bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the quality of hospital‐generated police reports using a structured proforma
Authors: Parker Helen , Kelly Anne‐Maree , Wells David
Published: March 2003

Objectives: This study compared the adequacy and utility of police statements prepared before and after the introduction of a structured proforma.

Method: The study utilized two samples of 37 statements each, one before and one after the introduction of a structured proforma. Blinded, independent reviewers drawn from the ranks of police or coronial officers assessed the statements for the presence of key items and rated structure, language, adequacy and utility in centimetres on a visual analogue scale. Fisher’s exact test was used for comparison of proportions and the Mann–Whitney U‐test for comparison of visual analogue scale scores.

Results: The overall rating of the adequacy of reports improved from a mean visual analogue scale score of 2.91 to 6.97 (P<0.001) with the structured proforma. Significant differences with the presence of opinions regarding causality and severity of injury were also demonstrated.

Conclusion: A structured proforma to assist in the writing of police statements resulted in a higher proportion of key content items being included and significantly higher ratings of various aspects by end‐users. This approach could be generalized to other health‐care settings and situations where communication between health workers and investigating officers is needed.
Emergency department management of hip fractures: Development of an evidence‐based clinical guideline by literature review and consensus
Authors: Considine Julie , Hood Kerry
Published: March 2003

The Emergency Department at Dandenong Hospital has recently developed an evidence‐based clinical guideline for the emergency department management of hip fractures. This paper will comment on the role of clinical guidelines in the emergency department, discuss the process of the development of evidence‐based guidelines for the care of hip fractures and present the evidence found during the development process. Evidence‐based recommendations for practice are made regarding pulse oximetry and supplemental oxygen, preoperative use of skin traction, thromboembolism prophylaxis, pain management including the use of nerve blocks, pressure area care, the use of indwelling urinary catheters and time to surgical repair.
Identifying the core components of an anaesthesiology curriculum for emergency medicine trainees in Australasia
Authors: Amarasinghe Varna , Kelly Anne‐Maree , Rogers Ian , Jacobs Ian
Published: March 2003

Objectives: To identify the components of anaesthesiology practice most important to emergency medicine practice with a view to informing discussion on a set of core objectives for an anaesthesiology attachment.

Method: The study was a postal survey. Participants consisted of all trainees and Fellows in Victoria and New Zealand as at February 1997 (total 315). Data collected included demographics and training level/experience of respondent, rating of anaesthesiology skills important to the practice of emergency medicine, rating of the skills judged to be learned most usefully in an anaesthesiology rotation, desirability of a formal anaesthesiology attachment and its optimal length and timing. Descriptive analyses were undertaken.

Results: The main aim of an anaesthesiology attachment should be the acquisition of airway skills. Fluid resuscitation and venous access techniques were considered secondary objectives. This is considered essential to emergency medicine training; the optimal attachment duration should be 6 months, occurring in the first 2 years of advanced training.

Conclusion: An anaesthesiology rotation is an important component of emergency medicine training that should focus on the acquisition of airway skills. Consideration should be given to the development of a set of specific objectives to assist planning training programmes and monitoring progress.
NTS versus waiting time: An indicator without definition
Authors: Fatovich Daniel M , Jacobs Ian G
Published: March 2003

Objective:

The National Triage Scale versus waiting time is a key performance indicator for Australasian emergency departments. However, the point at which the clock starts to measure waiting time has not been defined. The aim of this study was to determine how this indicator is measured in Australia, as well as a number of other issues relating to the application of the National Triage Scale.

Methods:

A postal survey was sent to the directors of emergency medicine at 147 emergency departments in Australia.

Results:

There were 105 responses (71.4%). For measurement of the National Triage Scale versus waiting time indicator, 52 (49.5%) started the clock at the time of patient arrival, 33 (31.4%) at the start of triage, and 11 (10.5%) at the end of triage. Seventy‐four emergency departments (70.5%) change the National Triage Scale (NTS) after it has been assigned, and approximately half use set codes for given presentations. Only 28 (26.7%) automatically upgrade children one NTS category. The age definition of a child ranged from 3 years to 18 years.

Conclusions:

The measurement of this key performance indicator is not consistent across Australia. Therefore, caution is advised when comparing such data between departments. The Australasian College for Emergency Medicine should produce operational definitions relating to the use of the National Triage Scale in order to provide meaningful comparative data.
Disaster management in Australia: The national emergency management system
Authors: Abrahams Jonathan
Published: March 2003

Australia has a well‐established emergency management system to manage the threats to communities from natural and technological hazards. The key elements of the system are described with particular emphasis on the impact of disasters on Australia, fundamental concepts, and principles of planning. Emergency physicians have a key role in the development of emergency plans and in the overall health response to disasters. They can enhance their understanding of local, State and national arrangements by participating in exercises and appropriate disaster medicine and emergency management courses. See Commentary, page 143.
A global view of suicidal behaviour
Authors: Goldney Robert D
Published: March 2003

Suicidal behaviour is a major public health problem. There is no one explanatory theory of suicidal behaviour, and various combinations of sociological and biological/medical interventions are required to reduce associated mortality and morbidity. The importance of primary prevention varies from community to community, and may have an impact at the population level. However, individual suicidal persons always require optimum assessment and management and that is usually provided by primary care and emergency physicians. This paper provides an overview of issues to be addressed in the assessment and management of suicidal patients. See Commentary, page 8.
Uvulitis and partial upper airway obstruction following cannabis inhalation
Authors: Boyce Stephen H , Quigley Michael A
Published: March 2003

The use of cannabis in our society is a common problem and the subject of much medical and political debate. We present a case in which a 17‐year‐old male regular cannabis user developed a large swollen uvula (uvulitis) and partial upper airway obstruction after smoking cannabis. Symptoms resolved with the administration of corticosteroids and antihistamines.
The appropriate use of references in a scientific research paper
Authors: Taylor David McD
Published: March 2003

References have an important and varied role in any scientific paper. Unfortunately, many authors do not appreciate this importance and errors within reference lists are frequently encountered. Most reference errors involve spelling, numerical and punctuation mistakes, although the use of too many, too few or even inappropriate references is often seen. The consequences of reference errors include difficulty in reference retrieval, limitation for the reader to read more widely, failure to credit the cited authors, and inaccuracies in citation indexes. This paper discusses the value of accurate reference lists and provides guidelines for their preparation.
Long distance road transport of a patient with Wegener’s Granulomatosis and respiratory failure using extracorporeal membrane oxygenation
Authors: Rosengarten Andrew , Elmore Patricia , Epstein Joseph
Published: March 2003

Wegener’s Granulomatosis is a necrotizing vasculitis that in its most severe form can cause respiratory failure, renal failure and subglottic stenosis requiring surgical airway access. We describe the use of portable extracorporeal membrane oxygenation and the long distance road transport of a patient with Wegener’s Granulomatosis who developed respiratory failure that was refractory to conventional mechanical ventilation. We have demonstrated the effective use of portable extracorporeal membrane oxygenation for stabilization and safe acute interhospital transfer over a long distance by road ambulance to a tertiary centre for further management.
Drowning and near‐drowning
Authors: Moon Richard E , Long Robert J
Published: March 2003

Water immersion is a frequent cause of accidental death and hospital admission. This article outlines the pathogenesis and principles of treatment. Drowning is defined as death by asphyxia due to submersion in a liquid medium. Near‐drowning is defined as immediate survival after asphyxia due to submersion.
Estimation of the general practice workload of a metropolitan teaching hospital emergency department
Authors: Sprivulis Peter
Published: March 2003

Background: A transparent and easily replicated method of estimating the number of, and costs associated with, low acuity presentations to an emergency department is required to assist evaluation of the utilization of emergency department services. This study presents two independent estimates of the number of, and costs associated with, low acuity presentations to an emergency department.

Methods: A retrospective analysis was conducted using emergency department information system data from a metropolitan mixed paediatric/adult teaching hospital emergency department/trauma centre. Low acuity patient presentation estimates were calculated by: Method one: The product of (A) total self‐referred presentations for triage categories three, four and five and (B) the difference between the self‐referred and general practitioner‐referred discharge rates from the emergency department. Total low acuity patient presentations = (A × B). Method two: Summing the number of self‐referrals with presenting problems never referred by general practictioners. Costs were calculated using Commonwealth cost weights.

Results: Method one gave a low acuity patient estimate of 12.5% (95% CI 12.0–13.0%) and method two 10.6% (95% CI 10.2–11.0%) of total presentations. Costs were 10.5% (method one) and 8.5% (method two) of total costs. Adjusted for assessment time, costs were 6.8% (method one) and 5.5% (method two) of total costs. Low acuity patients were more common outside of normal working hours, method one: 14.4% (95% CI 13.5–15.2%) versus 10.0% (95% CI 9.4–10.6%), P < 0.001; method two: 11.4% (95% CI 10.9–12.0%) versus 8.5% (95% CI 7.8–9.2%), P < 0.001. Provision of alternative daily 0900–2400 general practice services would change low acuity patients by no more than 2–3% of total presentations and change low acuity patient costs by no more than 2% of total costs.

Conclusions: Low acuity patients form a small, relatively constant part of the emergency department workload. The provision of alternative after‐hours services for low acuity patients would be unlikely to significantly reduce the overall work load of this metropolitan emergency department.
Interrater reliability of injury coding in the Queensland Trauma Registry
Authors: Neale Rachel , Rokkas Philippa , McClure Roderick J
Published: March 2003

Background: The capacity to accurately code injury event details and use the Abbreviated Injury Scale and Injury Severity Score to group injuries according to severity, underpins the audit and review activities of the trauma registries throughout the world. In the interests of transparency and benchmarking between registries, we aimed to assess the interrater reliability of coding in the Queensland Trauma Registry.

Methods: One hundred and twenty injury cases were randomly selected from the Queensland Trauma Registry database, stratified by hospital, severity and the coder who originally coded the chart. Cases were then recoded by six coders employed by the Queensland Trauma Registry. Coding was carried out by all raters simultaneously and independently.

Results: Interrater agreement between coders was high for external cause, intent, and place of injury with kappa scores for all interrater pairs being greater than 0.80, 0.58 and 0.44. Agreement between the six raters for Injury Severity Score was found to be very high (intraclass correlation coefficient of 0.9).

Conclusions: The accuracy of coding in the Queensland Trauma Registry is sufficiently high to ensure that quality data are available for research, audit and review.
Oesophagogastric variceal bleeding in portal hypertension
Authors: Branicki Frank James
Published: March 2003

This article reviews substantial progress made in the past decade in the management of patients with portal hypertension who present with major upper gastrointestinal bleeding. Variceal and portal pressure measurements and endoscopy facilitate a reasoned approach to management, and several treatment options are available to gain control of ongoing or recurrent haemorrhage. These encompass endoscopic therapy (sclerotherapy, endoscopic variceal ligation), radiological intervention with transjugular intrahepatic systemic shunt (TIPS) procedures, and a variety of surgical procedures for devascularization or shunting from the high‐pressure portal system to low‐pressure systemic venous connections. In most prospective randomized trials endoscopic variceal ligation has proved superior to sclerotherapy, and TIPS has found a role in the salvage of patients with further haemorrhage, sparing them surgical intervention. Advances in pharmacotherapy for the control of initial bleeding and secondary prophylaxis hold promise. Liver transplantation has become an option for selected patients with end‐stage liver disease.

image

image
Neuroendoscopy in pineal region tumor with obstructive hydrocephalus
Authors: Chan () Danny Tat‐Ming , Lam () Joseph Ming‐KuenLam , Poon (;) Wai‐Sang
Published: March 2003

Objective: Pineal region tumours are composed of a variety of tumour pathologies, for example germinoma, teratoma, pinealocytoma, pinealoblastoma, meningioma and benign pineal glial cyst. They commonly present with mass effect causing obstructive hydrocephalus or Parinaud’s Syndrome. This paper reviews seven patients with pineal region tumour who presented with obstructive hydrocephalus and who received neuroendoscopy as part of the management of their clinical condition.

Method: Neuroendoscopic techniques include endoscopic third ventriculoscopy (ETV) and endoscopic third ventriculo‐cisternostomy (ETVC). Diagnostic ETV allows direct visualization, localization and biopsy of the lesion, as well as sampling of cerebrospinal fluid (CSF). Endoscopic third ventriculo‐cisternostomy allows CSF diversion for relief of obstructive hydrocephalus.

Results and Conclusion: Four out of seven of the third ventriculoscopy cases had lesions successfully located and biopsy was performed in two cases. Endoscopic third ventriculo‐cisternostomy was performed in all 7 patients. Two patients with unknown pathology relied on ETVC as the only therapeutic procedure. Three patients were followed with subsequent definitive treatment (radiotherapy or surgery). All these patients showed clinical improvement or radiological relief of obstructive hydrocephalus. Minimal complications were recorded among these cases.

image

image

image

image
Endoscopic ultrasonography in pancreatitis
Authors: Liu () Chi‐Leung , Lo () Chung‐Mau , Fan () Sheung‐Tat
Published: March 2003

Endoscopic ultrasonography (EUS) is a useful imaging modality in the investigation of pancreatitis which provides a high‐resolution image of the pancreas and adjacent structures. In patients with ‘idiopathic’ pancreatitis diagnosed by conventional radiologic methods, EUS may help to identify the aetiology by detecting occult pancreatic neoplasm, biliary sludge and microlithiasis. In patients with biliary pancreatitis, EUS was found to be highly sensitive in detecting choledocholithiasis. Therefore, EUS can be used to select patients with choledocholithiasis for therapeutic endoscopic retrograde cholangiopancreatography (ERCP), thus avoiding unnecessary diagnostic endoscopic intervention and the morbidity associated with ERCP in more than one‐half of patients. In addition, EUS can reliably distinguish oedematous from necrotizing acute pancreatitis, and an EUS score appears to have prognostic significance in patients with acute pancreatitis. Clinical studies also suggest that EUS is at least as sensitive as ERCP for diagnosis of chronic pancreatitis, without the risk of causing or worsening pancreatitis as in ERCP. An EUS‐guided, fine‐needle aspiration may be useful in differentiating pancreatic pseudocysts from neoplastic cystic lesions of the pancreas. Also, EUS‐guided or assisted endoscopic drainage of a pseudocyst resulting from pancreatitis is an accepted alternative to surgery in selected patients.

image

image
Initial experience with laparoscopic ultrasonography in the staging of liver for colorectal cancer: A prospective study
Authors: Chan () Eva Sze‐Wah , Chung () Chi‐Chiu , Tsang () Wilson Wen‐Chieng , Li () Michael Ka‐Wah
Published: March 2003

Objective: Studies on the use of laparoscopic ultrasonography (LUS) in the staging of colorectal cancer are still scanty despite increasingly performed laparoscopic colorectal resection. We conducted a prospective study to compare and evaluate the sensitivity of LUS and preoperative ultrasound in the detection of liver metastases from colorectal primary.

Method: From June 1998 to December 1999, 72 patients admitted for laparoscopic resection of colorectal cancer were studied. Laparoscopic ultrasonography was successfully performed in 63 patients. The results were compared with the preoperative transabdominal ultrasound.

Results: The results showed that LUS was more sensitive than preoperative transabdominal ultrasound in detecting liver metastases and located the lesions with a greater degree of precision. More benign and malignant hepatic lesions were demonstrated by LUS than by preoperative imaging. In four patients (6%) the surgical plan and the subsequent management were altered as a result of the LUS findings.

Conclusion: Laparoscopic ultrasonography should be included as a standard component and essential step in laparoscopic colorectal resection. A large‐scale, prospective comparative study is warranted to confirm this.

image

image

image

image

image
Current issues in xenotransplantation
Authors: Chui () Albert Ka‐Keung
Published: March 2003

The possibility of using animal organs in transplantation has been attractive for a long time. Most experts believe that the pig will provide the most suitable solid organs and tissues for needy human recipients. Although porcine organs are known to be rapidly rejected by the process ‘hyperacute rejection’, there is now hope that several therapeutic strategies that are already available will overcome this problem. However, there are remaining hurdles to overcome. Delayed immune reaction, ethical concerns, physiological incompatibility and animal viruses will determine whether xenotransplantation will become a practical solution to the chronic shortage of allografts in clinical transplantation.

image

image
OK‐432 (Picibanil) therapy for lymphangioma: Collective experience in the literature
Authors: Sun Ning , Chan Kwong‐Leung
Published: March 2003

Lymphangiomas, especially the large ones, can sometimes be difficult to treat surgically if they are situated around vital structures such as regions of facial nerves or brachial plexuses. Many non‐operative methods have been tried without much success. However, since the report of Ogita in 1987 of the success of OK‐432 injection sclerotherapy for the treatment of lymphangiomas in children, there have been further favourable reports of its use from different institutions. The overall total shrinkage rate from these reports is 51% and the complication rate is low. OK‐432 therapy is recommended for the treatment of lymphangiomas especially when the lesions are situated in anatomical positions which make surgery difficult and hazardous. Its mode of action and the prognostic factors for successful treatment are still unknown and need further studies.
The millennium archives: Hong Kong contribution to World literature on video‐endosurgery in the second millennium
Authors: Ng Wai‐Tat , Ng Tsz‐Ki , Lui Ka‐Wing , Sze Yeung‐Sing , Lee Yiu‐Kee , Yuen Ka‐Sing , Cheung Kwok‐Fai
Published: March 2003

Laparoscopic surgery burst into the surgical scene in the late 20th century and completely changed the art, craft and scene of surgery in a most dramatic fashion. With the dawn of a new century, much of the pioneering literature is now invaluable surgical relics. A comprehensive review of publications from Fellows of the College of Surgeons of Hong Kong prior to the year 2000 reveals many significant innovations in major fields of surgery: a rich legacy worthy of a permanent, orderly record in the Annals of the College. Some of the novel techniques proposed therein have stood the test of time and have now become a standard of care worldwide.
EFFECTS OF PRESSURE GARMENT ON PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY — A PROSPECTIVE RANDOMIZED TRIAL
Authors: Lam C.Y.W. , Lim B.H. , Chiu P.W.Y. , Lee S.W. , Wu M. , Chow T.L. , Kwok S.P.Y.
Published: March 2003

Introduction: The treatment of choice for breast cancer is modified radical mastectomy or in selected case breast conserving surgery. Typically, patient will have a long hospital stay after surgery due to the collection of lymph. Premature removal of drain will incur seroma formation and may predispose to wound infection. Review of literature shows that there has not been adequate address to this condition, particularly the use of pressure garment in reducing lymph output. We report our experience in an interim analysis of a randomized controlled study. The aim of the study is to evaluate the effects of pressure garment on early removal of drains, shortening of hospital stay and reducing the incidence of seroma formation.

Methodology: From September 1999 to November 2000, 44 consecutive patients undergoing modified radical mastectomy for breast cancer were invited to participate in this study. Our occupational therapist arranged for tailor made pressure garments. Soft foam mimicking the external mammary prosthesis was fashioned so that appropriate pressure was applied on to the operative site to prevent lymph accumulation. They were randomized into two groups (1) with pressure garment (2) without pressure garment. The single surgeon performing the mastectomy was blinded until the completion of surgery when the result of randomization was sought from the principal investigator. The occupational therapist inspected daily to ensure the vest was filled satisfactorily. OPD assessments were arranged at 2 weeks and 8 weeks.

Results: (range in parentheses)

Conclusion: Use of breast pressure garment did not prevent seroma formation but reduced the volume of drainage and facilitated early removal of drains resulting in a significant reduction in the length of hospital stay of 2.7 days. Such breast vest has great impact on the hospital economy.
VENTRICULOSTOMY‐RELATED CEREBROSPINAL FLUID INFECTIONS: THE EFFECT OF CATHETER EXCHANGE. A RANDOMIZED CONTROLLED CLINICAL TRIAL
Authors: Wong G.K.C. , Poon W.S. , Wai S.
Published: March 2003

Introduction: External ventricular drains (EVD) are used for intracranial pressure monitoring and temporary cerebrospinal fluid drainage in neurosurgery. Cerebrospinal fluid infection is the major complication. Previous prospective epidemiological study from Mayhall (1) had recommended that the EVD should be changed every 5 days to reduce CSF infection. However, subsequent different retrospective series had yielded conflicting results.

Hypothesis: The aim was to test whether the practice of exchange of EVD every five days could reduce the CSF infection rate and subsequently improve outcome in terms of ICU stay, hospital stay, 3‐month outcome and mortality.

Method: We carried out a randomized controlled clinical trial between 11/1998 and 11/2000. 103 patients who needed EVD for more than 5 days and had no evidence of CSF infection on presentation were included. The patients were randomized between change (every five days) and no change of external ventricular drain.

Results:

Conclusion: The practice of regular exchange of EVD did not reduce CSF infection rate and did not improve outcome. This is in agreement with the current thinking that CSF infection mainly originated from the procedure of ventriculostomy. The associated high cost with regular exchange of EVD (operations and new catheters) did not seem to be justified. Thus, the practice of regular exchange of EVD should be abandoned.

(1) Ventriculostomy‐related infections: A prospective epidemiological study. Mayhall CG et al. New England of Journal of Medicine 310(9): 553–559, 1984.
INCIDENCE, DISTRIBUTION AND MECHANISMS OF MICROSATELLITE INSTABILITY IN DIFFERENT COLORECTAL CANCER AGE GROUPS
Authors: Yiu R. , Qiu H. , Lee S. , Rothenberger D.A. , García‐Aguilar J.
Published: March 2003

The increase in the incidence of colorectal cancer (CRC) is higher for proximal than for distal tumors. As microsatellite instability (MSI) is a feature of proximal tumors, we hypothesize that an increase in MSI tumors may account for the age‐related proximal shift in CRC.

Methods: A representative sample of 230 CRCs from 3 age groups was selected from a CRC database. MSI was determined by PCR. MLH1 and MSH2 expression was determined by immunohistochemistry, and the methylation of the MLH1 gene promotor (PM) by methylation‐specific PCR.

Results: MSI tumors became more frequent (p < 0.01 chi square) and more proximal in distribution (p = 0.01 loglinear) in the oldest age group. MSI was associated with loss of expression of MSH2 in the young age group. PM and inactivation of MLH1 increased with age.

Conclusion: MSI tumors became more frequent and proximal in older patients. This trend was associated with differences in the underlying mechanisms responsible for the MSI phenotype.
THE EFFECT OF SCHEDULED REPEAT ENDOSCOPY ON PEPTIC ULCER REBLEEDING—A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Chiu P.W.Y. , Lam C.Y.W. , Lee S.W. , Kwong K.H. , Lam S.H. , Lee D.T.Y. , Kwok S.P.Y.
Published: March 2003

Aim: Recurrent bleeding after initial haemostasis in peptic ulcer haemorrhage is an important factor that directly related to increased mortality. Conflicting reports have been published concerning the effectiveness of scheduled repeat endoscopy on ulcer rebleeding. We investigate the use of scheduled repeat endoscopy with subsequent further therapy in peptic ulcer bleeding.

Method: From August 1999 to January 2001, we prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel or adherent clot into two groups. Endoscopic therapy was standardized to be adrenaline injection and heater probe application. One group received scheduled second endoscopy 16–24 hours after initial endoscopic haemostasis (Group A), and further therapy applied if endoscopic stigmata persist as above. The other group received close observations (Group B). Those patients in the two groups that develop rebleeding will receive operation if further endoscopic therapy failed. The outcome measures include ulcer re‐bleeding, transfusion, length of stay, and mortality.

Results: After initial endoscopic haemostasis, 196 patients were randomized to two groups. 2 patients were excluded after randomization as pathology confirmed carcinoma of stomach. The results were analyzed by using either Chi square or student t tests.

Conclusion:

A scheduled repeat endoscopy with appropriate therapy 16 to 24 hours after initial endoscopic haemostasis reduce the amount of peptic ulcer rebleeding siginificantly.
Neck dissections: Its anatomy, indications, history and current terminology
Authors: To Edward Wai‐Hei , Pang Peter Chi‐Wang
Published: March 2003

This paper provides an overview of the anatomy of the neck lymph node distribution; indications, history and current terminology of various types of neck dissections and the therapeutic applications for different primary head and neck malignancy.
Sentinel node biopsies in breast cancer
Authors: Ng Kelvin Kwok‐Chai , Chow Louis Wing‐Cheong
Published: March 2003

Axillary lymph node status is an important prognostic factor for early breast cancer. As traditional axillary lymph node dissection is associated with a relatively high rate of mobidity, a less invasive procedure, sentinel lymph node biopsy, is being developed which aims to accurately predict the axillary nodal status and, thus, act as a guide to subsequent treatment. This new technique has a low complication rate and running costs. Although initial results are encouraging, the methodology has not been standardized across all centres. Current large‐scale studies should determine whether it is a suitable replacement for traditional axillary lymph node dissection.
Cognitive dysfunction after cardiopulmonary bypass
Authors: Yong Jamy Lap , Chui Wing‐Hung , Chiu Shui‐Wah , Cheung David Lik‐Ching
Published: March 2003

Cognitive dysfunction remains a significant complication after cardiopulmonary bypass, despite continuous improvement in the overall outcome in open‐heart surgery. Embolization of the atheromatous material, most notably during removal of the aortic clamp, is a major cause. Strategies have been developed to minimize cerebral embolization. Modified surgical techniques include the use of hypothermic circulatory arrest, venting of the left ventricle, minimizing aortic manipulation, and the use of epiaortic ultrasound to locate and avoid trauma to the aortic atheromatous plaque. Use of an intra‐aortic filter has been shown recently to reduce intraoperative cerebral embolic events and improve postoperative neurocognitive outcomes. Off‐pump coronary artery bypass technique has also been claimed to have lower neurological complications, which is probably attributable to the avoidance of aortic cannulation and cardiopulmonary bypass. Its role on cerebral protection is, however, debatable.

Chinese Abstract

imageimage
Seasonal variation in trachoma and bush flies in north‐western Australian Aboriginal communities
Authors: Da Cruz Lyndon , Dadour Ian R , McAllister Ian L , Jackson Alistair , Isaacs Tim
Published: March 2003

Background: Among younger age groups trachoma (Chlamydia
trachomatis) has been identified as a major cause of morbidity
in Australian Aboriginal communities. North‐western Australia has
two seasons, referred to as the wet and the dry, and until recently
most trachoma screening programmes were conducted during the dry season.
This study compared the prevalence of trachoma between three Aboriginal
communities, two in the west and one in the east Kimberleys with
differences in adult bush fly (Musca vetustissima) populations between the wet and dry seasons.

Methods: All preschool and school‐aged children in each community were screened for trachoma in February and July 1996 using the World Health Organization method for clinical assessment of trachoma. Flies were trapped fortnightly from September through to May (inclusive) using a wind‐orientated fly trap.

Results: Two communities in the west Kimberleys had a significantly higher rate of trachoma during the wet season (14−59% in dry season compared with 46−69% in wet season). One community showed no difference but this was probably due to the reduced re‐screening rate. Further­more, it was demonstrated that fly populations are so low during the dry season that they were untrappable; however, populations of bush fly significantly increased during the wet season (ranging from 6 to 146 flies per hectare per month).

Conclusions: If bush fly populations are correlated with increased levels of trachoma, then measures aimed at augmenting public health plans for bush fly control may decrease the cross‐infection rate. Additionally, based on the results of this study, wet season trachoma screening trips should be considered.
Population‐based assessment of refractive error in India: the Andhra Pradesh eye disease study
Authors: Dandona Rakhi , Dandona Lalit , Srinivas Marmamula , Giridhar Pyda , McCarty Catherine A , Rao Gullapalli N
Published: March 2003

Purpose: To assess the prevalence, distribution, and demographic associations of refractive error in the population of the southern Indian state of Andhra Pradesh.

Methods: From 94 clusters in one urban and three rural areas of Andhra Pradesh, 11 786 persons of all ages were sampled using a stratified, random, cluster, systematic sampling strategy in the Andhra Pradesh Eye Disease Study, a population‐based cross‐sectional study. A total of 10 293 people underwent an interview and detailed dilated eye examination. Refraction was performed by ophthalmic personnel trained in the study procedures. Objective refraction under cycloplegia was assessed for participants ≤ 15 years of age and subjective refraction for those > 15 years of age. Myopia was defined as spherical equivalent worse than ‐0.50 D and hyperopia as spherical equivalent worse than +0.50 D.

Results: In the participants ≤ 15 years of age, the prevalence of myopia was 3.19% (95% confidence interval [CI] 2.24−4.13%) and of hyperopia was 62.62% (95% CI 57.10−68.13%). In this age group, myopia increased with increasing age and was more prevalent in the urban study area, and hyperopia prevalence was greater in the participants < 10 years of age. In participants > 15 years of age, the prevalence of myopia was 19.45% (95% CI 17.88−21.02%) and of hyperopia was 8.38% (95% CI 6.91−9.85%). Myopia and hyperopia increased with increasing age. Myopia was more common in males, those with education higher than class 12, those with nuclear cataract, and those living in rural study areas. Hyperopia was more common in females, those with any level of formal education, and those living in the urban area and in the well‐off rural study area.

Conclusions: There is significant refractive error in this population. These data on the distribution and associations of refractive error can be useful for the planning of refractive eye‐care services.
Our responsibility in a developing world: from ethics to pragmatism
Authors: La Nauze Jamie
Published: March 2003

If development is defined as a process of enhancing human capabilities, that is, to expand choices and opportunities so that each person can lead a life of respect and value, then poverty is the deprivation of these capabilities. Nobel Laureate for Economics, Amartya Sen, states: ‘as people who live − in a broad sense − together, we cannot escape the thought that the terrible occurrences that we see around us are quintessentially our problems’. This year’s Council Lecture examines issues of individual and institutional responsibility in a developing world. Aspects of development relevant to ophthalmology are discussed and a review of Australian efforts undertaken. With a view to encouraging Fellows to take a more active role in development, it is demonstrated that there are a range of contributions that can be made. Appropriate practice models are explored and a strategy for College involvement presented.
Extending that little bit further
Authors: McDonald By Tein
Published: March 2003

Two long‐term practitioners in restoration extension reflect on how far we have come with remnant vegetation management in rural southern NSW — and how far we have yet to go
Effect of fire on the topsoil seed banks of rehabilitated bauxite mine sites in the jarrah forest of Western Australia
Authors: Smith By Martin A. , Loneragan William A. , Grant Carl D. , Koch John M.
Published: March 2003

Summary Germinable seed stores of 5‐ and 8‐year‐old rehabilitated bauxite mine pits in south‐west Western Australia were assessed before and after burning. These seed stores were compared to those of adjacent unmined Jarrah (Eucalyptus marginata) forest, to identify at what age fire can be reintroduced, in order to measure restoration success and reduce fire hazard. Soils were sampled in early summer (before fire) and late autumn (after fire). Before fire, the mean topsoil seed bank of 5‐year‐old sites was 2121 seeds per m2 while 8‐year‐old sites had a mean of 1520 seeds per m2. Only the 5‐year‐old sites were significantly different from the forest mean of 1478 seeds per m2 for the same season. After summer burns (and possibly due to seasonal effects) topsoil seed banks of rehabilitated areas (sampled in autumn) decreased by an average of 53 per cent. Topsoil seed banks of 5–8‐year‐old sites were resistant to lower intensity burns, with 362 seeds per m2 of native species surviving mild burns and 108 seeds per m2 of native species surviving after an intense summer fire. The topsoil seed reserve of 5–8‐year‐old rehabilitated areas had a high proportion of annual weed species while the forest sites had high levels of subshrubs and native annuals. Low‐intensity burns did not alter the composition of life‐forms in the soil seed bank, while intense burns favoured annual weed and shrub species. The results indicate that it is not appropriate to introduce fire to rehabilitated areas before 8 years, due to limited fuel reduction benefits and possible adverse effects on obligate seeding species. The large proportion of weed species in the soil seed bank of young rehabilitated areas is a concern, and remains a major consideration for future disturbance of these areas.
Translocation of Plains Rice‐flower (Pimelea spinescens ssp. spinescens), Laverton, Victoria
Authors: Mueck By Stephen G.
Published: March 2003

Summary The Department of Defence established three reserves at Laverton Airbase (now the Westpoint Business Park) prior to its sale to conserve nationally significant species and grassland values. These reserves excluded approximately 30 per cent of the largest known population of Plains Rice‐flower (Pimelea spinescens ssp. spinescens), an endangered Victorian endemic. These plants were not included in a reserve because they occurred in a small area relatively remote from intact grassland. Rather than accepting the eventual destruction of these plants, two translocation techniques were used to salvage as many plants as possible outside the reserves before the sale of the property was complete. First, a nursery population of approximately 100 plants was established from cuttings for later replanting into the reserves. Second, plants were excavated within blocks of soil and moved into a nearby reserve using two techniques. Plants were moved either in a specially constructed steel box or by using a tree spade. These methods moved a total of 93 and 129 plants, respectively. After approximately 2 years, the survival of the translocated plants was > 60% and the process was considered successful. Translocation using the steel box was relatively inefficient and generated a considerable amount of soil disturbance. Use of the tree spade was the preferred technique. Ongoing ecological management of the site follows an established management plan and is considered essential for the long‐term survival of the translocated plants and other nationally significant conservation values present.
Colonization by alpine native plants of a stabilized road verge on the Bogong High Plains, Victoria
Authors: McDougall By Keith L.
Published: March 2003

Summary Although many native species are now used in the revegetation of soil disturbances in Australian alpine areas, exotic species were, until recently, the only components of seed mixes. The use of exotic species and fertilizer was justified by their availability and low cost, and the prediction that native species would replace the exotic sward, presumably once soil nutrient levels dropped to those found in native vegetation. There was no apparent regard for the invasive capacities of the exotic species used. An investigation of a road verge on the Bogong High Plains, revegetated with a mixture of exotic species in the late 1950s, has shown that colonization by native plants can be very slow. Although many native species had colonized by 1993, exotic species still provided 50% of the cover. Agrostis capillaris accounted for most of this. The major native colonizers were Carex spp., Colobanthus affinis, Euchiton spp., Leptinella filicula, Poa hiemata, Ranunculus victoriensis and Scleranthus biflorus. Poa hiemata provided by far the most cover of the native colonizers. There have been considerable increases in the cover and number of native species on the verge since 1989. Cattle grazing and trampling are likely to have limited colonization of native plants prior to the removal of livestock in 1991. Recommendations are made on approaches to future revegetation in the alpine area.
Corneal transmissibility of diode versus argon lasers and their photothermal effects on the cornea and iris
Authors: Chew Paul TK , Wong Jun Shyan , Chee Caroline KL
Published: March 2003

Purpose: Diode laser (810 nm) may possess theoretical advantages over the argon blue‐green laser (488 nm) for iridotomy/iridoplasty in an eye with oedematous cornea, such as the acute angle‐closure glaucoma (AACG) patient, because of better diode laser tissue penetration in opaque media. We assessed the transmissibility of diode and argon lasers through corneas of varying clarity and evaluated the histopathological features of cornea and iris burns produced by these lasers.

Methods: The transmission of diode and argon lasers through human donor corneal buttons of three grades of clarity – clear, intermediate, and hazy – were compared. Corneal buttons of these varying levels of clarity were also treated with argon and diode lasers, with the beams deliberately focused onto the mid‐stroma to assess their photothermal effects. Exposed pigmented irides from whole human eyes were treated directly with argon and diode lasers. The lasers were delivered via slit‐lamp systems and the energy settings used were 1000 mW for argon and 980 mW for diode; spot sizes for both lasers were 100 μm, with exposure durations of 0.1 s. Light microscopy studies of these tissues were performed.

Results: Transmissibility of diode laser in clear, intermediate, and hazy corneas were 89, 87 and 85% respectively and was significantly superior to argon laser (78, 73 and 70% respectively; P < 0.001, paired Student’s t‐test). Diode laser did not produce morphological changes in all three grades of corneas whereas argon‐laser‐treated hazy corneas showed photothermal damage. Both lasers produced deep iris burns, with the diode laser tending to produce deeper burns.

Conclusion: Our findings suggest that diode laser may be the ideal laser for iridotomy/iridoplasty in the AACG patient with hazy cornea.
The New Zealand cataract and refractive surgery survey 1997/1998
Authors: Elder Mark , Tarr Ken , Md David Leaming
Published: March 2003

Background: This study documents the current practice for cataract and refractive surgery in New Zealand.

Method: A postal questionnaire was distributed in late 1997 to all consultant members of the Ophthalmological Society of New Zealand that were resident in the country at that time. Most questions were identical to the 1997 survey of the American Society of Cataract and Refraction Surgeons (ASCRS) to enable a comparision.

Results: There were 98 returns from 101 surveys distributed. Of the returns, 72 performed cataract surgery, 23 performed PRK and 11 performed LASIK. ASCRS members did more refractive surgery than did New Zealanders: 28 versus 1% of 1–5 RK per month, 7 versus 1% of 1–2 clear lens extractions per month and 85 versus 51% had access to an excimer laser. For cataract surgery, ASCRS members used more topical anaesthesia (30 vs 5.5%), used no sutures more often (73 vs 51%), used more preoperative antibiotics (76 vs 26%) and used fewer injections of antibiotic/steroids (38 vs 61%). Otherwise the two groups were broadly similar.
Intravenous pulse methylprednisolone in the treatment of uveitis associated with multiple sclerosis
Authors: Wakefield Denis , Jennings Angela , McCluskey Peter J
Published: March 2003

Purpose: To demonstrate the safety and effectiveness of intravenous methylprednisolone (IVMP) in the treatment of uveitis in association with multiple sclerosis (MS).

Methods: Uveitis is an unusual manifestation of MS that may be severe, chronic and require systemic immunosuppression therapy. High‐dose IVMP has previously been shown to be effective in the treatment of inflammatory eye disease and MS. Eight episodes of uveitis in five patients with MS were treated over a 10‐year period in an open, uncontrolled trial. Two patients had chronic anterior uveitis, one patient had bilateral panuveitis and two patients had intermediate uveitis.

Results: All patients responded to IVMP with evidence of a decrease in intraocular inflammatory activity and improved visual acuity (VA) within 2 weeks of commencing treatment. There were no severe ocular or systemic steroid side effects.

Conclusions: Intravenous methylprednisolone is an effective, well‐tolerated form of therapy for uveitis in patients with MS.
Change in central corneal thickness following laser in situ keratomileusis for myopia
Authors: Feltham Mark H , Stapleton Fiona
Published: March 2003

Central corneal thickness alterations may cause residual refractive errors following laser in situ keratomileusis (LASIK). This study reports associations between central corneal thickness alterations and residual refractive error following uncomplicated LASIK. Ninety‐one myopic patients with a mean refractive correction of –3.91 ± 3.2 DS / –0.66 ± 0.3 DC were evaluated. Central corneal thickness was measured prior to, during and following surgery and 2 months later using ultrasound pachometry. Results indicate increased tissue removal (94 ± 33 μm; mean ± SD) compared to the nominal Nidek value (52 ± 24 μm, P < 0.001). Twenty‐four hours later the tissue removal was 46 ± 27 μm. There was no association between altered central corneal thickness and ablation depth (r = 0.058, P = 0.454). Central corneal thickness change was inversely proportional to residual refractive error (r = –0.364, P < 0.01). Increased tissue removal may occur due to rapid stromal dehydration. Central corneal thickness changes between 24 h, and 2 months after surgery were constant over a range of ablation depths, which may partly explain the stability of LASIK procedures over a range of corrections.