bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complaints from emergency department patients largely result from treatment and communication problems
Authors: Taylor David McD , Wolfe Rory , Cameron Peter A 
Published: March 2003

AbstractObjective: Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates.Methods: We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner).Results: In all, 2419 emergency department patients complained about a total of 3418 separate issues (15.4% of all issues from all hospital departments). Of these, 1157 complaints (47.8%) were received by telephone and 829 (34.3%) were received by letter; 1526 (63.1%) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non‐English‐speaking countries and very young or very old. One thousand one hundred and forty‐one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients.Conclusions: Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended. See Commentary, page 9.
A sting from an unknown jellyfish species associated with persistent symptoms and raised troponin I levels
Authors: Taylor David McD , Pereira Peter , Seymour Jamie , Winkel Kenneth D 
Published: March 2003

AbstractWe describe a patient stung by an unknown jellyfish species offshore in Far North Queensland. The sting caused immediate and severe pain, multiple whip‐like skin lesions and constitutional symptoms. The jellyfish tentacular nematocysyts were similar to, but distinct from, those of Carukia barnesi, a cause of the ‘Irukandji’ syndrome. The patient’s symptoms largely resolved over seven months and were associated with elevated cardiac troponin levels, in the absence of other evidence of cardiac disease. This case highlights the envenomation risks associated with marine recreation, and the need for critical evaluation of cardiac troponin assays and for further research in marine toxicology.
Determining the most effective level of TRISS‐derived probability of survival for use as an audit filter
Authors: Kelly Anne‐Maree , Nicholl Jon , Turner Janette 
Published: March 2003

AbstractObjective: To determine the most effective cut‐off of TRISS‐derived probability of survival (TRISS‐PS) for the selection of trauma deaths for audit, using a large sample of trauma deaths from the United Kingdom (UK).Methods: TRISS‐PS and avoidability of death (as judged by an independent peer review panel) were compared for a sample of 222 trauma deaths. Sensitivity, specificity and predictive values were calculated for the 0.5 screening cut‐off. ROC curves were derived to assess the ability of different levels of TRISS‐PS to identify avoidable deaths. Calculations were made for both the raw sample and the sample adjusted for the sampling method used.Results: For the weight‐adjusted sample, the sensitivity of TRISS‐PS greater than 0.5 for the detection of avoidable death is 80% (95% CI 61–91%), the specificity is 86% (95% CI 80–90%), PPV 42% (95% CI 29–56%) and NPV 97% (95% CI 93–99%). Twenty percent of avoidable deaths would have been ‘missed’ if the 0.5 level of audit filter had been used. Based on the same sample, the best cut‐off is at TRISS‐PS 0.33, with a sensitivity of 90% and specificity of 80%. It is estimated that this cut‐off would have selected 62 deaths for audit and failed to identify 2 out of 25 avoidable deaths.Conclusion: The previously accepted audit filter of TRISS‐PS of greater than 0.5 fails to identify a significant proportion of avoidable deaths. This study suggests that the most effective level of audit filter cut‐off of TRISS‐PS for the trauma system studied is 0.33. This level would identify 90% of avoidable deaths with 80% specificity. Similar ROC curve analysis could be used to determine appropriate TRISS‐PS cut‐offs for institutions or other trauma systems.
Acute methyl salicylate toxicity complicating herbal skin treatment for psoriasis
Authors: Bell Anthony J , Duggin Geoffrey 
Published: March 2003

AbstractWe present an interesting case of salicylism arising from the use of methyl salicylate as part of a herbal skin cream for the treatment of psoriasis. A 40‐year‐old man became quite suddenly and acutely unwell after receiving treatment from an unregistered naturopath. Methyl salicylate (Oil of Wintergreen) is widely available in many over the counter topical analgesic preparations and Chinese medicated oils. Transcutaneous absorption of the methyl salicylate was enhanced in this case due to the abnormal areas of skin and use of an occlusive dressing. The presence of tinnitus, vomiting, tachypnoea and typical acid/base disturbance allowed a diagnosis of salicylate toxicity to be made. Our patient had decontaminated his skin prior to presentation, limiting the extent of toxicity and was successfully treated with rehydration and establishment of good urine flow.
Blunt carotid artery injury
Authors: Nunnink Leo 
Published: March 2003

AbstractBlunt carotid artery injury is an uncommon injury with a potentially devastating outcome. Although treatment is often unhelpful for an established neurologic deficit, there is frequently a delay between the episode of trauma and the onset of neurology. This delay provides a window of opportunity where early detection and intervention may significantly improve outcome and prevent lifelong morbidity in a generally young trauma patient population. This paper will review the literature regarding incidence, outcome, treatment options and optimal methods of diagnosis for this lesion. The following synopsis of a case seen at Royal Perth Hospital Emergency Department illustrates several of the classical features of blunt carotid injury, including delayed presentation and pattern of associated injuries. The patient, a 19‐year‐old female, presented following a single vehicle motor crash. On arrival she had a Glasgow Coma Scale (GCS) of 14 with no focal neurologic deficit. Multiple injuries were identified, including a large scalp laceration, a compound fracture of the mandible, pneumothorax, sternal fracture, subcapsular haematoma of the liver, and a knee laceration. Initial computed tomography (CT) scan of the head was normal. Twenty hours after the motor vehicle accident the patient's conscious state deteriorated to GCS 9. Repeat CT head demonstrated changes consistent with a left middle cerebral artery infarct. Cerebral angiography revealed traumatic dissection of the left internal carotid artery with complete occlusion of the lumen just distal to its origin. After 13 days in the intensive care unit and 2.5 months in the rehabilitation unit, she was discharged with a persistent severe receptive and expressive aphasia, as well as a dense right hemiparesis. She is now living at home with community supports.
The district hospital emergency department: Why do parents present?
Authors: Cooper Carolyn , Simpson Judy M , Hanson Ralph 
Published: March 2003

AbstractObjective: To identify parental reasons for presenting their child to the emergency department and their expectations of the consultation.Method: Cross‐sectional survey of parents of children and adolescents aged 14 years and under who presented to the Fairfield Emergency Department over a 2‐month period.Results: A questionnaire was returned from 694 of 839 eligible presentations (83%), with 51% having an urgent triage and 26% being admitted. Proximity was nominated as the reason for choosing the Fairfield Emergency Department by 48%, 62% of presentations were self‐referred and 44% had already seen another doctor. An urgent triage was associated with parental expectation of admission or observation in the emergency department (OR 2.79 [95% CI: 1.98–3.94]).Conclusions: The majority of presentations to the district emergency department are self‐referred and it is chosen because of proximity. The majority of children do not require admission; however, parents often have expectations that observation and further investigation will occur prior to discharge from the emergency department.
Central cord syndrome following assault and subsequent resuscitation
Authors: Ryan Matthew 
Published: March 2003

AbstractFollowing physical assault, a 71‐year‐old male suffered apparent cardio‐respiratory arrest. Bystander basic life support was provided. Advanced life support including endotracheal intubation was subsequently provided. The patient sustained an injury to the cervical spinal cord, manifesting as central cord syndrome. Central cord syndrome is a rare complication of endotracheal intubation and there is no published description following physical assault. This case illustrates that determining precise causality with respect to cervical cord injury may be difficult following standard resuscitation procedures. The pathophysiology of central cord syndrome is reviewed and the possible mechanism in this case, which was the subject of considerable legal debate, is also examined.
Diagnosis of acute myocardial infarct with ventricular paced rhythm
Authors: Knott Jonathan 
Published: March 2003

AbstractManagement of acute myocardial ischaemia is dependent upon interpretation of the 12‐lead electrocardiogram. The presence of ventricular pacing and acute myocardial infarction makes electrocardiogram interpretation difficult. This may impact upon patient management if treating staff are unaware of the expected electrocardiogram morphology or do not have a rapidly available means to make the diagnosis. This case highlights the difficulty with diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm and demonstrates the electrocardiogram changes that occur with myocardial infarction.
Single centre experience of chronic rejection in liver transplantation
Authors: Akk Chui 
Published: March 2003

Objective: To review the Australian National Liver Transplantation Unit’s (ANLTU) experience with chronic rejection (CR) in liver transplantation (LTx) in order to establish a better management strategy. Materials and Methods: Clinical records and prospective data on the ANLTU database were reviewed. Statistical analysis was performed on microcomputer. Results: Between January 1986 and June 1997, 17 patients (6.4%) (9 male, 8 female) were diagnosed with CR at a median 0.83 years (0.21–6.33 years) after LTx. Prior to the diagnosis of CR, all had a background of increasingly cholestatic liver function tests. The total number of prior acute rejection episodes was 42 (mean 2.5, range 1–5) with 18 episodes (42%) being steroid resistant. Other co‐morbid factors included: cytomegalovirus infection 10 (58%); low levels of immunosuppression 7 (41%); and biliary complications 6 (35%). Mortality was high at 14 (82%). Conclusions: The outcome is poor in adults with CR, with or without re‐Tx. Efforts should be made to avoid septic complications that require lowering the dosage of immunosuppression. Early diagnosis and prompt treatment of acute rejection are recommended. In cases of early CR, conversion to FK506 regimen is worthwhile.
Preliminary study of rat liver transplantation from non‐heart‐beating donors
Authors: Li Hongwei , Yan Jiqi , Zhang Mingjun , Yang Weiping , Cai Weiyao 
Published: March 2003

Objective: The aim of this study was to investigate the tolerance of warm ischaemia of liver grafts from non‐heart‐beating donors (NHBD). Livers harvested from NHBD would greatly expand the donor pool for transplantation. However, sensitivity of the donor liver to warm ischaemia is a major obstacle to the successful use of livers from NHBD and the limit of non‐heart‐beating time in the donor remains unclear. Materials and Methods: Rat orthotopic liver transplantation was performed in 5 groups (groups 1–5) with non‐heart‐beating time in the donor ranging from zero to 15, 30, 45 and 60 min. The cardiac‐arrest time was counted from clamping the base of the donor’s heart to the beginning of cold flushing the liver. Graft pathological changes, hepatic function and the recipients’ survival rates in each group were compared. Results: With a stepwise increase of the non‐heart‐beating time from zero to 15, 30, 45 and 60 min in donors, the recipient 1‐week survival rates from groups 1–5 were 100%, 75%, 62.5%, 25% and 0%, respectively. The stepwise increase of non‐heart‐beating time significantly reduced recipient survival rates after 30 min. The recipients in groups 1–4 could survive more than 60 days. Conclusions: The liver is less sensitive to warm ischaemia than was formerly believed. Rat liver can be used for transplantation after cardiac arrest for up to 45 min with a chance of survival.
Clinical observation of the effect of CO2 pneumoperitoneum on haemorrheology
Authors: Wu Zhi‐Mian , Li Xiao‐Yuan , Chen Liu‐Hua , Chen Guo‐Tai , Chiu Philip Wai‐Yan 
Published: March 2003

Objective: To discuss the relationship between CO2 pneumoperitoneum and haemorrheology and the possibility of thrombosis caused by CO2.Material and Methods: We compared indices of haemorrheology just prior to operation, 5 min after anaesthesia and 30 min after inflation or operation, and 24 h after operation. The indices included low‐shear and high‐shear whole‐blood relative viscosity; plasma relative viscosity; red cell aggregation index; red cell filtration index; haematocrit; and blood gas analysis. We analysed the relationship between a variation in haemorrheology and CO2 pneumoperitoneum.Results: After pneumoperitoneum, blood viscosity and red cell aggregation index rises markedly and red cell deformity weakens markedly.Conclusion: Carbon dioxide pneumoperitoneum can cause an increase in blood viscosity, red cell aggregation and a weakening of red cell deformity, and may lead to thrombosis after laparoscopic surgery.
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Methodical placement of mesh during endoscopic extraperitoneal inguinal hernioplasty
Authors: Lau Hung , Lee Francis , Patil Nivritti Gajanan , Yuen Wai‐Key 
Published: March 2003

Endoscopic extraperitoneal inguinal hernioplasty has been gaining in popularity worldwide recently. Placement of mesh remains a technically challenging part of the procedure. This paper describes a systematic method for the placement of mesh during endoscopic inguinal hernioplasty. To broaden the endoscopic view and maximize working space, the mesh should be kept far from the telescope within the limited extraperitoneal space. Unfolding the mesh requires prior stabilization of the mesh at one point, to avoid uncontrolled migration of the whole mesh and subsequent loss of mesh orientation. Mastering the skill of two‐handed technique is essential for coordinated manipulation and expeditious mesh placement. Before concluding the procedure, a trial of deflation can help to ensure appropriate repositioning of the peritoneum without displacement of the mesh. Chinese Abstract imageimage
Pattern of head injury among the paediatric population: Experience of a local neurosurgical centre
Authors: Leung Kar‐Ming , Fong Dawson 
Published: March 2003

Objective:To review the pattern of head injury among the paediatric population.Method:The hospital records of all patients younger than 12 years of age who had been admitted to the Neurosurgical Department at Tuen Mun Hospital for head injury between January 1992 and June 1996 were reviewed. The demographic data, causes and location of injury, initial Glasgow Coma Scale, associating symptoms and signs, radiological findings, and outcome were analyzed.Results:A total of 1240 patients were registered, the male to female ratio being 1.7 : 1. Annual incidence was 1.7 per 1000 population, and 41% of patients were younger than 1 year of age. Fall was the commonest cause, accounting for 77.5% of the cases, followed by accidental blow (13.5%), and traffic accident (7.9%). Of theses cases, 1.9% had significant intracranial injuries, of which epidural haematoma accounted for 48% of this category.Conclusions:Recognizing the pattern of head injury among children helps to identify any high‐risk groups and environment, which will then help us to design more appropriate preventive measures. Chinese Abstract imageimageimageimageimage
Initial experience with stapled haemorrhoidectomy: A local report
Authors: Yau Kwok‐Kay , Chung Chi‐Chiu , Chan Eva Sze‐Wah , Li Michael Ka‐Wah 
Published: March 2003

Objective:Stapled haemorrhoidectomy is a new modality in the surgical treatment of haemorrhoidal disease and rectal mucosal prolapse. This paper aims at reporting the initial experience in a local institution.Method:From July 2000 to March 2001, a total of 17 patients underwent stapled haemorrhoidectomy, including 16 patients with third‐degree haemorrhoids and one patient with rectal mucosal prolapse. With the aid of a specially designed assessment form, data were collected during the inpatient period and at 4 weeks, 8 weeks and 12 weeks after the operation.Results:The median operation time was 18 min (range 5–45 min) with a median blood loss of 10 mL (range 0–100 mL). Only three patients required pethidine injection during the postoperative period; other patients could be managed with simple oral analgesic. Thirteen patients (76%) could be discharged on the second day after the operation (range 1–7 patients), and the median time off work was 9 days (range 1–21 days). Complications encountered were minor, and symptom control and functional outcome appeared superior to excisional haemorrhoidectomy.Conclusion:Stapled haemorrhoidectomy is safe. The improved postoperative pain and the reduced time off work are evident; however, long‐term outcomes still need further evaluation. Chinese Abstract imageimageimageimageimage
Colonoscopy in adult patients: A review of its indications and its yield in detecting colorectal neoplasia
Authors: Lee Janet Fung‐Yee , Ng Simon Siu‐Man , Yiu Raymond Ying‐Chang , Leung Ka‐Lau , Lau Joseph Wan‐Yee 
Published: March 2003

Objective: To review the yield and indications of colonoscopy in a surgical unit at the Prince of Wales Hospital, the result of which may help to select future patients for colonoscopy.Method: The records of 869 patients undergoing elective colonoscopy at the Prince of Wales Hospital within an 18‐month period were reviewed retrospectively. Exclusion criteria included the following: a personal history of colorectal malignancy or polyps, tumours or polyps detectable on rectal examination or rigid sigmoidoscopy, a positive physical examination suggestive of gastrointestinal malignancies, anaemia or positive faecal occult blood.Results: Per rectal bleeding was the most common indication for colonoscopy. Complete colonoscopy rate was 93.7% and abnormalities were reported in 338 patients. Forty‐three patients were found to have cancer whereby age, duration of symptoms, blood mixed with stool and abdominal pain were identified as independent predictive factors. Neoplastic polyps were confirmed in 200 patients. Old age and being male were the only factors predictive of neoplastic polyps.Conclusion: Although the majority of patients present with typical haemorrhoidal bleeding, colonoscopy should be considered seriously for elderly patients, especially those who are male. Chinese Abstract imageimageimageimageimage
Retinal neurodegeneration: early pathology in diabetes
Authors: Lieth Erich , Gardner Thomas W , Barber Alistair J , Antonetti David A 
Published: March 2003

ABSTRACTNormal vision depends on the normal function of retinal neurons, so vision loss in diabetes must ultimately be explained in terms of altered neuronal function. However, to date relatively little attention has been paid to the impact of diabetes on the neural retina. Instead, the focus of most research has been primarily on retinal vascular changes, with the assumption that they cause altered neuronal function and consequently vision loss. An increasing body of evidence suggests that alterations in neuronal function and viability may contribute to the pathogenic mechanisms of diabetic retinopathy beginning shortly after the onset of diabetes. This view arises from neurophysiological, psychometric, histopathological and biochemical observations in humans and experimental animals. The collective evidence from past and recent studies supports the hypothesis that neurodegeneration, together with functional changes in the vasculature, is an important component of diabetic retinopathy. The authors invite other investigators to include the neural retina as a component of their studies so that the pathogenesis of diabetic retinopathy can be understood more clearly.
Hypovitaminosis A in metropolitan Adelaide
Authors: Qureshi Salmaan H , Selva‐Nayagam Dinesh N , Crompton John L 
Published: March 2003

ABSTRACTHypovitaminosis A is a well‐recognized condition in many developing countries. However, in the developed world the diagnosis is frequently missed or delayed because of its rarity. A 67‐year‐old man from metropolitan Adelaide presented to us with gradual but severe bilateral visual loss. He had marked punctate epithelial keratopathy in both eyes. Hypovitaminosis was suspected because of his bizarre dietary habit, and this was confirmed by a combination of impression cytology of the ocular surface and biochemical testing of his venous blood. His vision responded dramatically to vitamin A supplementation. Hypovitaminosis A should be suspected in severe cases of ‘dry‐eye’, especially in those patients with unusual dietary habit or malabsorption.