bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ketamine sedation for children in the emergency department
Authors: Priestley Stephen J , Taylor James , McAdam Catherine M , Francis Peter 
Published: March 2003

AbstractObjective:To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department.Method:A medical literature search was performed along with a review of existing ketamine‐use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty‐eight children aged 1.5–12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3–4 mg/kg) or i.v. (dose 1.00–2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases.Results:Onset of sedation was rapid (range 1–7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67–180 min) from time of drug administration. Side‐effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1–3 days after the sedation, no delayed adverse events were reported.Conclusion:Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department. See Commentary, page 7.
Asystolic cardiac arrest in Melbourne, Australia
Authors: Meyer Alastair DMcR , Bernard Stephen , Smith Karen L , McNeil John J , Cameron Peter A 
Published: March 2003

AbstractObjective:To study the outcome of victims of out‐of‐hospital cardiac arrest presenting to the Metropolitan Ambulance Service in asystole, in Melbourne, Australia.Methods:A retrospective case‐note review of all patients presenting to the Metropolitan Ambulance Service in asystole for 1997 was performed. Metropolitan Ambulance Service case notes and hospital records were examined to determine the presenting rhythm and the patients’ outcome.Results:In a 12‐month period, 778 patients met the entry criteria. Age mean was 67 years, 36% female, 64% male. Metropolitan Ambulance Service response time to scene time was a mean of 9.76 min. Resuscitation was commenced on 37% of patients. There was one survivor (0.12%).Conclusion:Adult victims of out‐of‐hospital cardiac arrest presenting as asystole should not receive treatment. See Commentary, page 145.
Gender issues in youth suicidal behaviour
Authors: Beautrais Annette L 
Published: March 2003

AbstractThere are gender differences in youth suicidal behaviour that are evident in childhood and persist throughout adolescence and young adulthood. In Western countries, young females are twice as likely as males to report suicidal ideation and suicide attempt behaviour. However, despite the fact that females make more suicide attempts, males are three‐ to fourfold more likely to die by suicide than females. This paper reviews the epidemiological evidence for gender differences in suicidal ideation, attempted suicide and completed suicide among young people and explores possible reasons for the observed differences. These reasons include differences in methods, intent, ascertainment, the cultural acceptability of suicide, psychopathology (including substance abuse, mood disorder, externalizing behaviours and propensity to violence), and psychosocial differences between males and females. While it is often suggested that gender differences in youth suicidal behaviour may be explained solely or predominantly by method choice, careful examination suggests that the issues are much more complex. In fact, females may enjoy more protection from suicide than males in a number of areas. See Commentary, page 8.
The use of rapid sequence intubation by ambulance paramedics for patients with severe head injury
Authors: Bernard Stephen , Smith Karen , Foster Shane , Hogan Phillip , Patrick Ian 
Published: March 2003

AbstractObjective: To determine the effects of rapid sequence intubation in patients with severe head injury performed by paramedics on a helicopter emergency medical service.Methods: The patient care records for patients with severe head injury who underwent rapid sequence intubation between November 1999 and February 2002 (inclusive) were examined. Data were extracted on the demographics of the patients, as well as the physiological changes before and after rapid sequence intubation.Results: There were 122 patients with severe head injury evaluated at the scene during the study period. Rapid sequence intubation was attempted in 110 patients and was successful in 107 (97%). Intubation was associated with improvements in systolic blood pressure, oxygen saturation and end‐tidal carbon dioxide levels, compared with baseline levels.Conclusion: Rapid sequence intubation in patients with severe head injury may be safely undertaken by helicopter‐based ambulance paramedics and is associated with improvements in oxygenation, ventilation and blood pressure. Further studies of this skill undertaken by road‐based paramedics are warranted.
Axillofemoral bypass for limb salvage
Authors: Lau () Hung , Cheng () Stephen Wing‐Keung 
Published: March 2003

Objective: To evaluate the early and long‐term outcomes of axillofemoral bypass performed at a tertiary referral vascular centre over a 17‐year period. Methods: From 1982 to 1998, 30 patients underwent axillofemoral bypass at the University of Hong Kong Medical Centre. A retrospective analysis of all these records was undertaken. Data on demographic features and results of surgical intervention were reviewed. Early outcomes were analyzed with respect to morbidity, mortality and improvement of clinical category (according to the Reporting Standards of the Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery). Long‐term outcomes were documented with respect to graft patency, patient survival and limb loss rates. Results: Clinical success was achieved in 22 patients (73%) after operation. The postoperative morbidity and mortality rates were 30% and 20%, respectively. The primary patency of axillofemoral bypass was 62%, 51% and 45% at 1, 2 and 3 years, respectively. Limb loss rate was 23% at 3 years. The cumulative survival rate of the study population was 67%, 57% and 57% at 1, 2 and 3 years, respectively. Conclusions: Axillofemoral bypass is a valuable limb‐salvaging surgical option for revascularization of lower limbs in high‐risk patients with aorto‐iliac occlusive disease.
A PROSPECTIVE RANDOMIZED STUDY TO EVALUATE CLINICALLY AND RADIOLOGICALLY THE EFFECTS OF DRAINS ON PATIENTS AFTER THYROIDECTOMY
Authors: Li A.C.N. , Leong H.T. 
Published: March 2003

Aim: To evaluate prospectively the usefulness of routine drainage of the neck following thyroid surgery and its effect on patient comfort.Method: Consecutive patients who underwent elective thyroid surgery were randomized to receive suction drainage or no drainage of the neck at the end of the operation. Drains were removed on the first postoperative day and all patients underwent sonographic examination of the neck to determine the dimension of the remaining haematoma. Pain relating to the operation was assessed at 6 hours post operation and on Day 1 by visual analogue scale (VAS). Pain caused by drain removal was also assessed similarly. Postoperative complications and the lengths of hospital stay were also recorded.Results: 60 patients were recruited and randomized, an equal number of patients with similar demographic characteristics were present in each group. The table below shows a summary of the results. The mean pain score for pain caused by drain removal was 3.1 (range: 0–6). There was no difference for complication rate and the postoperative lengths of hospital stay for the two groups.Conclusion: Routinely draining the neck for thyroid surgery not only failed to reduce the amount of postoperative haematoma and complication but also resulted in greater patient discomfort. Drains should therefore not be used routinely following thyroid surgery.
COX‐2 inhibitors and colorectal cancer chemoprevention
Authors: Tsu James Hok‐Leung , Ho Judy Wai‐Chu 
Published: March 2003

Despite recent advances in the understanding of its molecular genetics, colorectal cancer remains one of the worldwide leading causes of cancer death. Compounds with the potential to halt or reverse the carcinogenesis process are being studied as possible chemoprotective agents. Among these agents, non‐steroidal anti‐inflammatory drugs (NSAID) have been shown to significantly reduce colorectal cancer risk. A new generation of NSAID with specific inhibition towards the isozyme cyclo‐oxygenase 2 (COX‐2) has been introduced recently to clinical use with the aim of causing fewer adverse effects. Studies using these COX‐2 inhibitors have demonstrated a significant chemopreventive effect via various mechanisms. In a short‐term randomised controlled trial, these COX‐2 inhibitors have also shown encouraging results in patients with familial adenomatous polyposis (FAP). However, further studies are necessary before routine clinical use of this class of agents can be used in the management of FAP patients and other at‐risk population groups. Chinese Abstract imageimage
Clinical aspects of conjunctival melanoma
Authors: Layton Christopher , Glasson William 
Published: March 2003

AbstractConjunctival melanoma is a rare but important condition encountered in ophthalmology. This paper reviews conjunctival melanoma as a clinical entity, with particular emphasis on differential diagnosis, management and prognostic factors. Relevant references were located through a comprehensive search of articles published between 1980 and early 2001 on Medline, using both the WinSpirs and PubMed platforms. The references of these articles were then checked for further articles of relevance. The condition is uncommon and its presentation variable; therefore, relevant studies were found to suffer from small numbers of subjects. This may be the cause of the confusion that still surrounds the condition and its management.
Review of ecological restoration programme on subantarctic Macquarie Island: Pest management progress and future directions
Authors: Copson Geof , Whinam Jennie 
Published: March 2003

Summary The establishment of exotic species of vascular flora and vertebrate fauna on subantarctic Macquarie Island since its discovery in 1810 has resulted in major changes in the biota. A management programme aims to reduce the numbers of exotic plant and animal species and assist with the recovery of pre‐existing communities and processes. This paper reviews the integrated vertebrate pests management programme on Macquarie Island since 1974 and outlines future management considerations. As part of this programme, the responses of some native and exotic species of vascular flora and vertebrate fauna were monitored following control of European Rabbit (Oryctolagus cuniculus) numbers. Changes in the vegetation recorded over 10 years showed that approximately half of all the vascular species had benefited from rabbit grazing, including several which formed a major part of the rabbit’s diet. After rabbit control, some adversely affected plants responded rapidly to a reduction in grazing pressure while others will require an almost total cessation of grazing in order to re‐establish their former distributions. With the decrease in rabbit numbers it was also necessary to control Feral Cats (Felis catus) due to their increased predation on native burrow‐nesting birds. Feral Cat predation on introduced fauna also increased, one result of which was the eradication from the island of the introduced Weka (Gallirallus australis scotti). Reduced rabbit grazing is leading to re‐establishment of the native Tall Tussock (Poa foliosa) grassland and with it the spread of the introduced Ship Rat (Rattus rattus). This review indicates that an integrated approach to pest management, with monitoring of the responses of both target and non‐target species, is the most effective way to restore pre‐existing communities and processes.Key words grazing pressure, introduced species, predation, recovery, vertebrate pest management.
Co‐incubation of Acanthamoeba castellanii with strains of Pseudomonas aeruginosa alters the survival of amoeba
Authors: Cengiz Am , Harmis N , Stapleton F 
Published: March 2003

ABSTRACTEnhanced survival of Acanthamoeba castellanii has previously been reported following co‐incubation with a single strain of Pseudomonas aeruginosa. The aim of this study was to evaluate the impact of different strains of P. aeruginosa on amoebae survival. Four contact lens solutions were challenged with A. castellanii for between 6 and 24 h, and survival rates of amoeba were calculated. Subsequently, A. castellanii was co‐incubated with different strains of P. aeruginosa (strain 6294, an invasive isolate; 6206, a cytotoxic isolate; and Paer 001, a null isolate). Differences in amoeba survival over time between solutions for each bacterial strain were analysed. Non‐neutralized hydrogen peroxide was the most effective system against A. castellanii at all time points (P < 0.05). Survival rates were not different between multipurpose solutions and neutralized hydrogen peroxide. Co‐incubation with P. aeruginosa altered amoeba survival, and maximum survival occurred in the presence of the invasive strain of P. aeruginosa. Enhanced amoeba survival may occur in the presence of certain strains of Gram‐negative bacteria, and with certain types of contact lens disinfection systems.
Direct costs of blindness in Australia
Authors: Wright Suzie E , Keeffe Jill E , Thies Leslye S 
Published: March 2003

ABSTRACTThis study calculated the direct financial costs of blindness to the Australian government and community. Three case studies, representative of Australians with severely impaired vision, were used to calculate the annual costs associated with blindness. The costs include pensions, subsidies, concessions, equipment and services. Case 1 was a retired person with age‐related macular degeneration, case 2 a working aged person with diabetic retinopathy, and case 3 a school student with congenital vision impairment. Sensitivity analysis was used to show the possible range of costs for each case. For case 1, direct cost was $14 686 with a range from $9749 to $22 507. The cost for case 2 was $17 701 ranging from $9669 to $26 720. Costs associated with care and education of case 3 were $15 948 ranging from $5106 to $23 798. In addition to the social costs to a person who is blind, there are significant financial costs to the government and the community that will increase substantially with the ageing of the Australian population.
Association of presbyopic correction with changes in visual fields
Authors: Dimitrov Peter N , Nanjan Mukesh B , Taylor Hugh R , McCarty Cathy A 
Published: March 2003

ABSTRACTThe purpose of this study was to investigate the effect of presbyopic correction on changes in visual fields caused by an alteration in outflow of aqueous humour. Visual fields were compared before and after introduction of presbyopic correction in participants of the Melbourne Visual Impairment Project. Height and slope of the ‘Hill of Vision’ were assessed by calculating median thresholds in the four sets of three eccentric points. Analysis of 101 eyes in the study group and 101 eyes in the control group shows higher decrease of the ‘Hill of Vision’ height in the group of participants who started wearing presbyopic correction, than in the group without presbyopic correction (P = 0.02). Intraocular pressure measured irrespectively of participant’s accommodative activity was not significantly different between the two groups at both time points. These data suggest that the use of presbyopic correction is associated with changes in the visual field.
Ocular parameters in the subgroups of angle closure glaucoma
Authors: Sihota R , Lakshmaiah NC , Agarwal HC , Pandey RM , Titiyal JS 
Published: March 2003

ABSTRACT Purpose: This study was conducted to compare anatomical parameters, thought to be responsible for causing angle closure glaucoma (ACG), among eyes having acute, subacute or chronic ACG. Methods: Ninety consecutive patients diagnosed with a subgroup of ACG, and 30 age, sex and refraction matched controls, provided a total of 240 eyes for a prospective study. The refractive error, corneal diameter, keratometry, pachymetry, lens thickness and axial length were measured and the relative lens position was calculated. The data were analysed by paired t‐test,
ANOVA, signed rank test and multivariate analysis. Results: Acute ACG eyes were mildly hyperopic. All the ACG subgroups had similarly short eyeballs and a steeper corneal curvature compared to control eyes. Acute ACG lenses were thicker than all the other groups (P < 0.001), but all ACG eyes had thicker lenses than the controls. Corneal diameters and anterior chamber depths were decreased in acute and chronic ACG eyes compared with subacute ACG and controls (P < 0.001). The uninvolved fellow eyes in each subgroup differed from affected eyes only in having more posteriorly positioned lenses. Conclusions: There was a spectrum of anatomical variations seen in the subgroups of ACG. Acute ACG eyes expressed an extreme shift of anatomical features away from normal, especially, smaller corneal diameters, leading to a large mobile lens in an already crowded anterior segment. This predisposed them to a severe relative pupillary block, and to a form of ciliary block glaucoma. Chronic ACG eyes were less divergent from normal and therefore could have suffered a milder form of the same kind of angle closure, but over a more prolonged period. Subacute ACG eyes deviated least from controls, and therefore exhibited mild signs and spontaneous resolution. Further work is required to elucidate completely the pathophysiology that leads to ACG.
Brimonidine and postoperative pressure spikes in cataract surgery
Authors: Whitehouse Geoff 
Published: March 2003

ABSTRACT Purpose: To evaluate the efficacy of brimonidine in controlling postoperative pressure spikes following clear corneal cataract outpatient day surgery, in private practice in Australia. Methods: A prospective randomized trial was performed on 123 patients. Brimonidine 0.2% was instilled in the eyes 15 min prior to surgery, and intraocular pressure was checked 6 hours postoperatively. Results: Mean postoperative intraocular pressures at 6 hours were 30.33 mmHg in the treated group and 30.76 mmHg in the control group. Conclusion: Brimonidine 0.2% instilled preoperatively offered no significant reduction in postoperative intraocular pressure spikes.
Potential acuity meter results in cataract patients
Authors: Devereux Catherine J , Rando Angelo , Wagstaff Christine M 
Published: March 2003

ABSTRACT Purpose: To determine the ability of the potential acuity meter (PAM) to predict potential visual acuity through lenticular opacities in a group of cataract patients without significant other ocular pathology. Methods: This prospective study undertook PAM measurements on each eye of 84 subjects during preoperative hospital visits to either A Scan or Primary Care clinics. PAM results were compared to best corrected visual acuity findings obtained at least 6 weeks post‐cataract extraction. Results: Comparison of PAM result to visual outcome showed poor correlation (rho = 0.41, P = 0.0005). Using predictive estimates, 49% of subjects’ PAM results underestimated visual outcome as determined by a difference of greater than 2 Snellen acuity lines in these results. Factors such as preoperative vision level, cataract type and pupil dilation did not significantly influence the predictive power of the PAM. Preoperative pinhole results were also correlated with visual outcome (rho = 0.42, P = 0.0006). Vison in the fellow eye of subjects with 6/9 or better was correlated to the PAM result indicating a moderate to good predictive power in ‘normal’ eyes. Conclusions: PAM results were considered to be poor for a clinical test. The results of this study indicate that this instrument has only a limited usefulness as part of the standard preoperative examination in patients undergoing cataract extraction.
Random amplified polymorphic DNA analysis of Acinetobacter species isolated from worn contact lenses
Authors: Corrigan Karen M , Zhu Hua , Willcox Mark DP 
Published: March 2003

ABSTRACTThe purpose of this study was to explore the genotypes of Acinetobacter species and to compare the genotypes and phenotypes of the Acinetobacter isolated from contact lens wearers. Nineteen strains were used in the study, 13 were isolated from patients experiencing an adverse response event, and six strains were isolated from asymptomatic contact lens wearers. Random amplified polymorphic DNA and phenotypic analyses were carried out using commercially available kits. Random amplified polymorphic DNA analysis showed a higher discrimination power compared with the phenotypic analysis. The test strains were loosely clustered into six genotypic groups with no definite relation to any clinical events. These results indicate that many genotypes of Acinetobacter can cause adverse responses, and the initial source of the microorganisms rather than their clinical sequelae may determine classification.
Achromatic impulses unmask L‐ and M‐cone adaptive mechanisms
Authors: Zele Andrew J , Vingrys Algis J 
Published: March 2003

ABSTRACTThe mechanisms underlying the adaptive response for achromatic impulses seen on achromatic fields were investigated. Foveal thresholds were measured for a static probe‐impulse under two conditions of adaptation. Thresholds were obtained under gain‐clamped conditions after observers had reached steady‐state adaptation and with a probe‐flash paradigm. It was found that thresholds isolated on steady‐state fields cannot be modelled using a single mechanism. Likewise, the probe‐flash condition failed to reflect the response of a single mechanism. Both threshold functions showed distinct breaks occurring at about the same field luminance (approximately 1.0 log cd/m2). Optimum data fits required the incorporation of two mechanisms implying the existence of independent processes mediating detection. Chromatic isolation confirmed that differential adaptation had been unmasked in the long‐ and medium‐wavelength sensitive cone inputs to the achromatic channel.
Pretectal neurons responding to slow wide‐field retinal motion: could they compensate for slow drift during fixation?
Authors: Price Nicholas SC , Ibbotson Michael R 
Published: March 2003

ABSTRACTThe visual response properties are described of a group of retinal slip neurons in the wallaby pretectum, referred to as slow cells. Their responses to motion are direction‐selective: tempero‐nasal and naso‐temporal motion over the contralateral eye increase and decrease, respectively, the firing rate relative to the spontaneous level. Slow cells are maximally sensitive to image velocities from 0.08 to 10°/s. The present study focuses on slow cells that are maximally sensitive to image velocities below 1°/s. An interesting characteristic of 82% of slow cells is that once motion stops, the firing rate exhibits a same‐sign after‐response. This is characterized by a slow exponential return from the firing rate during motion to the spontaneous rate. The time constants of the after‐responses are independent of the temporal frequency, velocity, duration and direction of the motion stimulus. It is proposed that the neurons may assist the stabilization of eye position during fixation.