bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nasal septal haematomas: A case series and literature review
Authors: Elcock Mark 
Published: March 2003

AbstractNasal septal haematomas are a rhinological emergency that occur as a rare complication of direct nasal trauma. This case report presents a series of five cases identified from the 838 cases of nasal trauma seen at the Gold Coast Hospital, Queensland, during 1996. The main presenting complaints were headache, nasal pain, nasal swelling, epistaxis, fever and, most commonly, nasal congestion. On physical examination the external nose was swollen, deformed and tender. Nasal speculum examination revealed either unilateral or bilateral red/ blue discolouration with deformity or swelling of the anterior nasal septum. If complicated by a nasal septal abscess, this swelling was fluctuant and tender. A high index of suspicion of the presence of nasal septal haematoma is required in all cases of nasal trauma because prompt recognition is vital. Management is relatively simple and is usually undertaken in the emergency department. Aspiration or drainage of the haematoma/ abscess is performed under a local anaesthetic followed by bilateral nasal packing. Paediatric cases should have a general anaesthetic. Suitable antibiotic cover is required, along with close specialist ear, nose and throat follow up. Early diagnosis and intervention is paramount in preventing cosmetic deformity or other more life‐threatening sequelae.
Adrenoleukodystrophy presenting with Addisonian crisis
Authors: Raftos John 
Published: March 2003

AbstractThe case of a young boy who presented with Addisonian crisis as a manifestation of adrenoleukodystrophy (ALD) is presented. Adrenoleukodystrophy is an uncommon X‐linked genetic disease that may present with acute adrenocortical insufficiency. The pathogenesis, clinical presentation and management of adrenoleukodystrophy are presented.
Venom as a source of useful biologically active molecules
Authors: Bailey Paul , Wilce Jacqueline 
Published: March 2003

AbstractIn the specialty area of venomology, emergency physicians traditionally have been most interested in the description of a variety of envenomation syndromes and, subsequent to this, the most appropriate investigative and therapeutic strategies to employ when envenomation is present. Taking an alternative viewpoint, in this paper we have reviewed a selection of interesting areas of biomedical research in which venom components are being investigated for their potential as novel therapeutic agents, pesticides and ion‐channel probes. In addition, we describe the molecular imaging tools of X‐ray crystallography and nuclear magnetic resonance spectroscopy, key techniques in the development of rationally designed therapeutic agents. See Commentary, page 5.
Warfarin toxicity in the emergency department: Recommendations for management
Authors: Cruickshank Jaycen , Ragg Michael , Eddey David 
Published: March 2003

AbstractObjective:To examine patients who presented to a hospital emergency department with evidence of warfarin toxicity, and to review the available published literature to determine what guidelines are available for management of this problem.Method:A retrospective analysis of all adult patients who presented to The Geelong Hospital Emergency Department between 1 January 1996 and 30 June 1998 with international normalized ratio > 6 due to warfarin toxicity.Results:A total of 84 patients with international normalized ratio > 6 were included in the study. The average age was 68.3 years. Fifty‐three per cent were women. The international normalized ratio was between 6 and 10 in 33 patients (39%), and greater than 10 in 51 patients (61%). Major bleeding occurred in 16.7% of patients, minor bleeding in 17.8%. Sixty‐five per cent had no bleeding. Seven patients died, four of those with bleeding. Patients with an international normalized ratio > 10 were more likely to receive fresh frozen plasma (77.6%vs 28.6%; P < 0.001) and in greater amounts (3.0 units vs 0.8 units; P < 0.001) than those with an international normalized ratio of 6–10. There were also more episodes of major bleeding, although not significant. Patients with major bleeding were older (mean 75.4 years vs 67.5 years; P = 0.04), more likely to be admitted (P = 0.046), were more often given fresh frozen plasma (P = 0.003) and in greater amounts (3.28 units vs 2.0 units; P = 0.02).Conclusion:Warfarin toxicity is a common problem, and variation in management is not surprising considering the lack of consensus in the literature on this topic. Current recommendations are summarized and a simple flowchart for management of this problem is provided.
Major Incident Medical Management and Support (MIMMS): A practical, multiple casualty, disaster‐site training course for all Australian health care personnel
Authors: Sammut John , Cato Denys , Homer Tony 
Published: March 2003

AbstractMajor Incident Medical Management and Support is a 3‐day major incident training course designed specifically for doctors, nurses and ambulance personnel. It teaches a systematic, ‘all hazards’ approach to the principles of pre‐hospital, multiple‐casualty incident medical management. This article explores the origins and development of the course in Australia, it outlines the nature and content of the course, details the demographic profile of those who have successfully completed the course to date and, finally, looks at the future directions of the course in Australia. See Commentary, page 143.
Emergency Medical Services Fellowship in the United States of America
Authors: Zalstein Salomon 
Published: March 2003

AbstractTravelling outside Australia to undertake further training in an area of subspecialty interest is both interesting and beneficial to the advancement of the individual and our specialty. In the United States of America, such formal training following completion of specialist qualification in emergency medicine is referred to as ‘Fellowship’ training. While other authors have discussed the general areas of overseas work and emergency medicine Fellowships, this paper specifically addresses the area of prehospital care, known in the United States as ‘emergency medical services’. Although there are significant differences in prehospital care between the United States and Australia, a great deal of what can be learned from undertaking a Fellowship in prehospital care in the United States is locally applicable. A typical curriculum is outlined, and the steps in selecting and arranging such a programme are discussed. Some potential pitfalls are also mentioned. Given the paucity of formal training in prehospital care in this country, such fellowship programmes are an excellent means of obtaining a very solid understanding of this important aspect of emergency medicine.
Fatal pneumococcal Waterhouse–Friderichsen syndrome
Authors: Doherty Steven 
Published: March 2003

AbstractThere have only been six deaths reported in the English literature due to disseminated intravascular coagulation and Waterhouse–Friderichsen syndrome complicating pneumococcemia in otherwise healthy persons with normal spleens. Four of these deaths occurred in children and two in adults. A case of fulminant pneumococcemia complicated by disseminated intravascular coagulation and Waterhouse–Friderichsen syndrome in an otherwise healthy adult with a normal spleen is presented. The case is typical of the course of fulminant pneumococcal sepsis and highlights some of the difficulties experienced by rural general practitioners and rural retrieval services. Mechanisms by which Pneumococcus can elicit fulminant sepsis are discussed, although there is no explanation as to why this may occur in the setting of normal splenic function.
Factors influencing prehospital and emergency department analgesia administration to patients with femoral neck fractures
Authors: Vassiliadis John , Hitos Kerry , Hill Celine T 
Published: March 2003

AbstractObjectives:To assess the analgesia practices of ambulance personnel and emergency department staff treating patients with fractured neck of femur.Methods:This is a retrospective analysis of 176 patients with an admission diagnosis of fractured neck of femur, who presented to a major western Sydney teaching hospital, between January and November 1999.Results:One hundred and twenty‐eight patients met the inclusion criteria. The median age was 82, there were more female than male subjects. Ambulance officers made a clinical diagnosis of fractured neck of femur in 68% of cases. In 49% of cases no analgesia was given. Patients were given a higher triage category and pain relief faster if they had been given analgesia by ambulance officers,P = 0.0018 andP = 0.002, respectively. The median time to analgesia was 2 h 48 min.Conclusions:Only a modest proportion of patients with fractured neck of femur received prehospital analgesia and delays to analgesia in the emergency department are considerable. Strategies to address the delivery of appropriate analgesia to this group of patients should be developed.
Benchmarking in emergency health systems
Authors: Kennedy Marcus P , Allen Jacqueline , Allen Greg 
Published: March 2003

AbstractThis paper discusses the role of benchmarking as a component of quality management. It describes the historical background of benchmarking, its competitive origin and the requirement in today's health environment for a more collaborative approach. The classical ‘functional and generic’ types of benchmarking are discussed with a suggestion to adopt a different terminology that describes the purpose and practicalities of benchmarking.Benchmarking is not without risks. The consequence of inappropriate focus and the need for a balanced overview of process is explored. The competition that is intrinsic to benchmarking is questioned and the negative impact it may have on improvement strategies in poorly performing organizations is recognized. The difficulty in achieving cross‐organizational validity in benchmarking is emphasized, as is the need to scrutinize benchmarking measures. The cost effectiveness of benchmarking projects is questioned and the concept of ‘best value, best practice’ in an environment of fixed resources is examined.
Focused assessment with sonography for trauma patients by clinicians: Initial experience and results
Authors: Vassiliadis John , Edwards Robert , Larcos George , Hitos Kerry 
Published: March 2003

AbstractObjectives: To describe the establishment of a service to provide bedside focused assessment sonography in trauma and to evaluate the service to date.Setting: Emergency department of an urban trauma centre.Methods: A prospective study of trauma patients who received a focused assessment sonography in trauma examination performed by a clinician managing the trauma in the emergency department. Accuracy was determined by comparing the scan interpretation with abdomino‐pelvic computerized tomography, laparotomy or postmortem examination.Results: The study period ran from 1 January 2000 to 11 September 2001 inclusive (20 months). One hundred and forty patients were included, with a final diagnosis established by computerized tomography (n = 124) and/or laparotomy (n = 18). There were 26 true‐positives, 101 true‐negatives, two false‐positives and 11 false‐negatives. Ten of the false‐negative studies were performed by clinicians who had not reached accreditation. The sensitivity of focused assessment sonography in trauma was 70%, specificity 98% and diagnostic accuracy 91%.Conclusions: We have described the implementation of a clinician‐based focused assessment sonography in trauma service within the emergency department with the support of radiology/ultrasound and trauma service. Processes for credentialling, quality assurance and training need to be in place. Significant issues exist with the length of time it takes clinicians to reach accreditation, in order that a critical mass of clinicians exists to provide a consistent service. The credentialling process should mandate a minimum number of supervised examinations.
Emergency ultrasound credentialling for focused assessment sonography in trauma and abdominal aortic aneurysm: A practical approach for Australasia
Authors: Jones Peter G , Peak Stephen , McClelland Andy , Holden Andrew , Higginson Ian , Gamble Greg 
Published: March 2003

AbstractObjective:  Focused assessment with sonography for trauma and emergency ultrasound for abdominal aortic aneurysm are now practiced widely by non‐radiologists in emergency departments worldwide. Various credentialling programs have been proposed for novice sonographers; however, their feasibility has been questioned. We adopted the Australasian College for Emergency Medicine (ACEM) credentialling process for emergency ultrasound to determine whether it is feasible for emergency physicians in the Australasian environment.Methods:  Three full‐time emergency medicine specialists and a post‐Fellowship Examination trainee at Auckland Hospital undertook the credentialling process.Results:  All four participants had sufficient scans to complete the process after 16 months. Accuracy for focused assessment with sonography for trauma, 90% (95% CI 83–95%), and abdominal aortic aneurysm, 99% (95% CI 90–100%), is similar to that previously reported.Conclusion:  The ACEM credentialling process for focused assessment with sonography for trauma and abdominal aortic aneurysm is practical and achievable for emergency medicine specialists working in the Emergency Department at Auckland Hospital. Further studies are necessary to determine whether this holds true for other major trauma centres in Australasia.
Paediatric emergency department design: Does it affect staff, patient and community satisfaction?
Authors: Judkins Simon 
Published: March 2003

AbstractObjectives: To assess the change in perception of the standard of paediatric care following the opening of a dedicated paediatric emergency area in an established tertiary hospital emergency department on patients and families, hospital staff and the general practitioners of the local community.Methods: A questionnaire was circulated to the relevant parties prior to and 6 months after the opening of the paediatric department. The surveys were circulated to the families/custodians of the paediatric attendees, general practitioners who refer paediatric patients and the medical and nursing staff both within the emergency department and the inpatient paediatric ward. The questions related to the physical environment, perceived level of care and the overall satisfaction with treatment.Results: The most striking change was in the patient family group who showed an increase in their level of satisfaction with the physical environment and their overall care. The general practitioner group showed only a slight improvement, while the inpatient staff showed no notable changes. The emergency department staff developed a higher level of confidence and satisfaction when dealing with this population group.Conclusion: The change in the physical environment in which we treat our paediatric emergencies seemed to enhance the level of satisfaction of our attendees. Staff appear to be more confident when dealing with these patients in a dedicated paediatric area. The effect has not yet flowed on to the inpatient staff and general practitioners, perhaps reflecting a small exposure of these individuals to the survey subject matter.
Annual Scientific Meeting of The College of Surgeons of Hong Kong: A 5‐year audit
Authors: Lee Dwh , Chan Acw , Lai Pbs , Fung Tmk , Chung Scs 
Published: March 2003

Objective: To examine the quality of surgical research in Hong Kong by auditing the results of abstracts submitted for annual scientific meetings held by The College of Surgeons of Hong Kong. Materials and Methods: From 1993 to 1998, all abstracts submitted for the meetings were evaluated and classified according to the hierarchy of evidence. The institutions of the presenting authors were recorded. Ovid MEDLINE search was then conducted to determine whether the abstracts were subsequently published in an indexed medical journal. Results: In total, 165 abstracts were submitted for the meeting in a 5‐year period. Randomized controlled trials constituted 12% of this research. Participation from community surgeons showed an encouraging trend from 17% in 1993 to 63% in 1998. In the first 4 years, 38% of abstracts were of publishable quality. More than half of the prospective randomized controlled trials were selected for presentation and subsequently published. Those abstracts selected for presentation have a higher chance of being published subsequently (P < 0.03). Conclusions: The randomized controlled trial remains a powerful research tool but is scarce in Hong Kong surgical research.
Combined transoral and transnasal power‐assisted endoscopic adenoidectomy by a StraightShot® microdebrider and Endoscrub® device
Authors: Ku Peter Ka‐Ming , Pak Martin Wai , Hasselt Charles Andrew van 
Published: March 2003

Objective:To describe a combined transoral and transnasal approach power‐assisted endoscopic adenoidectomy by StraightShot® microdebrider and Endoscrub® device in children.Method:Transoral power‐assisted endoscopic adenoidectomy using a 45°‐curved cutting visor of a StraightShot® microdebrider (Medtronic Xomed, Jacksonville, FL, USA) is performed with an Endoscrub, irrigation device (Medtronic Xomed) attached to the rigid endoscope. The oscillating mode (1500 r.p.m.) of the microdebrider is selected. The dissection begins at the inferior pole of the adenoids and swifted upwards to the roof of the nasopharynx. Transnasal dissection of the choanal extension of the adenoids is achieved using a straight‐cutting visor with the aid of a 0° rigid endoscope.Results:The technique was performed in 11 consecutive patients (six male and five female) in a 6‐month period. The mean age of the patients was 6.9 years (range, 3–9 years). The main indication for surgery was obstructive sleep apnoea with huge obstructive adenoids and with choanal extension. The mean operative time was 4.8 min (range, 2–11 min). The mean blood loss was 12.8 mL (range, 4–16 mL). No intraoperative or postoperative complications were recorded.Conclusion:The described technique for dissection of adenoids in children is safe and is recommended for patients with large adenoids and with choanal extension. Chinese Abstract imageimageimageimageimage
Childhood optic atrophy
Authors: Mudgil Ananth V , Repka Michael X 
Published: March 2003

ABSTRACT Purpose: To determine the causes, and relative incidence of the common causes, of optic nerve atrophy in children under 10 years old and to compare prevalent aetiologies with those given in previous studies. Methods: The Wilmer Information System database was searched to identify all children, diagnosed between 1987 and 1997 with optic atrophy, who were under 10 years old at diagnosis. The medical records of these children were reviewed retrospectively. Results: A total of 272 children were identified. Complications from premature birth were the most frequent aetiology of optic atrophy (n = 44, 16%); 68% of these premature infants having a history of intraventricular haemorrhage. Tumour was the second most common aetiology (n = 40, 15%). The most frequent tumour was pilocytic astrocytoma (50%), followed by craniopharyngioma (17%). Hydrocephalus, unrelated to tumour, was the third most common aetiology (n = 26, 10%). In 114 cases (42%), the cause of optic atrophy became manifest in the perinatal period and/or could be attributed to adverse events in utero. A cause was not determined in 4% of cases. Conclusions: In the last decade, prematurity and hydrocephalus appear to have become important causes of optic atrophy in childhood. This trend is probably the result of improved survival of infants with extremely low birth weight.
Orbital granulomatous giant cell myositis: a case report and review
Authors: Selva Dinesh , Dolman Peter J , Rootman Jack 
Published: March 2003

ABSTRACTTo present a case of orbital granulomatous giant cell myositis and review the literature. We describe the case of a 51‐year‐old woman, with a past history of melanoma, who presented with an acutely painful orbital myositis. This evolved into a chronic relapsing process involving multiple muscles bilaterally, which demonstrated partial steroid responsiveness. Biopsy revealed a granulomatous giant cell myositis. Orbital granulomatous giant cell myositis is a rare histological entity which has an association with giant cell myocarditis and underlying malignancy.
Antimicrobial susceptibility of 19 Australian corneal isolates of Acanthamoeba
Authors: Lim Li , Coster Douglas J , Badenoch Paul R 
Published: March 2003

ABSTRACT Purpose: To determine the in vitro drug susceptibility of Australian corneal isolates of Acanthamoeba and to correlate the results with patient treatment and visual outcome. Methods: Acanthamoeba isolates were obtained from a reference laboratory. Cyst suspensions were prepared from 19 strains and exposed to 10 antimicrobial agents for 7 days. The minimum drug concentrations required to inhibit excystation were determined. Inhibited cells were then plated out to determine minimum cysticidal concentrations. Results: Overall, propamidine proved to be the most active anti‐Acanthamoeba agent tested. The disinfectant polyhexamethylene biguanide, either pure or in Baquacil, was also effective. Pentamidine, hexamidine, chlorhexidine and chloroxylenol had intermediate activity, while neomycin, amphotericin B and povidone‐iodine had poor activity. There was no clear relationship between in vitro susceptibility and visual outcome. Conclusions: Propamidine and polyhexamethylene biguanide drops are recommended as initial choices for the treatment of Acanthamoeba keratitis. The variability in the susceptibility to any one agent suggests that individual testing of isolates is necessary to identify the most appropriate treatment. A number of factors influence visual outcome in these cases; further studies are required to resolve the importance or otherwise of in vitro susceptibility.
Methods for detecting age‐related maculopathy: a comparison between photographic and clinical assessment
Authors: Tikellis Gabriella , Robman Luba D , Harper Alex , McNeil John J , Taylor Hugh R , McCarty Catherine A 
Published: March 2003

ABSTRACT Purpose: To examine the sensitivity, specificity and overall agreement between photographic and clinical assessment in detecting age‐related maculopathy (ARM) features in the context of an epidemiological study, the Vitamin E, Cataract and Age‐related Maculopathy Study (VECAT). Methods: A total of 1204 volunteers aged between 55 and 80 years of age, who were enrolled in the VECAT Study, had both slit‐lamp biomicroscopy examination and fundus photos taken as part of the baseline ophthalmic examination. The Nidek 3‐DX fundus camera (Nidek, Gamagori, Japan) was used to produce paired, one‐framed, coloured, 15° stereoslides of the macular area at a fixed angle. An International Classification and Grading System for Age‐related Maculopathy and Age‐related Macular Degeneration was used to grade the stereoslides. Agreement in the detection of drusen, pigment abnormalities, and late stage ARM features was assessed using unweighted kappa statistic. Cases of disagreement were verified using clinical data records, grading documentation and the review of stereoslides. Results: Macula status was available for 2386 eyes. For drusen of size < 63 μm, sensitivity was 47%, specificity was 68% with a kappa value of 0.20. For drusen ≥ 125 μm, sensitivity and specificity were ≥ 81%. Kappa values ranged from 0.56 to 0.71. Levels of agreement for pigment abnormalities and late ARM were in the substantial range (i.e. kappa values from 0.70 to 1.00). Conclusions: Slit‐lamp biomicroscopy was found to be comparable to photograding (using the Nidek 3‐DX fundus camera) for detecting features pertaining to ARM. However, given the objectivity and permanency of stereoslides, photograding is still the more reliable and the preferred system of assessing ARM in the context of an epidemiological study.