bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burnout in emergency physicians and trainees in Australasia
Authors: Goh Leong , Cameron Peter A , Mark Paul 
Published: March 2003

Abstract Objective: To measure the prevalence of burnout and potential cases of psychiatric disorder among emergency physicians and advanced trainees of emergency medicine in Australasia. Methods: A postal survey of all Fellows and advanced trainees of the Australasian College for Emergency Medicine using the Maslach Burnout Inventory and General Health Questionnaire‐28 was performed. Results: The survey showed that 71.8% of respondents had moderate to high levels of emotional exhaustion, 69.9% had moderate to high levels of depersonalization and 48.7% had moderate to low perception of personal accomplishment. A General Health Questionnaire‐28 score of 6 or more, indicating potential cases of psychiatric disorder, was seen in 26.8% of respondents. Burnout was correlated with male gender, trainee status, longer working hours, weekend shifts, shift work, work dissatisfaction, self‐report of feeling stressed and a desire to stop working in the emergency department within 10 years. Conclusions: There are emergency physicians and advanced trainees of emergency medicine working in emergency departments suffering from considerable burnout with a risk of psychiatric disorder. Those with burnout are likely to consider stopping work in the emergency department within 10 years. Interventions to improve the wellbeing of these doctors should be considered.
Neurogenic pulmonary oedema
Authors: Rehman Habib U 
Published: March 2003

AbstractAlthough neurogenic pulmonary oedema is an uncommon condition, it is found in 20% of victims with severe head injury. The onset is typically rapid with development of dyspnoea, cyanosis and hypoxia suddenly and unexpectedly after an intracranial injury. The pathogenesis is not entirely clear, but both increased hydrostatic pressure and capillary permeability are incriminated. It is important to differentiate neurogenic pulmonary oedema from aspiration pneumonia, because the treatment of the two conditions differ. A combination of measures to reduce intracranial pressure, optimize body oxygenation, decrease pre‐ and after‐load and improve cardiac contractility is the mainstay of treatment. Mortality is high despite these measures.
Recent advances in the management of late paracetamol poisoning
Authors: Jones Alison L 
Published: March 2003

AbstractManagement of early paracetamol poisoning is dependent on prompt administration of N‐acetylcysteine to patients whose plasma concentrations of paracetamol exceed the normal‐risk or high‐risk treatment lines. Paracetamol poisoning presenting after 15 h since ingestion, especially as fulminant hepatic failure, requires meticulous supportive care of organ dysfunction. The putative mechanisms of action of N‐acetylcysteine and its practical use are discussed. The best prognostic marker for paracetamol poisoning in ‘established hepatotoxicity’ is the prothrombin time. Indications for liver transplantation in paracetamol poisoning and exclusion criteria are also discussed.
Complex humanitarian emergencies: A major global health challenge
Authors: Brennan Richard J , Nandy Robin 
Published: March 2003

AbstractComplex humanitarian emergencies have been a major political, security and public health feature of the post‐Cold War world. These man‐made disasters account for more morbidity and mortality than all natural and technological disasters combined. In order to deliver effective aid during complex humanitarian emergencies, international relief agencies must have a solid understanding of the political and social climates in which they are operating. In addition, they should base their health interventions on objective epidemiological data, especially standardized rates of morbidity and mortality. Most deaths during complex humanitarian emergencies are due to preventable causes, especially increased rates of infectious diseases malnutrition and violent trauma. The most appropriate health interventions are therefore based on the models of public health and primary health care, emphasizing disease prevention and health promotion. The field of humanitarian assistance has become increasingly professionalized in recent years, with its own professional standards, literature, research agenda and training opportunities. It is an unfortunate reflection on the current state of international affairs that the number of complex humanitarian emergencies and the enormous levels of suffering associated with them are unlikely to decline in the foreseeable future. See Commentary, page 143.
Massive overdose with controlled‐release carbamazepine resulting in delayed peak serum concentrations and life‐threatening toxicity
Authors: Graudins Andis , Peden Guy , Dowsett Robert P 
Published: March 2003

AbstractIntroduction: Peak serum levels following overdose with immediate‐release formulations of carbamazepine have been reported to occur up to 2 days postingestion. We report a case of poisoning with carbamazepine controlled‐release resulting in peak levels 96 h postingestion.Case Reports: A 31‐year‐old female presented following a suspected polypharmacy overdose. She was haemodynamically stable with a Glasgow Coma Scale score of 3 and was endotracheally intubated in the emergency department. A single‐dose of activated charcoal was administered on admission and her neurological status improved gradually. Results of qualitative urine drug screen available 24 h postadmission to the intensive care department revealed benzodiazepines and carbamazepine. The serum carbamazepine concentration at this time was 66 µmol/L (therapeutic 17–42 µmol/L). A history of therapy with controlled‐release carbamazepine was discovered. Repeat‐dose activated charcoal and whole‐bowel irrigation were commenced, but poorly tolerated. Serum carbamazepine levels continued to rise and gastrointestinal tract decontamination was ceased due to the presence of an ileus. By day 4, the serum carbamazepine concentration peaked at 196 µmol/L. This was associated with coma, generalized intermittent seizure activity and hypotension. Charcoal haemoperfusion was commenced due the presence of end‐organ toxicity and failed gastrointestinal tract decontamination. Serum carbamazepine concentrations fell from 176 to 106 µmol/L after 1 h of haemoperfusion and the patient was rousable to voice and could obey commands at this time. She confirmed ingestion of 300 Tegretol‐CR® (200 mg) on extubation and was discharged without long‐term sequelae.Conclusion: Unrecognized poisoning with controlled‐release carbamazepine has the potential to produce significant delayed carbamazepine toxicity and delayed peak serum carbamazepine concentrations. This may occur much later than previously reported with immediate‐release carbamazepine preparations.
A follow‐up study of electromagnetic interference of cellular phones on electronic medical equipment in the emergency department
Authors: Tat Fung Hin , Wah Kam Chak , Hung Yau Hon 
Published: March 2003

AbstractObjective: Considering the growing use of cellular phones and the fast appearance of new phone models, the electromagnetic interference of currently popular cellular phones on electronic medical equipment was tested.Methods: Three Personal Communication System cellular phones were put at different distances from multiple electronic medical devices, the interference effect was observed and the electromagnetic field strength measured with a spectrum analyser.Results: Only two small pieces of equipment, the CO2 airway adapter and the haemoglucostix meter were affected and then only when the phone was in very close proximity.Conclusion: Compared to the results of our study in 1997 testing Global System for Mobile Communication phones, the Personal Communication System phones generated less electromagnetic interference. However a much larger scaled study and an accurate international electromagnetic interference standard are recommended before any change in the current restrictive hospital policy on mobile phone usage could be recommended.
Adverse events and complications among patients admitted to hospital in the home directly from the emergency department
Authors: Liu Anita L , Taylor David McD 
Published: March 2003

AbstractIntroduction: The nature and incidence of adverse events and complications among patients admitted from the emergency department to hospital in the home has not been investigated. This study aimed to investigate this problem and make recommendations for prevention strategies.Methods: This was an explicit retrospective chart review of patients admitted from the emergency department directly to hospital in the home between 22 February 1995 and 1 September 2000. A data extraction document was designed specifically for the study and used to extract data relating to patient demographics, diagnosis, past medical history and outcome. The outcomes of interest include adverse events, complications and death. An adverse effect is defined as an unintended injury or complication that results in disability, death or prolonged hospital stay and is caused by health care management. These adverse events may occur prior to or during the index admission and may be noted during or after the index admission. A complication is defined as an undesirable outcome that occurs during the management but not causing disability, death or prolonged hospital stay.Results: Three hundred and fifty‐seven patients were enrolled (51.3% male; median age 52 years, range 16–96 years). Fifty‐five adverse events were identified: 49 adverse events (89%) were due to management prior to hospital in the home admission and six adverse events (10.9%) were directly attributable to hospital in the home management. This represents a rate of 1.7 adverse events per 100 hospital in the home admissions directly attributable to hospital in the home management. One hundred and eighteen complications were identified. Most complications were easily managed. Thirty‐one patients had unplanned re‐admissions and two patients died within 28 days of hospital in the home admission.Conclusion: Most patients admitted to hospital in the home from the emergency department were managed successfully. Few adverse events arose from hospital in the home treatment. Complications were common but minor in nature. Strategies for the prevention of phlebitis and constipation are recommended.
Trauma systems and emergency medicine
Authors: Rainer Timothy H , De Villiers Smit Pieter 
Published: March 2003

AbstractThe impact of trauma is a major public health challenge which is likely to escalate in the early 21st century. A systematic approach to this problem is required. This review explains the conceptual framework that defines a trauma system, gives a brief historical perspective and describes some of the essential elements of the system which should make a difference to patient outcome. Emergency physicians are well placed to play a leading role in the development and implementation of trauma systems.
Upper mini‐sternotomy for aortic valve operations
Authors: Wan Iyp , Izzat Mb , Sihoe Adl , Lee Tw , Wan S , Yim Apc 
Published: March 2003

Objective: To review our experience in using an upper mini‐sternotomy approach to aortic valve surgery. Materials and methods: Nineteen consecutive non‐selected patients (15 males, mean age 66 years) underwent isolated aortic valve replacement using an upper mini‐sternotomy approach. Twelve patients had isolated aortic valve stenosis, four patients had isolated aortic valve incompetence and three patients had mixed aortic valve disease. Results: In all cases, an excellent view of the aortic valve was obtained, aortic valve replacement was performed and no intra‐operative difficulties were encountered. Mean aortic cross‐clamp time was 83 min and mean cardiopulmonary bypass perfusion time was 97 min. All patients except two were extubated in the operating theatre and there were no major postoperative complications. Mean hospital stay was 4 days. There were no late complications. Conclusions: Aortic valve surgery can be performed, in the conventional manner and using standard surgical instruments, through an upper mini‐sternotomy with no alteration to cardiopulmonary bypass or myocardial protection routines.
Notable names in the history of surgery: 1. Percivall Pott (1714–1788) *
Authors: Fu Louis Kuo‐Tai 
Published: March 2003

Surgery today owes much to the services of early practitioners who made their advances as a result of wide clinical experience and compassion. This two‐part series explores the careers of Percivall Pott and William Arbuthnot Lane. Percivall Pott was born in 1714 in east London. Pott was apprenticed to Nourse of St. Bartholomew's Hospital at 15 years of age. After gaining licence to practise in 1736, Pott remained as surgeon to the hospital from 1745 till his retirement aged 73. After falling from his horse in 1756, Pott sustained a fracture of his leg, confining him to bed. During this time, he wrote on his own fracture, as well as hernia and head injuries. Several diseases are named after him, viz. Pott's fracture, Pott's puffy tumour, and Pott's disease of the spine. He was the first to describe cancer of the scrotum in chimney sweepers, as the earliest occupational cancer.
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Unplanned inpatient admissions in a day surgery service in Hong Kong
Authors: Tam Carven Yuen‐Fong , Lee Francis 
Published: March 2003

Objective: To evaluate the cause of inpatient admissions in the first 50 months of a day surgery service in Hong Kong.Method: A retrospective analysis of all unplanned inpatient admissions from the Day Surgery Centre in Tung Wah Hospital from November 1995 to December 1999 was undertaken. The causes of admission were classified and analysed to whether they might be avoidable.Results and conclusion: Two percent of the 1688 day‐patients required inpatient admission. The commonest cause of admission was extended surgery followed by retention of urine. None of the admissions was due to a major complication. Over one‐third of admissions might be avoidable.
The location of insulin receptors in bovine retina and isolated retinal cells
Authors: Gosbell Andrew D , Favilla Ian , Jablonski Paula 
Published: March 2003

Abstract Purpose: The binding of insulin to its cell‐surface receptor is the sole means by which the hormone influences cellular activity. The location of insulin receptors in bovine retina and on isolated retinal cells was investigated to determine the specific cells sensitive to insulin. Methods: Insulin receptors were located in frozen retinal sections prepared from enucleated bovine eyes, with polyclonal anti‐insulin receptor antibodies using an immuno­peroxidase method. Isolated cells were obtained by enzymatic and physical dispersion of bovine retinal tissue. Insulin receptors on isolated cells were located by a monoclonal anti‐insulin receptor antibody using an immunogold silver staining technique. Results: Insulin receptors demonstrated a widespread dis­tribution throughout the bovine retina, being present in all retinal layers. A particular association with the plexiform layers and Müller cells was identified in the frozen sections. Consistent with these findings, insulin receptors were predominantly located on dendritic processes of isolated retinal neurones and on Müller cells. Conclusions: The widespread distribution of retinal insulin receptors in the bovine retina supports the hypothesis that insulin has a role in regulating retinal activity. Insulin receptors associated with plexiform regions suggests that insulin may influence neural activity, while receptors on Müller cells indicate that insulin may have a role in metabolic or functional mechanisms in bovine retina.
Hypersensitivity reaction to intravitreal clindamycin therapy
Authors: Kim Peter , Younan Nancy , Coroneo Minas T 
Published: March 2003

AbstractA Caucasian woman presenting with recurrence of intra­ocular toxoplasmosis was given intravitreal clindamycin. She subsequently developed a hypersensitivity reaction in the form of a generalized erythematous rash. To the authors’ knowledge, hypersensitivity reactions to an antibiotic given by the intra­vitreal route have not previously been reported.
Intravitreal pefloxacin therapy in postoperative endophthalmitis
Authors: Kumar A , Sridhar M S , Dada T , Tewari H K , Gupta S K 
Published: March 2003

ABSTRACT Purpose: To study the efficacy of intravitreal pefloxacin in the management of suspected bacterial endophthalmitis. Methods: Twenty eyes with suspected postoperative bacterial endophthalmitis were given an intravitreal injection of pefloxacin (200 μg in 0.1 mL). If required the injection was repeated after 24 h. The main parameters evaluated were visual acuity, response to intravitreal therapy and any complications due to intravitreal pefloxacin. Results: Fourteen eyes (70%) responded to intravitreal pefloxacin therapy alone, while an additional pars plana vitrectomy was required in six eyes (30%). Nineteen eyes retained a visual acuity of 6/60 or better at 3 months after the initiation of therapy. A retinal detachment developed in one of the eyes which received intravitreal therapy. Conclusions: Intravitreal pefloxacin may be a useful alternative therapy in bacterial endophthalmitis.
Bilateral choroidal infarction in a patient with antiphospholipid syndrome: a case report
Authors: Ang Leonard Pek‐Kiang , Yap Eng‐Yiat , Fam Han‐Boh 
Published: March 2003

ABSTRACT Purpose: To report a case of bilateral choroidal infarction occurring as a complication of primary antiphospholipid syndrome. Methods: The case notes of the patient were reviewed. Results: A 25‐year‐old man with primary antiphospholipid syndrome and a previous history of deep vein thrombosis and pulmonary embolism, developed episcleritis and bilateral choroidal infarction, with deterioration of vision to 6/12 OD and counting fingers at 5 feet OS. Anticoagulation therapy with warfarin was administered and the patient’s vision gradually improved to 6/6 OD and 6/9 OS. Conclusion: Primary antiphospholipid syndrome is associated with thrombotic phenomena, which may affect the ocular arterial and venous vasculature. Therefore, a detailed ophthalmological examination is warranted in those patients who present with ocular symptoms and deteriorating vision. Retinal fluorescein angiography is valuable in confirming the diagnosis when in doubt, and in determining the extent of vessel occlusion.
Visually significant calcification of hydrogel intraocular lenses necessitating explantation
Authors: Fernando Glen T , Crayford Basil B 
Published: March 2003

ABSTRACT Purpose: To report two cases of HydroviewR (Storz H60M) hydrogel intraocular lens (IOL) opacification necessitating explantation. To analyse the explanted lenses and compare them with a new lens in order to determine the cause of opacification. Methods: Two cases are presented. Both patients complained of subjective decreases in vision approximately 1 year following uneventful cataract extraction and implantation of hydrogel lenses by the same experienced surgeon in the same institution. The reduced contrast sensitivity was thought to be due to failure of the hydrogel lenses which appeared opacified at the slit‐lamp. They were then exchanged for acrylic lenses. Pre‐ and postoperative contrast sensitivity testing was performed using the VectorvisionR CSV‐1000E instrument. A detailed comparative analysis of the opacified explanted lenses and a new lens was undertaken. This included surface microscopy, infrared spectral analysis, X‐ray elemental analysis, scanning electron microscopy, and electron microscopy of lens slices. Results: Lens exchange resulted in an improvement in subjective visual acuity (VA) and in objective contrast sensitivity testing. Analysis revealed deposits of calcium phosphate (hydroxyapatite) on the explanted lens’ surfaces. Conclusions: The surface of the HydroviewR H60M intraocular lens is subject to opacification as a result of calcium phosphate (hydroxyapatite) deposition, thereby limiting the patient’s visual outcome, and in some cases necessitating explantation. The reason for surface calcification requires further study.
Differential diagnosis of corneal oedema assisted by in vivo confocal microscopy
Authors: Grupcheva Christina N , Craig Jennifer P , Sherwin Trevor , McGhee Charles NJ 
Published: March 2003

ABSTRACTThe purpose of this study was to demonstrate microstructural differences between clinically similar, but aetiologically different, cases of corneal oedema in four subjects. In vivo confocal microscopy highlighted oedema of the basal epithelium, prominent nerve–keratocyte interactions, and typical ‘epithelialization’ of the endothelium in a case of iridocorneal endothelial syndrome; however, a similar microstructural appearance was observed in a case of presumed herpetic disciform keratitis. The latter diagnosis was subsequently revised on this basis. Confocal examination of Fuchs’ endothelial dystrophy demonstrated oedema of the basal epithelium, prominent wing cells, anterior stromal alterations, fibrosis of Descemet’s membrane and a typical ‘strawberry’ appearance of the endothelium. In contrast, in vivo microstructural examination of bilateral keratoconus with hydrops confirmed oedema mainly involving the epithelium and anterior stroma. In vivo confocal microscopy allows the clinician to observe the living cornea at a microstructural level and to better diagnose and differentiate borderline or unusual cases of corneal oedema.
The contribution of cone responses to rat electroretinograms
Authors: Nixon Peter J , Bui Bang V , Armitage James A , Vingrys Algis J 
Published: March 2003

ABSTRACTThe contribution of rods and cones to the scotopic electroretinogram (ERG) of small animals is unclear, with a recent report suggesting that the mouse has no cone a‐wave. The present study considered the contribution of cones to the ERG of the rat. Dark‐adapted Long Evans rats (n = 4) had ERG signals collected following a single flash, which stimulated rods and cones (mixed response), or a twin‐flash paradigm (short interstimulus interval, 1 s), which isolated cone responses. Rod signals were derived by digital subtraction of the cone signal from the mixed rod/cone ERG. The rat a‐wave was found to be dominated by rod responses but cone responses contributed substantially (45%) to post‐receptoral waveforms (b‐wave) at higher light levels.
Pathogenesis and intervention strategies in diabetic retinopathy
Authors: PhD Dao‐Yi Yu Md , PhD Stephen J Cringle , PhD Er‐Ning Su Md , PhD Paula K Yu , Fracp George Jerums , Fracp Mark E Cooper 
Published: March 2003

ABSTRACTDiabetic retinopathy is the leading cause of new blindness in the working‐age population. If improved treatment regimens are to be developed it is crucial that the underlying pathophysiological mechanisms responsible for diabetic retinopathy are better understood. The multifactorial nature of the many pathways implicated in diabetic retinopathy requires a very detailed approach to elucidate the key mechanisms involved and their interactions in order to develop logical strategies aimed at therapeutic intervention. Fortunately, the streptozotocin rat model of diabetes displays many of the morphological and functional changes to the retinal vasculature that are evident in human diabetic retinopathy. This study reviews some of the recent experimental work by the authors in the streptozotocin rat, compares their findings to the human pathology, and outlines potential new avenues for therapeutic intervention. In particular, the improved understanding of which layers of the inner retina have the most stringent metabolic demands has helped identify which retinal layers are most susceptible to metabolic or hypoxic/ischaemic insult. It is concluded that improved treatment outcomes may ensue if the therapy is targeted at the appropriate tissue at specific stages of the disease.