximum flexion position, while their left legs were kept in the initial healthy status and acted as the comparing reference. Four weeks later, the basic symptoms of early LCPD of the femoral head appeared. The results of X-ray, magnetic resonance imaging (MRI), gross anatomy observation, and H-E section also revealed it.

Socioeconomic Status Accounts for Rapidly Increasing Geographic Variation in the Incidence of Poor Fetal Growth

PubMed Central

Ball, Stephen J.; Jacoby, Peter; Zubrick, Stephen R.

2013-01-01

Fetal growth is an important risk factor for infant morbidity and mortality. In turn, socioeconomic status is a key predictor of fetal growth; however, other sociodemographic factors and environmental effects may also be important. This study modelled geographic variation in poor fetal growth after accounting for socioeconomic status, with a fixed effect for socioeconomic status and a combination of spatially-correlated and spatially-uncorrelated random effects. The dataset comprised 88,246 liveborn singletons, aggregated within suburbs in Perth, Western Australia. Low socioeconomic status was strongly associated with an increased risk of poor fetal growth. An increase in geographic variation of poor fetal growth from 1999–2001 (interquartile odds ratio among suburbs = 1.20) to 2004–2006 (interquartile odds ratio = 1.40) indicated a widening risk disparity by socioeconomic status. Low levels of residual spatial patterns strengthen the case for targeting policies and practices in areas of low socioeconomic status for improved outcomes. This study indicates an alarming increase in geographic inequalities in poor fetal growth in Perth which warrants further research into the specific aspects of socioeconomic status that act as risk factors. PMID:23799513

Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the hospital anxiety and depression scale

PubMed Central

2012-01-01

Background Perinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers’ anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding. Methods A repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS) was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results. Results The mean anxiety levels at baseline for the fathers in the intervention group (n=289) and control group (n=244) were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs), intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048). Depression scores for intervention fathers at baseline (mean =1.09) and at six weeks (mean=1.09) were very similar to fathers in the control group at baseline (mean=1.11) and at six weeks (mean =1.07) with no significant changes. Conclusions Both intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their knowledge and potentially lower the risk of postnatal anxiety. Trial registration (Australian New Zealand Clinical Trials Registry ACTRN12609000667213) PMID:22849509

Effects of temperature variation between neighbouring days on daily hospital visits for childhood asthma: a time-series analysis.

PubMed

Li, K; Ni, H; Yang, Z; Wang, Y; Ding, S; Wen, L; Yang, H; Cheng, J; Su, H

2016-07-01

To identify the relationship between temperature variation between neighbouring days (TVN) and hospital visits for childhood asthma in age- and sex-specific groups. An ecological design was used to explore the effect of TVN on hospital visits for childhood asthma. A Poisson generalised linear regression model combined with a distributed lag non-linear model was used to analyse the association between TVN and hospital visits for childhood asthma. All hospital visits for childhood asthma from June 2010 to July 2013 were included (n = 17,022). Daily climate data were obtained from Hefei Meteorological Bureau. A significant correlation was found between TVN and hospital visits for childhood asthma in age- and sex-specific groups. For different gender groups, the effect of TVN on childhood asthma was the greatest at 3 and 5 days lag for males and females. For different age groups, the effect of TVN on childhood asthma was the greatest at 1 and 5 days lag for 0-4 years and 5-14 years children, respectively. A 1 °C increase in TVN was associated with a 4.2% (95% confidence interval 0.9-7.6%) increase in hospital visits for childhood asthma. TVN is associated with hospital visits for childhood asthma. Once the temperature change rapidly, guardians will be urged to pay more attention to their children's health, which may reduce the morbidity of childhood asthma. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Royal Wine Corporation d/b/a/ Royal Kedem (Herzog Wine Cellars), Oxnard, CA; Consent Agreement and Final Order

EPA Pesticide Factsheets

Consent Agreement and Final Order (Proposed CA/FO), between the U.S. Environmental Protection Agency, Region 9 (EPA or Complainant), and Royal Wine Corporation, d/b/a Royal Kedem (Herzog Wine Cellars or Respondent). Docket Number CWA-09-2018-0004.

Quantification of major royal jelly protein 1 in fresh royal jelly by indirect enzyme-linked immunosorbent assay.

PubMed

Yamaguchi, Kikuji; He, Shaoyu; Li, Zhengyue; Murata, Kiyoshi; Hitomi, Nobuyuki; Mozumi, Manaho; Ariga, Risa; Enomoto, Toshiki

2013-01-01

Rabbit polyclonal antibody produced by a major royal jelly protein 1 (MRJP1) specific peptide reacted only with a MRJP1. Indirect ELISA with the antibody revealed a MRJP1 level of 4.12-4.67 g/100 g in different company's royal jelly, which almost agreed with that of a hexametric form of MRJP1 (apisin) measured by high performance liquid chromatography. These results suggest that MRJP1 exists mainly as apisin in royal jelly.

Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London.

PubMed

Gowland, Emily; Ball, Karen Le; Bryant, Catherine; Birns, Jonathan

2016-10-01

Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects. © Royal College of Physicians 2016. All rights reserved.

The introduction of new critical care equipment into the aeromedical evacuation service of the Royal Air Force.

PubMed

Lamb, Di

2003-04-01

Changing world events over recent years and an increasingly complex patient casemix have led to a review of the equipment used by the Aeromedical Evacuation Squadron of the Royal Air Force. The initial special purpose aeromedical equipment (SPAME) project was completed in 2001 with the new equipment being brought into service in August of the same year. The project incorporated long term planning for replacing the equipment along with its rapidly developing technology, especially with that used for the care of the critically ill. An intensive training programme was simultaneously introduced to support the deployment of this new technology. Critical care teams comprise a consultant anaesthetist, a critical care nurse, a flight nurse attendant (paramedic) and a technician, all of whom attend courses designed specifically to accommodate their role within the team.A considerable amount of work has been undertaken by a dedicated team to ensure this project became a reality and which has resulted in the provision of care to meet the needs of any casualty, anywhere in the world, being achieved using the latest technology proportionate to any hospital-based ICU.

Royal Wine Corporation d/b/a/ Royal Kedem (Herzog Wine Cellars), Oxnard, CA; Proposed Settlement of Clean Water Act Class II Administrative Penalty and Opportunity to Comment

EPA Pesticide Factsheets

Public Notice of Proposed Settlement of Clean Water Act Class II Administrative Penalty and Opportunity to Comment In the Matter of Royal Wine Corporation d/b/a/ Royal Kedem (Herzog Wine Cellars), Oxnard, California.

50 CFR 622.43 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Spanish mackerel taken under the bag limits. (4) Royal red shrimp in the Gulf. Royal red shrimp in or from the Gulf EEZ may not be retained, and the sale or purchase of royal red shrimp taken from the Gulf EEZ... Spanish mackerel, royal red shrimp, or specified snapper-grouper species in paragraphs (a)(1), (a)(3)(iii...

Cardioprotective effect of royal jelly on paclitaxel-induced cardio-toxicity in rats

PubMed Central

Malekinejad, Hassan; Ahsan, Sima; Delkhosh-Kasmaie, Fatemeh; Cheraghi, Hadi; Rezaei-Golmisheh, Ali; Janbaz-Acyabar, Hamed

2016-01-01

Objective(s): Paclitaxel is a potent chemotherapy agent with severe side effects, including allergic reactions, cardiovascular problems, complete hair loss, joint and muscle pain, which may limit its use and lower its efficiency. The cardioprotective effect of royal jelly was investigated on paclitaxel-induced damages. Materials and Methods: Adult male Wistar rats were divided into control and test groups (n=8). The test group was assigned into five subgroups; 4 groups, along with paclitaxel administration (7.5 mg/kg BW, weekly), received various doses of royal jelly (50, 100, and 150 mg/kg BW) for 28 consecutive days. The last group received only royal jelly at 100 mg/kg. In addition to oxidative and nitrosative stress biomarkers, the creatine kinase (CK-BM) level was also determined. To show the cardioprotective effect of royal jelly on paclitaxel-induced damages, histopathological examinations were conducted. Results: Royal jelly lowered the paclitaxel-elevated malondialdehyde and nitric oxide levels in the heart. Royal jelly could also remarkably reduce the paclitaxel-induced cardiac biomarker of creatine kinase (CK-BM) level and pathological injuries such as diffused edema, hemorrhage, congestion, hyaline exudates, and necrosis. Moreover, royal jelly administration in a dose-dependent manner resulted in a significant (P<0.05) increase in the paclitaxel-reduced total antioxidant capacity. Conclusion: Our data suggest that the paclitaxel-induced histopathological and biochemical alterations could be protected by the royal jelly administration. The cardioprotective effect of royal jelly may be related to the suppression of oxidative and nitrosative stress. PMID:27081469

Cardioprotective effect of royal jelly on paclitaxel-induced cardio-toxicity in rats.

PubMed

Malekinejad, Hassan; Ahsan, Sima; Delkhosh-Kasmaie, Fatemeh; Cheraghi, Hadi; Rezaei-Golmisheh, Ali; Janbaz-Acyabar, Hamed

2016-02-01

Paclitaxel is a potent chemotherapy agent with severe side effects, including allergic reactions, cardiovascular problems, complete hair loss, joint and muscle pain, which may limit its use and lower its efficiency. The cardioprotective effect of royal jelly was investigated on paclitaxel-induced damages. Adult male Wistar rats were divided into control and test groups (n=8). The test group was assigned into five subgroups; 4 groups, along with paclitaxel administration (7.5 mg/kg BW, weekly), received various doses of royal jelly (50, 100, and 150 mg/kg BW) for 28 consecutive days. The last group received only royal jelly at 100 mg/kg. In addition to oxidative and nitrosative stress biomarkers, the creatine kinase (CK-BM) level was also determined. To show the cardioprotective effect of royal jelly on paclitaxel-induced damages, histopathological examinations were conducted. Royal jelly lowered the paclitaxel-elevated malondialdehyde and nitric oxide levels in the heart. Royal jelly could also remarkably reduce the paclitaxel-induced cardiac biomarker of creatine kinase (CK-BM) level and pathological injuries such as diffused edema, hemorrhage, congestion, hyaline exudates, and necrosis. Moreover, royal jelly administration in a dose-dependent manner resulted in a significant (P<0.05) increase in the paclitaxel-reduced total antioxidant capacity. Our data suggest that the paclitaxel-induced histopathological and biochemical alterations could be protected by the royal jelly administration. The cardioprotective effect of royal jelly may be related to the suppression of oxidative and nitrosative stress.

Keratometry obtained by corneal mapping versus the IOLMaster in the prediction of postoperative refraction in routine cataract surgery.

PubMed

Dulku, Simon; Smith, Henry B; Antcliff, Richard J

2013-01-01

To establish whether simulated keratometry values obtained by corneal mapping (videokeratography) would provide a superior refractive outcome to those obtained by Zeiss IOLMaster (partial coherence interferometry) in routine cataract surgery. Prospective, non-randomized, single-surgeon study set at the The Royal United Hospital, Bath, UK, District General Hospital. Thirty-three patients undergoing routine cataract surgery in the absence of significant ocular comorbidity. Conventional biometry was recorded using the Zeiss IOLMaster. Postoperative refraction was calculated using the SRK/T formula and the most appropriate power of lens implanted. Preoperative keratometry values were also obtained using Humphrey Instruments Atlas Version A6 corneal mapping. Achieved refraction was compared with predicted refraction for the two methods of keratometry after the A-constants were optimized to obtain a mean arithmetic error of zero dioptres for each device. The mean absolute prediction error was 0.39 dioptres (standard deviation 0.29) for IOLMaster and 0.48 dioptres (standard deviation 0.31) for corneal mapping (P = 0.0015). Keratometry readings between the devices were highly correlated by Spearman correlation (0.97). The Bland-Altman plot demonstrated close agreement between keratometers, with a bias of 0.0079 dioptres and 95% limits of agreement of -0.48-0.49 dioptres. The IOLMaster was superior to Humphrey Atlas A6 corneal mapping in the prediction of postoperative refraction. This difference could not have been predicted from the keratometry readings alone. When comparing biometry devices, close agreement between readings should not be considered a substitute for actual postoperative refraction data. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine.

PubMed

Mellor, Adrian; Dodds, Naomi; Joshi, Raj; Hall, John; Dhillon, Sundeep; Hollis, Sarah; Davis, Pete; Hillebrandt, David; Howard, Eva; Wilkes, Matthew; Langdana, Burjor; Lee, David; Hinson, Nigel; Williams, Thomas Harcourt; Rowles, Joe; Pynn, Harvey

2015-01-01

To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic.

Anaemia in elective orthopaedic surgery - Royal Adelaide Hospital, Australia.

PubMed

Kearney, B; To, J; Southam, K; Howie, D; To, B

2016-01-01

An anaemia clinic was established to improve the preoperative management of elective orthopaedic patients scheduled for arthroplasty. This paper is a report on the first 100 patients assessed. To assess the incidence and causes of anaemia in patients on a waiting list for elective arthroplasty in a public hospital and to assess the impact of anaemia detection in this patient population. Patients attending an Anaemia Clinic for elective orthopaedic surgical patients, during March 2010 to June 2013 were studied. Outcome measures included change in haemoglobin preoperative results and perioperative transfusion rates by preoperative haemoglobin. Seventeen per cent of patients scheduled for elective surgery were found to be anaemic. Of the 100 patients who attended, approximately half were found to be iron deficient and the remainder had anaemia of chronic disease. Serum ferritin <30 µg/L alone did not identify iron deficiency in 80% of patients with iron deficiency. Patients with iron deficient anaemia were able to be treated, in all cases, to achieve a significant increase in preoperative haemoglobin. The general unavailability of erythropoietin limited effective intervention for the non-iron-deficient anaemic patients. Seven patients had their surgery cancelled because of the screening programme. Half of the anaemic patients in a joint replacement screening clinic were iron deficient, and treatment was effective in improving the pre-operative haemoglobin and reducing perioperative transfusion rates. This screening process should improve patient outcome. Another important finding in this group of patients is that ferritin levels cannot be reliably used as the sole indicator in the diagnosis of iron deficiency anaemia in this group of patients undergoing elective arthroplasty. © 2015 Royal Australasian College of Physicians.

Case mix in paediatric rheumatology: implications for training in Australia.

PubMed

Lim, Sern Chin; Allen, Roger C; Munro, Jane E; Akikusa, Jonathan D

2012-05-01

Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other. This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each. An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared. Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%). The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Outcome of patients in laparoscopic training courses compared to standard patients.

PubMed

Kanakala, V; Bawa, S; Gallagher, P; Woodcock, S; Attwood, S E; Horgan, L F; Seymour, K

2010-06-01

Current Laparoscopic simulators have limited usefulness and patients have been used for training since the dawn of surgery. NUGITS (Northumbrian Upper Gastro Intestinal Team of Surgeons) Laparoscopic Skills courses utilise hands-on experience with simulators moving to live operating on volunteer patients. It is vital to know that the volunteer patient is not disadvantaged by greater surgical risk. This was a case-controlled prospective comparison of patients undergoing both Laparoscopic Cholecystectomy (LC) [n=51] and Laparoscopic Inguinal Hernia (LIH) [n=62] during NUGITS training courses. They are compared with a matched (age, sex and ASA grade) control group LC (n=51) and LIH (n=62) operated on by consultants. The outcome measures were surgical peri-and post-operative complications, post-operative hospital stay, readmission and early recurrence of inguinal hernia (<6 months). In the LC cohort, there was no significant difference in the length of hospital stay (p=0.07) or readmission (p=0.16) in both the groups. The mean operating time was higher in the trainee compared to the control group (p=0.001). There was no difference in the post-operative morbidity or mortality in either group. In LIH cohort, the mean operating time was higher in the trainee compared with the control group. There was no significant difference in post-operative complications (p>0.05) and early post-operative recurrence of hernia (p>0.05). The post-operative outcomes of patients undergoing laparoscopic surgery during laparoscopic training courses are similar to consultant-operated patients. Thus, it is acceptable and safe to encourage patients to volunteer for laparoscopic training courses. Copyright (c) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Early Mentoring of Medical Students and Junior Doctors on a Path to Academic Cardiothoracic Surgery.

PubMed

Fricke, Tyson A; Lee, Melissa G Y; Brink, Johann; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E

2018-01-01

In 2005 the Department of Cardiothoracic Surgery at The Royal Children's Hospital started an early academic mentoring program for medical students and junior doctors with the aim of fostering an interest in academic surgery. Between 2005 and 2015, 37 medical students and junior doctors participated in research in the Department of Cardiothoracic Surgery at The Royal Children's Hospital. Each was given an initial project on which to obtain ethics approval, perform a literature review, data collection, statistical analysis, and prepare a manuscript for publication. A search of the names of these former students and doctors was conducted on PubMed to identify publications. A total of 113 journal articles were published in peer-reviewed journals with an average impact factor of 4.1 (range, 1.1 to 19.9). Thirty (30 of 37, 81%) published at least one article. A mean of 4.3 journal articles was published per student or junior doctor (range, 0 to 29). Eleven (11 of 37, 30%) received scholarships for their research. Nine (9 of 37, 24%) have completed or are enrolled in higher research degrees with a cardiothoracic surgery focus. Of these 9, 2 have completed doctoral degrees while in cardiothoracic surgery training. Five will complete their cardiothoracic surgery training with a doctoral degree and the other 2 are pursuing training in cardiology. A successful early academic mentoring program in a busy cardiothoracic surgery unit is feasible. Mentoring of motivated individuals in academic surgery benefits not only their medical career, but also helps maintain high academic output of the unit. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Does earlier arrival of the retrieval team improve short-term outcomes in outborn extremely premature infants?

PubMed

Sharpe, Janet B; Davies, Mark W

2018-05-31

The risk of mortality and morbidity is increased in outborn, extremely premature infants. We aim to determine whether earlier arrival of the retrieval team after the birth of infants less than 29 weeks gestation improves short-term mortality and morbidity. This is a retrospective analysis of a cohort of infants less than 29 weeks gestation who were retrieved to the Royal Brisbane and Women's Hospital (RBWH) over a 5-year period. Demographic information regarding the infant and mother, retrieval team arrival time and outcome data was collected. Primary outcomes investigated were mortality prior to discharge from hospital or a composite of mortality or severe intraventricular haemorrhage (IVH). Data on 105 infants were analysed; 88 infants (83.8%) survived to discharge home, and 79 (75.2%) survived to discharge without severe IVH. On univariate analysis, there was no significant association between age at arrival of the retrieval team and death prior to discharge (P = 0.94) or death prior to discharge or severe IVH (P = 0.83). On logistic regression analysis, age at arrival of retrieval team remained non-significant for a reduction in death prior to discharge and composite of death or severe IVH (P = 0.70 and P = 0.99, respectively). The earlier arrival of the retrieval team is not associated with improved short-term outcomes in outborn, extremely preterm infants who are retrieved and admitted to a tertiary neonatal intensive care unit - for infants where the retrieval team arrived within about 8 h of birth. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Preoperative fasting for elective surgery in a regional hospital in Oman.

PubMed

Abdullah Al Maqbali, Mohammed

2016-07-28

A fasting period before anesthesia is necessary to avoid the aspiration of stomach contents, which can be threatening to the patient's life. Guidelines from professional societies in the USA and UK recommend that healthy patients fast for 6 hours from solid food and 2 hours from liquids. Despite this, many institutions still practice nil-by-mouth after midnight. This can affect the patient's recovery after surgery, and increase the length of stay in hospital. The aim of this study was to assess the duration of fasting before elective surgery on the part of adult patients. A prospective study was conducted to identify the fasting time and complications among surgical patients undergoing elective surgery over a 4-month period. The patients were asked for preoperative fasting times, and the complication. The demographic data were taken from the patients' files. A total of 169 patients were included in the study, 88 male and 81 female. The minimum and maximum fasting hours with regard to food were 7 hours and 19 hours, respectively; all the patients fasted from food for longer than the recommended time. The minimum and maximum fasting hours for fluids were 4 hours and 19 hours, respectively; all the patients fasted from fluid for longer than the recommended time. Most of the patients fasted from food and fluids for more than the time recommended by the American Society of Anaesthesiologists, the Royal College of Nursing, the Association of Anaesthetists of Great Britain and Ireland and the Royal College of Anaesthetists. Excessive fasting could lead to discomfort and possible morbidity in surgical patients. The surgical team needs to collaborate to reduce the fasting time by revising the operative list.

Temporal trends in paediatric bacterial meningitis in a tropical Australian region: 1992-2014.

PubMed

White, Stephanie; Katf, Hala; Baird, Rob; Francis, Joshua

2018-05-13

The epidemiology of community-acquired bacterial meningitis has changed following the introduction of routine immunisation against common causative organisms. Indigenous children living in the Northern Territory, Australia, have high rates of bacterial infections. This study describes changes in the epidemiology of childhood bacterial meningitis and the distribution of the burden of disease in the Top End. A retrospective review of cases derived from hospital medical records and laboratory data was performed. Inclusion criteria were children aged 3 months to 14 years of age, admitted to Royal Darwin Hospital between 1992 and 2014 and diagnosed with bacterial meningitis. Annual incidence of bacterial meningitis and the distribution of causative pathogens are described. Demographic data, investigations, treatment and outcomes were compared between Indigenous and non-Indigenous children. There were 137 cases of childhood bacterial meningitis identified over the 23-year period. The incidence reduced from 21 per 100 000 children per year for 1992-2002 to 11 per 100 000 per year for 2003-2014 (P = 0.0025). Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis were the most common causative organisms, with a reduction in cases for each pathogen observed across the study period. Indigenous children were over-represented (104/137, 76%). Case fatality rate was 8% (11/137); 91% of fatal cases presented to a remote facility. The incidence of childhood bacterial meningitis has declined in the Northern Territory of Australia, but Indigenous children are disproportionately affected. Routine immunisation is beneficial for all, although further efforts to 'Close the Gap' between health outcomes in Indigenous and non-Indigenous Australians is required. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Surgeons' work engagement: influencing factors and relations to job and life satisfaction.

PubMed

Mache, Stefanie; Vitzthum, Karin; Klapp, Burghard F; Danzer, Gerhard

2014-08-01

Work engagement has become a topic of great interest in recent years. However, clinicians' work engagement has rarely been studied and relatively little is known about its predictors and consequences. Therefore the objective of this cross-sectional questionnaire study was to test a model of possible institutional and personal predictors and significant relations to job and life satisfaction. 123 clinicians specializing in Surgery Medicine participated in the study. Self-administered questionnaires, including the Copenhagen Psychosocial Questionnaire, the Utrecht Work Engagement Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism, were administered. Bivariate analyses and a stepwise regression analysis were performed. The whole sample of surgeons rated work engagement with a high mean of M = 4.38; SD = .91. Job satisfaction and perceived quality of life have been rated with moderate scores. The results show that job resources have a greater impact on surgeons' work engagement than their job demands. Significant correlations between surgeons' work engagement, their job satisfaction and quality of life were found. Moreover, work engagement mediated the relation between institutional factors and surgeons' job satisfaction. Our research suggests that strengthening surgeons' work engagement will contribute to a more sustainable workplace, in terms of both individual and hospital performance. Therefore, increasing work engagement among surgeons should be of concern for supervisors and hospital managers. Future research should focus on further predictors that may have an influence on health professionals' work engagement. Another field for future research is to study potential effects of interventions on work engagement. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

PubMed

Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

2015-12-01

To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost. Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study.

PubMed

Dunnigan, Matthew G; Pollock, Allyson M

2003-04-26

To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.

Surgical capacity building in Timor-Leste: a review of the first 15 years of the Royal Australasian College of Surgeons-led Australian Aid programme.

PubMed

Guest, Glenn D; Scott, David F; Xavier, Joao P; Martins, Nelson; Vreede, Eric; Chennal, Antony; Moss, Daliah; Watters, David A

2017-06-01

Timor-Leste suffered a destructive withdrawal by the Indonesian military in 1999, leaving only 20 Timorese-based doctors and no practising specialists for a population of 700 000 that has now grown to 1.2 million. This article assesses the outcomes and impact of Royal Australasian College of Surgeons (RACS) specialist medical support from 2001 to 2015. Three programmes were designed collaboratively with the Timor-Leste Ministry of Health and Australian Aid. The RACS team began to provide 24/7 resident surgical and anaesthesia services in the capital, Dili, from July 2001. The arrival of the Chinese and Cuban Medical Teams provided a medical workforce, and the Cubans initiated undergraduate medical training for about 1000 nationals both in Cuba and in Timor-Leste, whilst RACS focused on specialist medical training. Australian Aid provided AUD$20 million through three continuous programmes over 15 years. In the first 10 years over 10 000 operations were performed. Initially only 10% of operations were done by trainees but this reached 77% by 2010. Twenty-one nurse anaesthetists were trained in-country, sufficient to cover the needs of each hospital. Seven Timorese doctors gained specialist qualifications (five surgery, one ophthalmology and one anaesthesia) from regional medical schools in Papua New Guinea, Fiji, Indonesia and Malaysia. They introduced local specialist and family medicine diploma programmes for the Cuban graduates. Timor-Leste has developed increasing levels of surgical and anaesthetic self-sufficiency through multi-level collaboration between the Ministry of Health, Universidade Nacional de Timor Lorosa'e, and sustained, consistent support from external donors including Australian Aid, Cuba and RACS. © 2016 Royal Australasian College of Surgeons.

Compliance with the 2009 Royal College of Obstetricians and Gynaecologists guidelines for venous thromboembolic disease prophylaxis in pregnancy and postpartum period in Uruguay.

PubMed

Grille, Sofía; Vitureira, Gerardo; Morán, Rosario; Retamosa, Lucía; Alonso, Valeria; Gómez, Luis M; Quartara, Federico; Feldman, Florencia; López, Valentina; Turcatti, Paola; Castro, Viviana; Sosa, Leonardo; Guillermo, Cecilia; Díaz, Lilián; Stevenazzi, Mariana

2018-04-01

: Venous thromboembolism remains as one of the leading causes of maternal death. Prevention of venous thromboembolism in the obstetric population is challenging as recommendations for prophylaxis have low grade of evidence. Risk factors and prophylaxis guidelines have been highlighted by Royal College of Obstetricians and Gynaecologists. In 2014, we developed a written alert following this guidelines to guide thromboprophylaxis. The aim of this study is to assess recommendations compliance. This study was conducted at University-Hospital in Uruguay from January 2014 to December 2016. A total of 1035 women were enrolled and stratified in high, intermediate or low risk based on Royal College of Obstetricians and Gynaecologists guidelines. Thromboprophylaxis was recommended for women at intermediate and high risk. Women were followed up to assess symptomatic thromboembolism or haemorrhagic complications. A total of 309 were pregnant and 731 puerperal. Median age was 24 (19-29) years old. Of them, 3.0% (n = 31) were at high risk and 35.4% (n = 366) at intermediate risk. All high-risk women received prophylaxis with low-molecular-weight heparin. Of the 366 intermediate-risk women, 52.7% received prophylaxis. Venous thromboembolism was developed in only one woman of the intermediate group, who had received prophylaxis. Bleeding complications were not observed. Awareness of the thrombotic risk, as conferred by an easy and suitable risk assessment, has the potential to improve venous thromboembolism prophylaxis in pregnant and puerperal women. We have a good guidelines compliance with the written alert in the high-risk women group. However, we have to improve low-molecular-weight heparin indication in intermediate-risk group, especially in postcaesarean women.

Forensic Analysis of Human DNA from Samples Contamined with Bioweapons Agents

DTIC Science & Technology

2011-10-01

Forensic analysis of human DNA from samples contaminated with bioweapons agents Jason Timbers Kathryn Wright Royal Canadian Mounted...Police Forensic Science and Identification Service Prepared By: Royal Canadian Mounted Police RCMP Forensic Science Identification Services... Royal Canadian Mounted Police Forensic Science and Identification Service Prepared By: Royal Canadian Mounted Police RCMP Forensic Science

Forest Resources of Isle Royale National Park 2010

Treesearch

Wilfred J. Previant; Linda M. Nagel; Scott A. Pugh; Christopher W. Woodall

2012-01-01

This publication provides a baseline overview of forest resources for Isle Royale National Park (Isle Royale) using data from the Forest Inventory and Analysis (FIA) Program of the U.S. Department of Agriculture, Forest Service. The availability of permanent FIA plots allows for the first-ever comparison of Isle Royale's forest conditions (2006-2010) to reserved...

Factors associated with initiation and exclusive breastfeeding at hospital discharge: late preterm compared to 37 week gestation mother and infant cohort.

PubMed

Ayton, Jennifer; Hansen, Emily; Quinn, Stephen; Nelson, Mark

2012-11-26

To investigate and examine the factors associated with initiation of, and exclusive breastfeeding at hospital discharge of, late preterm (34 0/7 - 36 6/7 weeks) compared to 37 week gestation (37 0/7 - 37 6/7 week) mother and baby pairs. A retrospective population-based cohort study using a Perinatal National Minimum Data Set and clinical medical records review, at the Royal Hobart Hospital, Tasmania, Australia in 2006. Late preterm and 37 week gestation infants had low rates of initiation of breastfeeding within one hour of birth, 31 (21.1%) and 61 (41.5%) respectively. After multiple regression analysis, late preterm infants were less likely to initiate breastfeeding within one hour of birth (OR 0.3 95% CI 0.1, 0.7 p = 0.009) and were less likely to be discharged exclusively breastfeeding from hospital (OR 0.4 95% CI 0.1, 1.0 p = 0.04) compared to 37 week gestation infants. A late preterm birth is predictive of breastfeeding failure, with late preterm infants at greater risk of not initiating breastfeeding and/or exclusively breastfeeding at hospital discharge, compared with those infants born at 37 weeks gestation. Stratifying breastfeeding outcomes by gestational age groups may help to identify those sub-populations at greatest risk of premature cessation of breastfeeding.

Assessing surgical research at the teaching hospital level.

PubMed

McBride, Kate E; Young, Jane M; Bannon, Paul G; Solomon, Michael J

2017-01-01

To undertake a comprehensive needs assessment to determine the baseline of surgical research activity at a tertiary referral hospital in Sydney, Australia. The comprehensive needs assessment comprised three components: a retrospective audit of the hospital ethics committee records to identify surgical research activity; a survey of all 17 surgical departments about the availability of 10 potential research resources and a survey of surgical staff to ascertain perceptions of research culture at the organizational, team and individual levels. Of all research studies submitted to the hospital ethics committee in a 2-year period, only 9% were identified as surgical studies. Among the 17 surgical departments, there was wide variation in activity with only four defined as being 'research active'. On average, 52% of potential resources for surgical research were found to be in place within surgical departments. Only five departments were considered to be adequately research resourced (≥75% potential resources in place). Surgical research culture was rated 'moderate' at the organizational and team level, and 'low' at the individual level. Medical staff rated research capacity significantly higher at the team and individual levels compared to nursing staff. Collectively, the baseline results indicate there is considerable opportunity to enhance surgical research at the hospital level and to use this information to guide new and innovative approaches in the future. © 2016 Royal Australasian College of Surgeons.

An exploration of Australian hospital pharmacists' attitudes to patient safety.

PubMed

Lalor, Daniel J; Chen, Timothy F; Walpola, Ramesh; George, Rachel A; Ashcroft, Darren M; Fois, Romano A

2015-02-01

To explore the attitudes of Australian hospital pharmacists towards patient safety in their work settings. A safety climate questionnaire was administered to all 2347 active members of the Society of Hospital Pharmacists of Australia in 2010. Part of the survey elicited free-text comments about patient safety, error and incident reporting. The comments were subjected to thematic analysis to determine the attitudes held by respondents in relation to patient safety and its quality management in their work settings. Two hundred and ten (210) of 643 survey respondents provided comments on safety and quality issues related to their work settings. The responses contained a number of dominant themes including issues of workforce and working conditions, incident reporting systems, the response when errors occur, the presence or absence of a blame culture, hospital management support for safety initiatives, openness about errors and the value of teamwork. A number of pharmacists described the development of a mature patient-safety culture - one that is open about reporting errors and active in reducing their occurrence. Others described work settings in which a culture of blame persists, stifling error reporting and ultimately compromising patient safety. Australian hospital pharmacists hold a variety of attitudes that reflect diverse workplace cultures towards patient safety, error and incident reporting. This study has provided an insight into these attitudes and the actions that are needed to improve the patient-safety culture within Australian hospital pharmacy work settings. © 2014 Royal Pharmaceutical Society.

The casemix system of hospital funding can further disadvantage Aboriginal children.

PubMed

Ruben, A R; Fisher, D A

1998-10-19

The Northern Territory Health Service implemented a casemix system of hospital funding in 1996 using national averages and national cost weights as benchmarks for length of stay and funding. Clinicians and health administrators were concerned about the potential of this model to impair health service delivery, especially to children of Aboriginal or Torres Strait Islander (ATSI) descent, whose current poor health has been well described. Data were collected on children aged under 10 years who were discharged from the Royal Darwin Hospital between 1 July 1991 and 30 June 1996 and assigned one of four DRGs (simple pneumonia, bronchitis and asthma, gastroenteritis, nutritional and metabolic disorders). Data collected included age, sex, ethnicity, duration of hospital stay, location of residence and presence of comorbidities. There were significant differences in the proportion of children with multiple comorbidities between ATSI and non-ATSI children, as well as between rural- and urban-dwelling ATSI children. A higher proportion of ATSI compared with non-ATSI children had prolonged hospital stays (22.6% v. 1.5%), with the variables influencing length of stay in ATSI children including "age < 2 years", "living in a remote area", and "presence of two or more comorbidities". These results confirm clinical impressions about disease patterns and length of hospital stay in ATSI children, and highlight the problems of imposing a casemix classification system for a "typical" Australian population on a region with a high proportion of people of ATSI descent.

Risk profile of young people admitted to hospital for suicidal behaviour in Melbourne, Australia.

PubMed

Borschmann, Rohan; Stark, Patrick; Prakash, Chidambaram; Sawyer, Susan M

2018-05-20

Self-harm and suicidal behaviour is most prevalent during adolescence, but little is known about the risk profile of adolescents admitted to hospital for suicidal behaviour. Young people who self-harm are at an increased risk of mortality compared to those who do not self-harm; adolescents admitted to hospital for suicidal behaviour are particularly at risk. The aim of this study was to generate a risk profile of adolescents admitted to hospital with suicidal behaviour. We conducted a 12-month retrospective audit of adolescent admissions to the mental health inpatient unit at a tertiary children's hospital in Melbourne, Australia. Routinely collected data were used to generate a risk profile. We found that 212 of 271 (78.2%) admissions were due to suicidal behaviour. Of these, 107 (51%) adolescents were diagnosed with one or more mental disorders at discharge, most commonly major depressive disorder. Beyond known distal determinants of health risk, the proximal risk profile of these adolescents included factors relating to gender, substance use, prior mental health diagnoses and prior admission to hospital. Poor sleep was also a risk factor, with 159 (75%) reporting a recent history of sleeping problems. The very high proportion of admissions to the mental health inpatient unit due to suicidal behaviour reinforces the importance of finding effective methods of identification of the risk processes underpinning suicidal behaviours to reduce the unnecessary waste of young lives by suicide. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

To Medicate or Not to Medicate?: The Decision-Making Process of Western Australian Parents Following Their Child's Diagnosis with an Attention Deficit Hyperactivity Disorder

ERIC Educational Resources Information Center

Taylor, Myra; O'Donoghue, Tom; Houghton, Stephen

2006-01-01

This article examines the decision-making processes that Western Australian parents utilise when deciding whether to medicate or not to medicate their child diagnosed with Attention Deficit Hyperactivity Disorder. Thirty-three parents (five fathers and 28 mothers) from a wide range of socio-economic status suburbs in Perth, Western Australia were…

Rates of Self-Reported Delinquency among Western Australian Male and Female High School Students: The Male-Female Gender Gap

ERIC Educational Resources Information Center

Houghton, Stephen; Tan, Carol; Khan, Umneea; Carroll, Annemaree

2013-01-01

The Adapted Self-Report Delinquency Scale (ASDS) was administered to 328 adolescents (174 males and 154 females) from eight high schools in Perth, Western Australia. The ages of the sample ranged from 13 to 17 years. Males reported a greater percentage level of involvement than females in 36 of 40 individual delinquent behaviours comprising the…

"Eighty Per Cent Is Not Enough for Chinese-Australians but Seventy Per Cent Is Okay for Anglo-Australians"--Some Disturbing Consequences

ERIC Educational Resources Information Center

Malik, Ranbir Singh

2004-01-01

In a doctoral study undertaken at Edith Cowan University the author set out to investigate the influence of home and school environments on the academic performance and educational/occupational aspirations of high school students from eight Chinese-Australian and Anglo-Australian families residing in a middle class suburb of Perth metropolitan…

Research in Science Education, Volume 1990. Selected Refereed Papers from the Annual Conference of the Australasian Science Education Research Association (21st, Perth, Western Australia, July 1990).

ERIC Educational Resources Information Center

Gardner, Paul L., Ed.

1990-01-01

This book contains selected refereed papers from the 21st Annual Conference of the Australasian Science Education Research Association. The papers are as follows: "A Learning Model for Science Education: Developing Teaching Strategies" (Appleton); "Researching Balance between Cognition and Affect in Science Teaching" (Baird et…

Marine Mammals and Noise-Progress Since 1995

DTIC Science & Technology

2015-09-30

1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Marine Mammals & Noise - Progress Since 1995 Christine...Erbe Centre for Marine Science & Technology Curtin University GPO Box U1987 Perth, WA 6845, Australia phone: +61-8-9266 7380 email: c.erbe...effects of underwater noise on marine mammals has grown steadily over the last few decades. Results and information are scattered across the peer

High-School Students' Informal Reasoning and Argumentation about Biotechnology: An Indicator of Scientific Literacy?

ERIC Educational Resources Information Center

Dawson, Vaille; Venville, Grady Jane

2009-01-01

The aim of this research was to explore Australian high-school students' argumentation and informal reasoning about biotechnology. Data were obtained from semi-structured interviews with 10 Year-8 students (12-13 years old), 14 Year-10 students (14-15 years old) and 6 Year-12 students (16-17 years old) from six metropolitan high schools in Perth,…

"The Kings New Training Courses"--A Research Project: The New Clothes May Have a CBT Label, but Do They Really Promote Lifelong Learning?

ERIC Educational Resources Information Center

Barratt-Pugh, Llandis

This paper outlines the background and preliminary findings of a study currently in progress in Perth, Western Australia, to investigate the relationship between competence based training and the development of lifelong learning skills. The paper explores both the underlying aims of competency-based training (CBT) and the educational antecedents…

Manual for Courts-Martial United States 1998 Edition.

DTIC Science & Technology

1998-01-01

exam- ination papers, outline-figure and fingerprint cards, forensic laboratory reports, chain of custody docu- ments, morning reports and other...examination papers, outline figure and fin- gerprint cards, forensic laboratory reports, chain of custody documents, morning reports and other per...the 1969 Manual, "Polygraph tests and drug- induced or hypnosis -induced interviews," has been deleted as a result of the adoption of Rule 702. Para

The management of Legg-Calvé-Perthes' disease: is there a consensus? : A study of clinical practice preferred by the members of the European Paediatric Orthopaedic Society.

PubMed

Hefti, Fritz; Clarke, N M P

2007-03-01

The aim of the study was to find out whether or not there is consensus among experienced pediatric orthopaedists about the management of certain clinical scenarios in Legg-Calvé-Perthes' disease. A questionnaire was sent to all 297 members of the European Paediatric Orthopaedic Society (EPOS) describing four cases of Legg-Calvé-Perthes' disease (LCPD) with two X-rays each and a short description of the clinical scenario. Two of the patients were younger and two were older than six years of age. From both age groups there was one with a good range of motion and an X-ray classified as Herring A or B, while the other patient had a poor range of motion and an X-ray classified as Herring C. EPO members were asked to choose from various treatment options or to describe any other therapy that they would advise in the clinical scenarios. One-hundred and fifty members answered the questionnaire. The participants had an average of 20 years of experience in pediatric orthopaedics. There was a consensus that no surgery should be performed in a young patient with a good range of motion and that there should be no weight relief when older with a good range of motion. Conservative containment treatment (abduction splint, Petrie cast) and arthrodiastasis was suggested in only very few centres. There was a tendency to perform an operation when the patient is older with a poor range of motion and to perform operative treatment only when there were subluxation or head at risk signs. pelvic osteotomies or a combination of pelvic and femoral osteotomies rather than femoral osteotomies alone. Age did not determine the indication for treatment and there was no agreement on the indications for physiotherapy. There was also no consensus on the type of pelvic osteotomy to be used. The study showed that indications for the treatment of LCPD is based more on the personal experience of the surgeon rather than on scientific data.

Improving discharge planning communication between hospitals and patients.

PubMed

New, P W; McDougall, K E; Scroggie, C P R

2016-01-01

A potential barrier to patient discharge from hospital is communication problems between the treating team and the patient or family regarding discharge planning. To determine if a bedside 'Leaving Hospital Information Sheet' increases patient and family's knowledge of discharge date and destination and the name of the key clinician primarily responsible for team-patient communication. This article is a 'before-after' study of patients, their families and the interdisciplinary ward-based clinical team. Outcomes assessed pre-implementation and post-implementation of a bedside 'Leaving Hospital Information Sheet' containing discharge information for patients and families. Patients and families were asked if they knew the key clinician for team-patient communication and the proposed discharge date and discharge destination. Responses were compared with those set by the team. Staff were surveyed regarding their perceptions of patient awareness of discharge plans and the benefit of the 'Leaving Hospital Information Sheet'. Significant improvement occurred regarding patients' knowledge of their key clinician for team-patient communication (31% vs 75%; P = 0.0001), correctly identifying who they were (47% vs 79%; P = 0.02), and correctly reporting their anticipated discharge date (54% vs 86%; P = 0.004). There was significant improvement in the family's knowledge of the anticipated discharge date (78% vs 96%; P = 0.04). Staff reported the 'Leaving Hospital Information Sheet' assisted with communication regarding anticipated discharge date and destination (very helpful n = 11, 39%; a little bit helpful n = 11, 39%). A bedside 'Leaving Hospital Information Sheet' can potentially improve communication between patients, families and their treating team. © 2016 Royal Australasian College of Physicians.

Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

PubMed

Cooper, P David; Smart, David R

2017-06-01

Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

PubMed

Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

2015-01-01

Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Identification of genes related to high royal jelly production in the honey bee (Apis mellifera) using microarray analysis

PubMed Central

Nie, Hongyi; Liu, Xiaoyan; Pan, Jiao; Li, Wenfeng; Li, Zhiguo; Zhang, Shaowu; Chen, Shenglu; Miao, Xiaoqing; Zheng, Nenggan; Su, Songkun

2017-01-01

Abstract China is the largest royal jelly producer and exporter in the world, and high royal jelly-yielding strains have been bred in the country for approximately three decades. However, information on the molecular mechanism underlying high royal jelly production is scarce. Here, a cDNA microarray was used to screen and identify differentially expressed genes (DEGs) to obtain an overview on the changes in gene expression levels between high and low royal jelly producing bees. We developed a honey bee gene chip that covered 11,689 genes, and this chip was hybridised with cDNA generated from RNA isolated from heads of nursing bees. A total of 369 DEGs were identified between high and low royal jelly producing bees. Amongst these DEGs, 201 (54.47%) genes were up-regulated, whereas 168 (45.53%) were down-regulated in high royal jelly-yielding bees. Gene ontology (GO) analyses showed that they are mainly involved in four key biological processes, and pathway analyses revealed that they belong to a total of 46 biological pathways. These results provide a genetic basis for further studies on the molecular mechanisms involved in high royal jelly production. PMID:28981563

Identification of genes related to high royal jelly production in the honey bee (Apis mellifera) using microarray analysis.

PubMed

Nie, Hongyi; Liu, Xiaoyan; Pan, Jiao; Li, Wenfeng; Li, Zhiguo; Zhang, Shaowu; Chen, Shenglu; Miao, Xiaoqing; Zheng, Nenggan; Su, Songkun

2017-01-01

China is the largest royal jelly producer and exporter in the world, and high royal jelly-yielding strains have been bred in the country for approximately three decades. However, information on the molecular mechanism underlying high royal jelly production is scarce. Here, a cDNA microarray was used to screen and identify differentially expressed genes (DEGs) to obtain an overview on the changes in gene expression levels between high and low royal jelly producing bees. We developed a honey bee gene chip that covered 11,689 genes, and this chip was hybridised with cDNA generated from RNA isolated from heads of nursing bees. A total of 369 DEGs were identified between high and low royal jelly producing bees. Amongst these DEGs, 201 (54.47%) genes were up-regulated, whereas 168 (45.53%) were down-regulated in high royal jelly-yielding bees. Gene ontology (GO) analyses showed that they are mainly involved in four key biological processes, and pathway analyses revealed that they belong to a total of 46 biological pathways. These results provide a genetic basis for further studies on the molecular mechanisms involved in high royal jelly production.

Optimized determination method for trans-10-hydroxy-2-decenoic acid content in royal jelly by high-performance liquid chromatography with an internal standard.

PubMed

Zhou, Jinhui; Xue, Xiaofeng; Li, Yi; Zhang, Jinzhen; Zhao, Jing

2007-01-01

An optimized reversed-phase high-performance liquid chromatography method was developed to detect the trans-10-hydroxy-2-decenoic acid (10-HDA) content in royal jelly cream and lyophilized powder. The sample was extracted using absolute ethanol. Chromatographic separation of 10-HDA and methyl 4-hydroxybenzoate as the internal standard was performed on a Nova-pak C18 column. The average recoveries were 95.0-99.2% (n = 5) with relative standard deviation (RSD) values of 1.3-2.1% for royal jelly cream and 98.0-100.0% (n = 5) with RSD values of 1.6-3.0% for lyophilized powder, respectively. The limits of detection and quantitation were 0.5 and 1.5 mg/kg, respectively, for both royal jelly cream and lyophilized powder. The method was validated for the determination of practical royal jelly products. The concentration of 10-HDA ranged from 1.26 to 2.21% for pure royal jelly cream samples and 3.01 to 6.19% for royal jelly lyophilized powder samples. For 30 royal jelly products, the 10-HDA content varied from not detectable to 0.98%.

Trends in hospital admissions involving suicidal behaviour in the Northern Territory, 2001-2013.

PubMed

Leckning, Bernard A; Li, Shu Qin; Cunningham, Teresa; Guthridge, Steven; Robinson, Gary; Nagel, Tricia; Silburn, Sven

2016-06-01

To investigate trends in hospital admissions involving suicidal behaviour in the Northern Territory (NT) resident population over the period 2001-2013. Estimates of age-standardised rates and average changes in the annual rate of hospital admissions involving suicidal behaviour were calculated by socio-demographic characteristics and types of suicidal behaviour. Overall rates for Indigenous admissions were 2.7 times higher than non-Indigenous admissions and had increased by almost twice as much. While male and female rates of admission were similar for both Indigenous and non-Indigenous residents, the average annual change in rates was greater for Indigenous females (13.4%) compared to males (8.8%) and for non-Indigenous males (7.7%) compared to females (5.2%). Younger and middle-aged Indigenous admissions experienced increasing rates of admissions, whilst trends were similar across age groups for non-Indigenous admissions. Admissions with a diagnosis of suicidal ideation increased the most across all groups. Trends in intentional self-harm admissions differed according to Indigenous status and sex. There have been substantial increases in hospital admissions involving suicidal behaviour in the NT, most markedly for Indigenous residents. Indigenous females and youth appear to be at increasing risk. The steep increase in suicidal ideation across all groups warrants further investigation. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Provision of out-of-hours interventional radiology services in the London strategic health authority.

PubMed

Illing, R O; Clark, C L Ingham; Allum, C

2010-04-01

To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An "ad-hoc" service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24h service. Only two hospitals providing a 24h service had six radiologists on the rota. Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

A good time to panic? Premorbid and postmorbid panic disorder in heart failure affects cardiac and psychiatric cause admissions.

PubMed

Tully, Phillip J

2015-04-01

The authors sought to identify characteristics associated with premorbid and postmorbid panic disorder onset in relation to heart failure (HF) onset, and examine the effect on unplanned hospital admissions. In a two-stage screening process, 404 HF patients admitted to three hospitals in South Australia were referred for structured psychiatric interview when any of the following four criteria were met: (a) Patient Health Questionnaire≥10; (b) Generalized Anxiety Disorder Questionnaire≥7); (c) positive response to one-item panic attack screener; (d) or evidence of suicidality. A total of 73 referred HF patients (age 60.6±13.4, 47.9% female) were classified into three groups: premorbid panic disorder (27.4%), postmorbid panic disorder (24.7%), and no panic disorder (47.9%). Postmorbid panic disorder was associated with more psychiatric admissions and longer hospital stay in the 6 months prior to the index psychiatric assessment, and also in the 6 months after the index psychiatric assessment (all p<.05 unadjusted). In sensitivity analysis, years since panic disorder onset were associated with longer cardiac length of stay (β=.34, p=.03). Panic disorder onset in relation to HF diagnosis was associated with discrete patterns of hospital admissions for cardiac and psychiatric causes. © The Royal Australian and New Zealand College of Psychiatrists 2015.

INVESTIGATION ON THE EVENTUAL RADIOPROTECTIVE EFFECT OF ROYAL JELLY IN THE RAT (in Italian)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Giordano, A.; Trenta, A.; Mazza, L.

Experiments made with equal irradiation (600 r) of groups of rats (Mus musculus L.), half of them fed with the usual diet and the other half also given royal jelly, have shown a significant variation between the two groups. The groups fed with royal jelly had a prolongation of the average life, less damage to the hematopoietic system, and, in particular, only reversible alterations to the liver and spleen. From these experimental data and from theoretical considerations on the composition of royal jelly, it is suggested that royal jelly provides a radioprotective effect. (tr-auth)

Evaluation of paediatric nursing-sensitive outcomes in an Australian population using linked administrative hospital data

PubMed Central

2013-01-01

Background Research into nursing-sensitive outcomes using administrative health data has focussed on hospitalised adults. However, we developed algorithms for the identification of 13 paediatric nursing-sensitive outcomes, which we seek to examine for clinical utility. The aims were to determine the rates of paediatric nursing-sensitive outcomes in a Western Australian hospital and ascertain sociodemographic and clinical characteristics associated with a greater risk of developing nursing-sensitive outcomes in hospitalised children. Method A retrospective cohort study used linked administrative data of all Western Australian children ≤18 years admitted to the only tertiary paediatric hospital in Perth between 1999 and 2009. Rates per 1,000 hospital separations and per 10,000 patient days were calculated for the following nursing-sensitive outcomes: lower respiratory tract infection (LRTI), gastrointestinal (GI) infection, pneumonia, sepsis, arrest/shock/respiratory failure, central nervous system complication, central venous line infection, infectious disease, pressure ulcer, failure to rescue, surgical wound infection, physiologic/metabolic derangement, and postoperative cardiopulmonary complications. Poisson multiple regression models were fitted to estimate rate ratios (RR) and 95% confidence intervals (CI) for suspected risk factors. Results Linked records of 129,719 hospital separations were analysed. Rates ranged from 0.5/1,000 for pressure ulcer to 14.0/1,000 hospital separations for GI infections. Age was significantly associated with the risk of a nursing-sensitive outcome: compared with adolescents, toddlers had greater risk of GI infection (RR 9.89; 95% CI 6.24, 15.69); infants had 7.74 times greater risk of LRTI (95% CI 5.11, 11.75), while neonates had lower risks for sepsis (RR 0.26; 95% CI 0.08, 0.90) and physiologic/metabolic derangement (RR 0.12; 95% CI 0.04, 0.35). The risk of surgical wound infection was 7.78 times greater (95% CI 5.10, 11.86) for emergency admissions than elective admissions. Conclusions Seven of the 13 defined nursing-sensitive outcomes occurred with sufficient frequency (>100 events over the 10 year study period) to be potentially useful for monitoring the quality of nursing care. These nursing-sensitive outcomes are: LRTI, GI infection, pneumonia, surgical wound infection, physiologic/metabolic derangement, sepsis and postoperative cardiopulmonary complications. When used for quality improvement or to benchmark with other agencies, data need to be adjusted for, or stratified by age and admission type, to ensure equitable comparisons. PMID:24103062

Ultrasound-guided high-intensity focused ultrasound ablation for treating uterine arteriovenous malformation.

PubMed

Yan, X; Zhao, C; Tian, C; Wen, S; He, X; Zhou, Y

2017-08-01

To explore HIFU treatment for uterine arteriovenous malformation. A case report. Gynaecological department in a university teaching hospital of China. A patient with uterine arteriovenous malformation. The diagnosis of uterine arteriovenous malformation was made through MRI. Ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation was performed. HIFU is effective in treating uterine arteriovenous malformation. The patient had reduction of the lesion volume and obvious symptom relief, without significant adverse effects. HIFU can be used as a new treatment option for uterine arteriovenous malformation. Ultrasound-guided high-intensity focused ultrasound ablation is effective in treating uterine arteriovenous malformation. © 2017 Royal College of Obstetricians and Gynaecologists.

A Clinical Decision Support System to Assist Pediatric Oncofertility: A Short Report.

PubMed

Hand, Meredith; Kemertzis, Matthew A; Peate, Michelle; Gillam, Lynn; McCarthy, Maria; Orme, Lisa; Heloury, Yves; Sullivan, Michael; Zacharin, Margaret; Jayasinghe, Yasmin

2018-05-07

Fertility preservation discussions with pediatric and adolescent cancer patients can be difficult for clinicians. This study describes the acceptability of a fertility clinician decision support system (CDSS). A cross-sectional study of clinicians at The Royal Children's Hospital, Melbourne. Participants were trained on CDSS purpose, contents, and use. A survey captured the perceived benefits and weaknesses of the CDSS. Thirty-nine clinicians participated. Over 90% felt the CDSS aims and format were clear, and understood the components. Over 80% felt it would enable adherence to clinical pathways, policy, and standards of care. The CDSS provided significant perceived benefits to oncofertility care.

Pattern of burn injury in hang-glider pilots.

PubMed

Campbell, D C; Nano, T; Pegg, S P

1996-06-01

High-voltage electrical injury has been well documented in a number of situations, such as the occupational hazard of linesmen and construction workers, and in the context of overhead railway power lines. Two cases of hang-glider pilots contacting 11,000-volt power lines have recently been treated in the Royal Brisbane Hospital Burns Unit. They demonstrate an interesting pattern of injury, not described in current burns literature, involving both hand and lower abdominal burns. Both patients sustained full-thickness patches of burn injury, with underlying muscle damage and peripheral neurological injury. This distribution of injury seems to be closely related to the design of the hang glider.

Research is the Future, the Future is…….

PubMed

Gilchrist, Francis J

2016-01-01

Over the past two decades, Professor Lenney has established the Paediatric Respiratory Department at the Royal Stoke University Hospital as a centre recognised for high quality research. A broad portfolio of clinical and laboratory based research is in progress. Four research areas are discussed that are likely to contribute to the continued academic output from the unit. These are the use of selected ion flow tube mass spectrometry for the detection of biomarkers associated with pulmonary pathogens, the measurement of lung clearance index in preschool children, structured light plethysmography in children and the use of oral prednisolone for asthma exacerbations in children. Copyright © 2015. Published by Elsevier Ltd.

Advance Care Planning: is quality end of life care really that simple?

PubMed

Johnson, Stephanie; Kerridge, Ian; Butow, Phyllis N; Tattersall, Martin H N

2017-04-01

The routine implementation of Advance Care Planning (ACP) is now a prominent feature of policy directed at improving end of life care in Australia. However, while complex ACP interventions may modestly reduce medical care at the end of life and enable more people to die at home or outside of acute hospital settings, existing legal, organisational, cultural and conceptual barriers limit the implementation and utility of ACP. We suggest that meaningful improvements in end of life care will not result from the institutionalisation of ACP but from more significant changes to the design and delivery of care. © 2017 Royal Australasian College of Physicians.

Samuel Wilks (1824-1911): neurologist and generalist of the Mid-Victorian Era.

PubMed

Eadie, Mervyn J

2008-11-01

Sir Samuel Wilks, sometime Physician to Guy's Hospital and President of the Royal College of Physicians (1896-99), was regarded as the leading British scientific physician of his day. His contributions to gastroenterology, cardiology and clinical science in general have been emphasized in recent times. He also recognized that syphilis affected the internal organs as well as the skin. In 1866 he realised that epileptogenesis occurred in the cerebral cortex: independently of Sir Charles Locock (1799-1875), he discovered the antiepileptic properties of potassium bromide. He provided possibly the first account of alcoholic peripheral neuritis and published an early account of probable myasthenia gravis.

The impact of the built environment on health across the life course: design of a cross-sectional data linkage study

PubMed Central

Villanueva, Karen; Pereira, Gavin; Knuiman, Matthew; Bull, Fiona; Wood, Lisa; Christian, Hayley; Foster, Sarah; Boruff, Bryan J; Beesley, Bridget; Hickey, Sharyn; Joyce, Sarah; Nathan, Andrea; Saarloos, Dick; Giles-Corti, Billie

2013-01-01

Introduction The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course. Methods and analysis This cross-sectional data linkage study involves 15 954 children (0–15 years), young adults (16–24 years), adults (25–64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australia's (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants’ residential address was geocoded and features of their ‘neighbourhood’ were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages. Ethics and dissemination The University of Western Australia's Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents. PMID:23325897

Hyperinsulinemic Normoglycemia during Cardiac Surgery Reduces a Composite of 30-day Mortality and Serious In-hospital Complications: A Randomized Clinical Trial.

PubMed

Duncan, Andra E; Sessler, Daniel I; Sato, Hiroaki; Sato, Tamaki; Nakazawa, Keisuke; Carvalho, George; Hatzakorzian, Roupen; Codere-Maruyama, Takumi; Abd-Elsayed, Alaa; Bose, Somnath; Said, Tamer; Mendoza-Cuartas, Maria; Chowdary, Hyndhavi; Mascha, Edward J; Yang, Dongsheng; Gillinov, A Marc; Schricker, Thomas

2018-06-01

Hyperinsulinemic normoglycemia augments myocardial glucose uptake and utilization. We tested the hypothesis that hyperinsulinemic normoglycemia reduces 30-day mortality and morbidity after cardiac surgery. This dual-center, parallel-group, superiority trial randomized cardiac surgical patients between August 2007 and March 2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital, Montreal, Canada, to intraoperative glycemic management with (1) hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant variable glucose infusion titrated to glucose concentrations of 80 to 110 mg · dl; or (2) standard glycemic management, low-dose insulin infusion targeting glucose greater than 150 mg · dl. The primary outcome was a composite of 30-day mortality, mechanical circulatory support, infection, renal or neurologic morbidity. Interim analyses were planned at each 12.5% enrollment of a maximum 2,790 patients. At the third interim analysis (n = 1,439; hyperinsulinemic normoglycemia, 709, standard glycemic management, 730; 52% of planned maximum), the efficacy boundary was crossed and study stopped per protocol. Time-weighted average glucose concentration (means ± SDs) with hyperinsulinemic normoglycemia was 108 ± 20 versus 150 ± 33 mg · dl with standard glycemic management, P < 0.001. At least one component of the composite outcome occurred in 49 (6.9%) patients receiving hyperinsulinemic normoglycemia versus 82 (11.2%) receiving standard glucose management (P < efficacy boundary 0.0085); estimated relative risk (95% interim-adjusted CI) 0.62 (0.39 to 0.97), P = 0.0043. There was a treatment-by-site interaction (P = 0.063); relative risk for the composite outcome was 0.49 (0.26 to 0.91, P = 0.0007, n = 921) at Royal Victoria Hospital, but 0.96 (0.41 to 2.24, P = 0.89, n = 518) at the Cleveland Clinic. Severe hypoglycemia (less than 40 mg · dl) occurred in 6 (0.9%) patients. Intraoperative hyperinsulinemic normoglycemia reduced mortality and morbidity after cardiac surgery. Providing exogenous glucose while targeting normoglycemia may be preferable to simply normalizing glucose concentrations.

The changing interface between district hospital cardiology and the major cardiac centres

PubMed Central

1997-01-01

The national priority for reducing mortality and morbidity from cardiovascular disease, the resulting expansion in the number of consultant cardiologists, and the reforms of the National Health Service have produced significant changes in delivery of care for cardiac patients and in the relations between district general hospitals (DGH) and the old regional cardiac centres. 1.2 The British Cardiac Society, the Medical Royal Colleges of Physicians of London and Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow established a working group to make recommendations on the most appropriate evolution of these changes to secure high quality care in a cost-effective and professionally rewarding environment. The principal conclusions of the working group were: i) The establishment of new cardiac catheterisation laboratories in DGHs remote from a major cardiac centre should be encouraged provided the workload is adequate to ensure efficient use of the facility. ii) Cardiologists working in districts close to a major centre should be encouraged to catheterise their patients at the centre. iii) Close liaison of the district cardiologist with a cardiac surgeon and interventionist is vitally important. iv) The centres will be required to provide tertiary care for emergency and urgent cases from their traditional catchment area, specialised expertise for the management of rare and difficult cases, and angioplasty. Some centres will also offer complex electrophysiology, and ablation techniques. v) The centres must also provide routine cardiology services for their local district, facilities for cardiac catheterisation for DGH cardiologists, and training for doctors, nurses, technicians, and radiographers. vi) Some centres will be linked with paediatric cardiology and paediatric cardiac surgical units. vii) District cardiac centres will be required to provide a full non-invasive diagnostic service and emergency care for patients referred by general practitioners and hospital colleagues as well as facilities for preventative and rehabilitation cardiology. Arrangements for invasive investigation and treatment of their patients will vary according mainly to the distance from the major centre. viii) Both the major centres and the district cardiac units should participate in training and research. 


 PMID:9415018

Is place of birth associated with mode of birth? The effect of hospital on caesarean section rates in a public metropolitan health service.

PubMed

Biro, Mary A; Knight, Michelle; Wallace, Euan; Papacostas, Kerrie; East, Christine

2014-02-01

The effects of place of birth on birth outcomes have been examined in several studies both locally and internationally. However, none has examined the impact on caesarean section rates of different level maternity hospitals operating within the one health service. This study aimed to examine the impact of place of (Hospital level 6; 4-5 or 4) on birth outcomes in a large metropolitan health service in Victoria. A cross-sectional study utilising data on births to low-risk first-time mothers during 2010-2011. Data were obtained from the Birthing Outcome System (BOS) database of Monash Health. Unadjusted and adjusted analyses were undertaken using logistic regression to examine the association between place of birth and caesarean section. In this group of low-risk nulliparae, there was evidence of a significant association between place of birth and caesarean section. The lower the acuity of the hospital, the higher the odds for the caesarean section. Compared with the level 6 hospital, the AdjOR for caesarean section at the level 4 hospital was 1.81 (95% CI: 1.37-2.41) and at the level 4-5 hospital, 1.30 (95% CI: 1.0-1.7). Low-risk nulliparae in spontaneous labour giving birth at the level 4 hospital in this health service are at significantly increased risk of caesarean section. This may have implications for the organisation and resource management of other level 4 public maternity units. Care in a tertiary (level 6) service may not necessarily equate to the higher rates of intervention reported by others. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Prevalence of prediabetes in patients with acute coronary syndrome: impact on in-hospital outcomes.

PubMed

AbuShady, M M; Mohamady, Y; Enany, B; Nammas, W

2015-02-01

Prediabetes is a serious condition that is associated with an increase in cardiovascular morbidity and mortality. We sought to explore the prevalence of prediabetes in patients admitted with acute coronary syndrome (ACS) who were not known to have diabetes and to determine the impact of prediabetes on in-hospital clinical outcomes versus non-diabetic patients. Prospectively, we enrolled 200 patients not known to have diabetes or prediabetes, admitted with ACS. Laboratory tests included fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) after 75 g glucose, HbA1c and lipid profile. Electrocardiogram and echocardiography were done. The primary end-point was in-hospital major adverse cardiovascular events (MACE). Mean age was 50.9 ± 6.8 years (70.5% males). The prevalence of patients with diabetes and patients with prediabetes was 24.5% and 20% respectively. Newly discovered diabetic patients were excluded. Compared with patients without diabetes, prediabetic patients had a higher body mass index (BMI) (P = 0.002) and a longer hospital stay (P = 0.09). In-hospital MACE occurred in 10 (25%) patients with prediabetes versus six (5.4%) in patients without diabetes (P = 0.001). In-hospital MACE correlated with prediabetes (r = 0.28, P < 0.001), BMI (r = 0.14, P = 0.093), FPG (r = 0.19, P = 0.014), 2hPG (r = 0.19, P = 0.017) and HbA1c (r = 0.19, P = 0.019). Multivariate regression analysis identified prediabetes as the only independent predictor of in-hospital MACE. Prediabetes is common in patients presenting with ACS who are not previously known to have diabetes. Prediabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes. © 2014 Royal Australasian College of Physicians.

Royal jelly modulates oxidative stress and tissue injury in gamma irradiated male Wister Albino rats.

PubMed

Azab, Khaled Shaaban; Bashandy, Mohamed; Salem, Mahmoud; Ahmed, Osama; Tawfik, Zaki; Helal, Hamed

2011-06-01

Royal jelly is a nutritive secretion produced by the worker bees, rich in proteins, carbohydrates, vitamins and minerals. The present study was designed to determine the possible protective effects of royal jelly against radiation induced oxidative stress, hematological, biochemical and histological alterations in male Wister albino rats. Male Wister albino rats were exposed to a fractionated dose of gamma radiation (2 Gy every 3 days up to 8 Gy total doses). Royal jelly was administrated (g/Kg/day) by gavages 14 days before exposure to the 1(st) radiation fraction and the treatment was continued for 15 days after the 1(st) irradiation fraction till the end of the experiment. The rats were sacrificed 3(rd), equivalent to 3rd post 2nd irradiation fraction, and equivalent to 3rd day post last irradiation fraction. In the present study, gamma- irradiation induced hematological, biochemical and histological effects in male Wister albino rats. In royal jelly treated irradiated group, there was a noticeable decrease recorded in thiobarbituric reactive substances concentration when compared to γ-irradiated group. Also, the serum nitric oxide concentration was significantly improved. The administration of royal jelly to irradiated rats according to the current experimental design significantly ameliorates the changes induced in serum lipid profile. Moreover, in royal jelly treated irradiated group, there was a noticeable amelioration recorded in all hematological parameters along the three experimental intervals. The microscopic examination of cardiac muscle of royal jelly treated irradiated rats demonstrated structural amelioration, improved nuclei and normal features of capillaries and veins in endomysium when compared to gamma-irradiated rats. It was suggested that the biochemical, hematological and histological amelioration observed in royal jelly (g/Kg/day) treated irradiated rats might be due to the antioxidant capacity of royal jelly active constituents.

That's Not for Our Kids: The Strange Death of Philosophy and Ethics in a Low Socioeconomic Secondary School

ERIC Educational Resources Information Center

Thompson, Greg; Lašic, Tomaž

2014-01-01

This article reflects on the successes and failures of a new Philosophy and Ethics course in a low socioeconomic context in Perth, Western Australia, with the eventual demise of the subject in the school at the end of 2010. We frame this reflection within Deleuzian notions of geophilosophy to advocate for a Philosophy and Ethics that is informed…

GEMINI-TITAN (GT)-11 - EARTH SKY - OUTER SPACE

NASA Image and Video Library

1966-09-14

S66-54706 (14 Sept. 1966) --- Western half of Australia, including the coastline from Perth to Port Darwin, looking west, as seen from the Gemini-11 spacecraft during its 26th revolution of Earth. Photograph was made while the spacecraft was at a record-high apogee of 740 nautical miles. Taken with a modified 70mm Hasselblad camera, using Eastman Kodak, Ektachrome, MS (S.O. 368) color film. Photo credit: NASA

Learning and Capacity Building for Irrigators in Western Australia's East Wanneroo Area: A Theoretical Framework for Educational Provision and a Sketch of the Socioecological Context

ERIC Educational Resources Information Center

Hewitt, Nan; Horwitz, Pierre

2006-01-01

In Western Australia the East Wanneroo horticultural area is reliant on a superficial aquifer, the Gnangara Groundwater Mound, for irrigation. The area is affected by social and political change as the sprawling city of Perth expands, as well as by ecological changes resulting from a decline in groundwater levels. Horticulturalists face increasing…

After Twenty-Five Years: A Twenty-Five Year Follow-up Study of Middlesex County Vocational and Technical High School Graduates of the Class of June 1953.

ERIC Educational Resources Information Center

Rogers, William; Zanzalari, J. Henry

A twenty-five-year follow-up study was conducted to determine the occupational, educational, marital and armed forces experiences of the graduating class of 1953 from the Middlesex County Vocational and Technical high schools located in New Brunswick, Perth, Amboy, and Woodbridge, New Jersey. Data, in the form of questionnaire responses, were…

Hazardous waste in the Asian Pacific region.

PubMed

Prasad, Rajendra; Khwaja, Mahmood A

2011-01-01

The production and disposal of hazardous waste remains a substantial problem in the Asian Pacific region. Remediation of waste disposal sites, including landfill sites, is attracting considerable research attention within the region. A recognition of the need for community engagement in this process is also growing. This article reviews the work presented in the Hazardous Waste sessions at the Pacific Basin Consortium for Environment and Health held in November 2009 in Perth.

Safety Training Evaluation: The Case of Construction Induction Training and the Impact on Work-Related Injuries in the Western Australian Construction Sector

ERIC Educational Resources Information Center

Bahn, Susanne; Barratt-Pugh, Llandis

2014-01-01

This paper presents the findings of an evaluation of the mandatory Construction Induction Training initiative (CIT). The paper details a pilot study conducted in 2010 with the commercial construction sector and a subsequent study in 2011 of the housing and civil sectors conducting business in the metropolitan area of Perth and in regional Western…

The Balkanisation of Power in Australian Education: Political Lessons from the Recent Collapse of National Partnership in Policy Making.

ERIC Educational Resources Information Center

Macpherson, R. J. S.

During the Perth meeting of the Australian Education Council (AEC) on July 1-2, 1993, policy making power shifted from the AEC to the states and from Labor to non-Labor ministers. Labor ministerial power directed public education through much of the 1980s, when the rhetoric of national partnership was all-pervasive. At the July conference, the…

A Prototype JFACC: General George C. Kenney

DTIC Science & Technology

1994-06-01

Corps, as well as air forces from Australia and New Zealand . Many accounts of the Battles for Leyte and Luzon center around ground and naval forces...St Clair Streett USA Royal New Zealand Air Force (RNZAF) Royal Australian Air Force (RAAF) Air Command Organization SWPA June 15, 1944 Figure 5...Ground Task Force OPCON Operational Command POA Pacific Ocean Areas RAAF Royal Australian Air Force RNZAF Royal New Zealand Air Force SAP

Differential effects on socioeconomic groups of modelling the location of mammography screening clinics using Geographic Information Systems.

PubMed

Hyndman, J C; Holman, C D

2000-06-01

To evaluate spatial access to mammography clinics and to investigate whether relocating clinics can improve global access. To determine whether any change in access is distributed equitably between different social groups. The study was undertaken in Perth, Western Australia in 1996. It was an analysis of travel distances to mammography clinics, comparing distances to the pattern of existing clinics and modelled relocated clinics. The study population was the 151,162 women aged 40-64 years resident in Perth in 1991. Overall travel distances to the existing clinics was reduced by 14% when a GIS system was used to relocate them so as to minimise the travel distance for all women. The travel distance of the most disadvantaged groups fell by 2% and by 24% for the least disadvantaged group. GIS modelling can be used to advantage to evaluate potential locations for screening clinics that improve the access for the target population, however global analysis should be supplemented by analysis of special groups to ensure that no group is disadvantaged by the proposal. If new technology is not used to evaluate the placement of health services, population travel distances may be greater than necessary, with possible impacts on attendance rates.

Designing water supplies: Optimizing drinking water composition for maximum economic benefit.

PubMed

Rygaard, M; Arvin, E; Bath, A; Binning, P J

2011-06-01

It is possible to optimize drinking water composition based on a valuation of the impacts of changed water quality. This paper introduces a method for assessing the potential for designing an optimum drinking water composition by the use of membrane desalination and remineralization. The method includes modeling of possible water quality blends and an evaluation of corrosion indices. Based on concentration-response relationships a range of impacts on public health, material lifetimes and consumption of soap have been valued for Perth, Western Australia and Copenhagen, Denmark. In addition to water quality aspects, costs of water production, fresh water abstraction and CO(2)-emissions are integrated into a holistic economic assessment of the optimum share of desalinated water in water supplies. Results show that carefully designed desalination post-treatment can have net benefits up to €0.3 ± 0.2 per delivered m(3) for Perth and €0.4(±0.2) for Copenhagen. Costs of remineralization and green house gas emission mitigation are minor when compared to the potential benefits of an optimum water composition. Finally, a set of optimum water quality criteria is proposed for the guidance of water supply planning and management. Copyright © 2011 Elsevier Ltd. All rights reserved.

Supporting mothers to breastfeed: the development and process evaluation of a father inclusive perinatal education support program in Perth, Western Australia.

PubMed

Tohotoa, Jenny; Maycock, Bruce; Hauck, Yvonne; Howat, Peter; Burns, Sharyn; Binns, Colin

2011-09-01

Entry into fatherhood is a challenging period with new responsibilities and changes in family dynamics. Hegemonic imagery of men portray them as capable, confident and able which can disadvantage expectant fathers who often struggle to make sense of the changes occurring around and within their own parenting journey. Although fathers historically have not been included in breastfeeding classes, antenatal education programs can be an opportunity to inform and support them in their new role. Forty-five antenatal sessions for fathers (n = 342) of 1h duration were conducted by five male educators between May 2008 and June 2009 in Perth, Western Australia. A theoretical framework from health promotion literature was used as a guide in the program's development. Fathers in the intervention group gained information about their role, the importance of communication and the benefits of breastfeeding to both mother and baby. An evaluation was obtained from fathers immediately after the session and again at 6 week post-birth, whilst mothers reported on the perception of their partners' support for breastfeeding in the 6 week survey. The aim of this paper is to describe the development and process evaluation of a perinatal education and support program for fathers to assist their partners to breastfeed.

Water scarcity and institutional change: lessons in adaptive governance from the drought experience of Perth, Western Australia.

PubMed

Bettini, Y; Brown, R; de Haan, F J

2013-01-01

Urban water systems will be increasingly challenged under future climates and global pressures. Meeting challenges by reconfiguring water systems to integrate supplies and deliver multifunctional uses is technically well described. Adjusting the institutions that frame the management of these systems is not well operationalized in practice or conceptualized in theory. This study seeks to address this gap through an institutional analysis of Perth, Australia, a city where drought crisis has put under pressure both management practices and the institutional setting that underlies them. The study found that while trusted practices moderated water scarcity, the stability of the institutional setting may not facilitate a shift toward adaptable institutional configurations suited to future conditions. The results identified three key ingredients for a flexible institutional setting: (i) feedbacks in the system through better information management, (ii) reflexive dialogue and strategic use of projects to generate greater learning opportunities, and (iii) policy level support for sector-wide collaboration through progressive agendas, incentives for innovation and capacity building in stakeholder and community engagement. Further, the results suggest that a deeper understanding of institutional dynamics is needed to enable adaptive governance. The paper provides an analytical framework for diagnosing how greater adaptive capacity might be mobilized through influencing these dynamics.

Astronomical publications of Melbourne Observatory

NASA Astrophysics Data System (ADS)

Andropoulos, Jenny Ioanna

2014-05-01

During the second half of the 19th century and the first half of the 20th century, four well-equipped government observatories were maintained in Australia - in Melbourne, Sydney, Adelaide and Perth. These institutions conducted astronomical observations, often in the course of providing a local time service, and they also collected and collated meteorological data. As well, some of these observatories were involved at times in geodetic surveying, geomagnetic recording, gravity measurements, seismology, tide recording and physical standards, so the term "observatory" was being used in a rather broad sense! Despite the international renown that once applied to Williamstown and Melbourne Observatories, relatively little has been written by modern-day scholars about astronomical activities at these observatories. This research is intended to rectify this situation to some extent by gathering, cataloguing and analysing the published astronomical output of the two Observatories to see what contributions they made to science and society. It also compares their contributions with those of Sydney, Adelaide and Perth Observatories. Overall, Williamstown and Melbourne Observatories produced a prodigious amount of material on astronomy in scientific and technical journals, in reports and in newspapers. The other observatories more or less did likewise, so no observatory of those studied markedly outperformed the others in the long term, especially when account is taken of their relative resourcing in staff and equipment.

EDITORIAL: 50th anniversary issue

NASA Astrophysics Data System (ADS)

Beddoe, Alun H.

2006-07-01

In July 1956, 50 years ago, the first issue of Physics in Medicine and Biology (PMB) was published. It was subtitled The Journal of the Hospital Physicists' Association and published in association with the Philosophical Magazine by Taylor and Francis. Subscriptions were £1 per part or £3 10s for an annual subscription. The Editor, Professor J E Roberts, prefaced the first issue with a cautious editorial noting: The appearance of a new journal is usually greeted with mixed feelings by scientific workers, a common response being that there are far too many journals already. Justification for a new publication is only possible if there is a clearly defined gap in the publishing facilities available to workers in a particular scientific field.... Professor Roberts ended by seeking support from the scientific community for the new venture. He certainly got it! From a tentative few hundred pages in four issues a year for the first few years, the journal is now issued twice monthly with nearly 8000 pages expected in volume 51. In this anniversary issue we have invited some 28 senior authors to submit papers on a range of subjects spanning the discipline. We decided that to be an author one had to be old, but age was not to be the only criterion! Indeed readers will recognize all names as major contributors to both the development of medical physics and the success of PMB. Authors were not asked to write formal topical reviews of the state-of-the-art of the sub-disciplines which make up medical physics, but rather to present short historical reviews, didactic in style, perhaps highlighting the role of PMB in the development of their fields. Nevertheless, other than a page limit (which many subsequently ignored!) no formal format was imposed on authors, so what follows is a range of contributions from the almost conversational, personal statement to the more formal and familiar scientific paper. Whatever the writing style we are confident that readers will gain some appreciation of the development of our wide-ranging discipline over the last half century. Some readers may feel that one or two subjects have not been represented, and for that I can only apologise. We did ask for contributions to several other topics (for example radiation metrology and optical techniques) but inevitably there were authors who for various reasons were unable to meet the deadline. Inevitably we will also have missed contributions from excellent potential authors (who satisfied the age criterion!). As Guest Editor I must bear the responsibility for those omissions. While page limits do not permit me to discuss the contributions to this issue individually I would like to mention the first contribution by Dr J E (Bob) Burns. Dr Burns was on the Editorial Board in the early sixties working with the second Editor, Professor Sir Joseph Rotblat. Both in his article and in personal communications Dr Burns has emphasized the important role of Professor Rotblat in the early years. I did write to Professor Rotblat seeking a contribution from him but, sadly, received a reply saying that he was not well enough to contribute `at present'; he died a few weeks later at the age of 96 years (please refer to www.pugwash.org for tributes from Mikhail Gorbachev, Kofi Annan and many others). Dr Burns wrote a short note to me shortly after his death including the following comment which is reproduced below: Although many people have contributed to the success of PMB over the last 50 years it was Rotblat's restless energy, power of persuasion and already existing fame (he was well known both scientifically and to the public at the time) that enabled him to rescue the journal from an early death. After discussions with colleagues around the UK, including Dr Burns, and with the Editorial Board, we all felt that it would be highly appropriate to dedicate this anniversary issue to the memory of Professor Rotblat. Institute of Physics Publishing (IOP) took over the publishing of PMB in 1972, firstly on behalf of the Hospital Physicists' Association and then on behalf of the Institute of Physics and Engineering in Medicine (IPEM). I wish to pay tribute to the staff at the IOP Publishing Office for the continuing excellent quality and short publication times for articles appearing in PMB. There can be no doubt that this contributes to the popularity with authors and readers alike. It almost goes without saying but I should also thank all the contributors, referees, Editorial Board members and International Advisory Board members who have, collectively, made PMB the success that it is. For historical interest I list below the 11 editors of PMB since its inception. Three of these editors have contributed papers to this issue. 1956-1961 Professor J E Roberts, Middlesex Hospital, London 1961-1972 Professor Sir Joseph Rotblat, St Bartholomew's Hospital, London 1973-1978 Professor H A B Simons, Royal Free Hospital, London 1979-1982 Mr J Clifton, University College Hospital, London 1983-1985 Professor R P Parker, University of Leeds, Leeds 1986-1987 Dr M J Day, Newcastle General Hospital, Newcastle 1988-1991 Professor S C Lillicrap, Royal United Hospital, Bath 1992-1995 Professor B L Diffey, Dryburn Hospital, Durham 1996-1999 Professor M O Leach, Royal Marsden NHS Foundation Trust, London 2000-2005 Professor A H Beddoe, University Hospital, Birmingham 2006- Professor S Webb, Royal Marsden NHS Foundation Trust, London Finally, apart from noting the usual caveat that the Guest Editor, Editor-in Chief, IOP and IPEM take no responsibility for opinions expressed by authors, I would like to conclude by wishing Professor Steve Webb and future editors every success. While I may not be around for the centenary issue in July 2056 I have every reason to believe that it will be a good one.

[Anaphylaxis caused by royal jelly].

PubMed

Roger, A; Rubira, N; Nogueiras, C; Guspi, R; Baltasar, M; Cadahia, A

1995-01-01

Royal jelly is the food on which are fed and which causes them to develop into queen bees. It is claimed to have rejuvenating virtues for human beings. This report describes a 15-year-old atopic woman who presented, 15 minutes after the intake of royal jelly, local angioedema, generalised urticaria, dysphonia and bronchospasm. She was given antihistaminics and corticoesteroids and responded well. The ingested product contains royal jelly, lactose and potassium sorbate. No anaphylactic reactions to lactose and sorbates have been described previously. Prick test to common food allergens hymenoptera venoms and pollens were negative. RAST to meletin was also negative. Blood eosinophils were 600 and total IgE 465. Non-commercial prepared specific IgE to royal jelly was positive (0.8 KU/l). Prick by prick was positive to 1/10 dilution, being negative in controls (undiluted). No oral provocation test was performed due to the risk of anaphylaxis. No reported cases of royal jelly allergy were founded in a review of the medical literature. Concluding, it is the first described case of IgE anaphylactic reaction due to royal jelly.

Electron spin resonance spectral analysis of irradiated royal jelly.

PubMed

Yamaoki, Rumi; Kimura, Shojiro; Ohta, Masatoshi

2014-01-15

The analysis of unpaired electron components in royal jelly was carried out using electron spin resonance (ESR) with the aim to develop a detection method for irradiated royal jelly. The ESR spectrum of royal jelly had natural signals derived from transition metals, including Fe(3+) and Cu(2+), and a signal line near g=2.00. After irradiation, a new splitting asymmetric spectrum with overall spectrum width ca. 10mT at g=2.004 was observed. The intensities of the signals at g=2.004 increased in proportion to the absorbed dose in samples under different storage conditions: fresh frozen royal jelly and dried royal jelly powder at room temperature. The signal intensity of the fresh frozen sample was stable after irradiation. One year after 10kGy irradiation of dried powder, the signal intensity was sevenfold greater than before irradiation, although the intensity continued to steadily decrease with time. This stable radiation-induced radical component was derived from the poorly soluble constituent of royal jelly. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Burnout in Dutch medical students: prevalence and causes].

PubMed

Conijn, Maartjie; Boersma, Henri J M V; van Rhenen, Willem

2015-01-01

To investigate the prevalence and causes of burnout in Dutch medical students. Questionnaire survey. All 14,570 student members of the KNMG (Royal Dutch Medical Association) were invited to fill in a digital survey. Burnout was determined with the Utrecht Burnout Scale (UBOS). Triggering and protective factors for burnout were also investigated . 2,739 medical students (18.8%) completed the survey and 14.5 per cent of all respondents met the burnout criteria. 17.8 per cent of the hospital interns who responded and 11.6 per cent of the preclinical students who responded met these criteria. Work-home interference and high levels of emotional pressure had the strongest link to burn-out, while a sufficient amount of support from family, friends and peers reduced the risk of burnout in both undergraduates and hospital interns. Our exploratory research suggests that the prevalence of burnout is high, particularly among the hospital interns who responded. The most important contributory factors are high levels of emotional pressure and work-home interference. The low percentage of respondents makes it difficult to make any statement about the prevalence and causes of burnout among all Dutch medical students.

When should governments increase the supply of psychiatric beds?

PubMed

Allison, S; Bastiampillai, T; Licinio, J; Fuller, D A; Bidargaddi, N; Sharfstein, S S

2018-04-01

Low numbers of hospital-based psychiatric beds create problems for people with severe mental illness (SMI), when they face extended emergency department (ED) waits, higher thresholds for admission to an acute bed, and short revolving-door stays with high rates of rehospitalisation. Limited access to inpatient treatment has been associated with higher suicide risk, premature mortality, homelessness, violent crime and incarceration. Ultimately, people with SMI can be transinstitutionalised to the criminal justice system. In the USA, for example, prisons have replaced mental hospitals as the largest institutions housing people with SMI. There is no international consensus on the safe minimum numbers of acute, forensic and rehabilitation beds needed to reduce these risks. As a consequence, Organisation for Economic Cooperation and Development (OECD) countries have wide variations in the mix of hospital beds with an average of 71 beds per 100 000 population. Policymakers face difficult choices with few studies to guide decisions on supplying beds. The UK Royal College of Psychiatrists offered a policy framework, which was adapted for Australia. The government of the State of South Australia increased the supplies of crisis, acute and forensic beds to meet a mandatory target to safely reduce mental health boarding in the EDs.

Paediatric clinical research from the perspective of hospital pharmacists from France and Canada.

PubMed

Guérin, Aurélie; Tanguay, Cynthia; Lebel, Denis; Prot-Labarthe, Sonia; Bourdon, Olivier; Bussières, Jean-François

2014-12-01

To compare pharmacy support for paediatric research services in France and Canada and to describe the perception of pharmacists and rank the paediatric clinical research issues. This was a cross-sectional descriptive study. All paediatric hospitals from Canada and the main hospitals from France were contacted. A survey was conducted from May-September 2012. Descriptive statistics were performed. Results from 11 paediatric hospitals in Canada (11/12, 92%) and 11 (11/18, 61%) in France were obtained. There was a similar number of ongoing paediatric clinical trials per hospital in France versus Canada (38 (10-81) versus 20 (4-178)). A lower number of pharmacists per hospital was observed in France (17 (11.5-35) versus 45 (18.9-76.8)), but a similar number of pharmacists were assigned to clinical trials (1.5 (1-3) versus 1.9 (0.2-17.4)). Institutional protocols represented the majority of paediatric clinical trials in France (61% (14-100) versus 25% (0-100)). Similar pharmacy support services were offered, but the majority of French respondents also offered help for institutional protocol development (91 versus 50% P = 0.063). The main issues associated with paediatric clinical research were absence of financial interest from the pharmaceutical industry, prohibitive cost versus profit ratio, small patient cohorts and the non-availability of the appropriate drug formulations. Difficulties related to pharmaceutical compounding were identified as the main hindrance to paediatric clinical research; particular attention should be paid to these details when setting up a paediatric trial. © 2014 Royal Pharmaceutical Society.

Protective effect of royal jelly on the sperm parameters and testosterone level and lipid peroxidation in adult mice treated with oxymetholone

PubMed Central

Zahmatkesh, Ensieh; Najafi, Gholamreza; Nejati, Vahid; Heidari, Reza

2014-01-01

Objectives : The aim of the present study was to evaluate protective effect of royal jelly on sperm parameters, testosterone level, and malondialdehyde (MDA) production in mice. Materials and Methods: Thirty-two adult male NMRI mice weighing 30±2 g were used. All the animals were divided into 4 groups. Control group: received saline 0.1 ml/mouse/day orally for 30 days. Royal jelly group (RJ): received royal jelly at dose of 100 mg/kg daily for 30 days orally. Oxymetholone group: the received Oxymetholone (OX) at dose of 5 mg/kg daily for 30 days orally. Royal jelly+Oxymetholone group: received royal jelly at dose of 100 mg/kg/day orally concomitant with OX administration. Sperm count, sperm motility, viability, maturity, and DNA integrity were analyzed. Furthermore, serum testosterone and MDA concentrations were determined. Results: In Oxymetholone group, sperm count, motility as well as testosterone concentration reduced significantly (p<0.05), while significant (p<0.05) increases in immature sperm, sperm with DNA damaged, and MDA concentration were announced in Oxymetholone group in comparison with control group and Royal jelly+Oxymetholone group. RJ caused partially amelioration in all of the above- mentioned parameters in Royal Jelly+Oxymetholone group. Conclusion: In conclusion, RJ may be used in combination with OX to improve OX-induced oxidative stress and male infertility. PMID:25050300

Royal Jelly Inhibits Pseudomonas aeruginosa Adherence and Reduces Excessive Inflammatory Responses in Human Epithelial Cells

PubMed Central

Susilowati, Heni; Amoh, Takashi; Hirao, Kouji; Hirota, Katsuhiko; Matsuo, Takashi; Miyake, Yoichiro

2017-01-01

Pseudomonas aeruginosa is a Gram-negative bacterium and causes respiratory infection especially in elderly patients. Royal jelly has been used worldwide as a traditional remedy and as a nutrient; however, the effect against P. aeruginosa is unclear. The aim of this study was to analyze antibacterial, antiadherent, and anti-inflammatory effects of royal jelly against P. aeruginosa. Wild-type strain PAO1 and clinical isolates of P. aeruginosa were used for antibacterial assay and antiadherent assay to abiotic surface and epithelial cells, which are pharynx (Detroit 562) and lung (NCI-H292) epithelial cells. In anti-inflammatory assay, epithelial cells were pretreated with royal jelly before bacterial exposure to investigate its inhibitory effect on interleukin (IL-8) and macrophage inflammatory protein-3α/CCL20 overproduction. Although royal jelly did not have antibacterial activity at concentration of 50% w/v, antiadherent activity was confirmed on the abiotic surface and epithelial cells under concentration of 25%. Pretreatment with royal jelly significantly inhibited overproduction of IL-8 and CCL20 from both cells. These results demonstrated that royal jelly inhibits P. aeruginosa adherence and protects epithelial cells from excessive inflammatory responses against P. aeruginosa infection. Our findings suggested that royal jelly may be a useful supplement as complementary and alternative medicine for preventing respiratory infection caused by P. aeruginosa. PMID:29075644

Body-enlarging effect of royal jelly in a non-holometabolous insect species, Gryllus bimaculatus

PubMed Central

Miyashita, Atsushi; Kizaki, Hayato; Sekimizu, Kazuhisa; Kaito, Chikara

2016-01-01

ABSTRACT Honeybee royal jelly is reported to have body-enlarging effects in holometabolous insects such as the honeybee, fly and silkmoth, but its effect in non-holometabolous insect species has not yet been examined. The present study confirmed the body-enlarging effect in silkmoths fed an artificial diet instead of mulberry leaves used in the previous literature. Administration of honeybee royal jelly to silkmoth from early larval stage increased the size of female pupae and adult moths, but not larvae (at the late larval stage) or male pupae. We further examined the body-enlarging effect of royal jelly in a non-holometabolous species, the two-spotted cricket Gryllus bimaculatus, which belongs to the evolutionarily primitive group Polyneoptera. Administration of royal jelly to G. bimaculatus from its early nymph stage enlarged both males and females at the mid-nymph and adult stages. In the cricket, the body parts were uniformly enlarged in both males and females; whereas the enlarged female silkmoths had swollen abdomens. Administration of royal jelly increased the number, but not the size, of eggs loaded in the abdomen of silkmoth females. In addition, fat body cells were enlarged by royal jelly in the silkmoth, but not in the cricket. These findings suggest that the body-enlarging effect of royal jelly is common in non-holometabolous species, G. bimaculatus, but it acts in a different manner than in holometabolous species. PMID:27185266

Protective effect of royal jelly on the sperm parameters and testosterone level and lipid peroxidation in adult mice treated with oxymetholone.

PubMed

Zahmatkesh, Ensieh; Najafi, Gholamreza; Nejati, Vahid; Heidari, Reza

2014-01-01

Objectives : The aim of the present study was to evaluate protective effect of royal jelly on sperm parameters, testosterone level, and malondialdehyde (MDA) production in mice. Thirty-two adult male NMRI mice weighing 30±2 g were used. All the animals were divided into 4 groups. received saline 0.1 ml/mouse/day orally for 30 days. Royal jelly group (RJ): received royal jelly at dose of 100 mg/kg daily for 30 days orally. Oxymetholone group: the received Oxymetholone (OX) at dose of 5 mg/kg daily for 30 days orally. Royal jelly+Oxymetholone group: received royal jelly at dose of 100 mg/kg/day orally concomitant with OX administration. Sperm count, sperm motility, viability, maturity, and DNA integrity were analyzed. Furthermore, serum testosterone and MDA concentrations were determined. In Oxymetholone group, sperm count, motility as well as testosterone concentration reduced significantly (p<0.05), while significant (p<0.05) increases in immature sperm, sperm with DNA damaged, and MDA concentration were announced in Oxymetholone group in comparison with control group and Royal jelly+Oxymetholone group. RJ caused partially amelioration in all of the above- mentioned parameters in Royal Jelly+Oxymetholone group. In conclusion, RJ may be used in combination with OX to improve OX-induced oxidative stress and male infertility.

Royal Jelly Inhibits Pseudomonas aeruginosa Adherence and Reduces Excessive Inflammatory Responses in Human Epithelial Cells.

PubMed

Susilowati, Heni; Murakami, Keiji; Yumoto, Hiromichi; Amoh, Takashi; Hirao, Kouji; Hirota, Katsuhiko; Matsuo, Takashi; Miyake, Yoichiro

2017-01-01

Pseudomonas aeruginosa is a Gram-negative bacterium and causes respiratory infection especially in elderly patients. Royal jelly has been used worldwide as a traditional remedy and as a nutrient; however, the effect against P. aeruginosa is unclear. The aim of this study was to analyze antibacterial, antiadherent, and anti-inflammatory effects of royal jelly against P. aeruginosa . Wild-type strain PAO1 and clinical isolates of P. aeruginosa were used for antibacterial assay and antiadherent assay to abiotic surface and epithelial cells, which are pharynx (Detroit 562) and lung (NCI-H292) epithelial cells. In anti-inflammatory assay, epithelial cells were pretreated with royal jelly before bacterial exposure to investigate its inhibitory effect on interleukin (IL-8) and macrophage inflammatory protein-3 α /CCL20 overproduction. Although royal jelly did not have antibacterial activity at concentration of 50% w/v, antiadherent activity was confirmed on the abiotic surface and epithelial cells under concentration of 25%. Pretreatment with royal jelly significantly inhibited overproduction of IL-8 and CCL20 from both cells. These results demonstrated that royal jelly inhibits P. aeruginosa adherence and protects epithelial cells from excessive inflammatory responses against P. aeruginosa infection. Our findings suggested that royal jelly may be a useful supplement as complementary and alternative medicine for preventing respiratory infection caused by P. aeruginosa .

An analysis of the delivery of anaesthetic training sessions in the United Kingdom.

PubMed

Green, A; Tatham, K C; Yentis, S M; Wilson, J; Cox, M

2017-11-01

We analysed data from the electronic rota system CLWRota, covering 2,689,962 anaesthetic sessions between 01/01/2014 and 31/12/2015, in 91 UK Trusts, in order to investigate trainees' supervision. There were 8209 trainee attachments analysed, during which 618,695 sessions were undertaken by trainees. The number of supervised sessions per week that trainees worked varied considerably (median (IQR [range]) 2.6 (1.6-3.6 [0-10]) for all grades combined), with senior trainees more likely than junior trainees to be supervised for fewer than the three sessions per week mandated by the Royal College of Anaesthetists. The number of supervised sessions was unrelated to Trusts' size, suggesting that trainees in smaller hospitals receive the same level of supervision as in larger teaching hospitals. Analysis of a dataset of this size should be a good reflection of the delivery of anaesthesia training in the UK. © 2017 The Association of Anaesthetists of Great Britain and Ireland.