bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of the general practice workload of a metropolitan teaching hospital emergency department
Authors: Sprivulis Peter 
Published: March 2003

AbstractBackground: A transparent and easily replicated method of estimating the number of, and costs associated with, low acuity presentations to an emergency department is required to assist evaluation of the utilization of emergency department services. This study presents two independent estimates of the number of, and costs associated with, low acuity presentations to an emergency department.Methods: A retrospective analysis was conducted using emergency department information system data from a metropolitan mixed paediatric/adult teaching hospital emergency department/trauma centre. Low acuity patient presentation estimates were calculated by: Method one: The product of (A) total self‐referred presentations for triage categories three, four and five and (B) the difference between the self‐referred and general practitioner‐referred discharge rates from the emergency department. Total low acuity patient presentations = (A × B). Method two: Summing the number of self‐referrals with presenting problems never referred by general practictioners. Costs were calculated using Commonwealth cost weights.Results: Method one gave a low acuity patient estimate of 12.5% (95% CI 12.0–13.0%) and method two 10.6% (95% CI 10.2–11.0%) of total presentations. Costs were 10.5% (method one) and 8.5% (method two) of total costs. Adjusted for assessment time, costs were 6.8% (method one) and 5.5% (method two) of total costs. Low acuity patients were more common outside of normal working hours, method one: 14.4% (95% CI 13.5–15.2%) versus 10.0% (95% CI 9.4–10.6%), P < 0.001; method two: 11.4% (95% CI 10.9–12.0%) versus 8.5% (95% CI 7.8–9.2%), P < 0.001. Provision of alternative daily 0900–2400 general practice services would change low acuity patients by no more than 2–3% of total presentations and change low acuity patient costs by no more than 2% of total costs.Conclusions: Low acuity patients form a small, relatively constant part of the emergency department workload. The provision of alternative after‐hours services for low acuity patients would be unlikely to significantly reduce the overall work load of this metropolitan emergency department.
Interrater reliability of injury coding in the Queensland Trauma Registry
Authors: Neale Rachel , Rokkas Philippa , McClure Roderick J 
Published: March 2003

AbstractBackground: The capacity to accurately code injury event details and use the Abbreviated Injury Scale and Injury Severity Score to group injuries according to severity, underpins the audit and review activities of the trauma registries throughout the world. In the interests of transparency and benchmarking between registries, we aimed to assess the interrater reliability of coding in the Queensland Trauma Registry.Methods: One hundred and twenty injury cases were randomly selected from the Queensland Trauma Registry database, stratified by hospital, severity and the coder who originally coded the chart. Cases were then recoded by six coders employed by the Queensland Trauma Registry. Coding was carried out by all raters simultaneously and independently.Results: Interrater agreement between coders was high for external cause, intent, and place of injury with kappa scores for all interrater pairs being greater than 0.80, 0.58 and 0.44. Agreement between the six raters for Injury Severity Score was found to be very high (intraclass correlation coefficient of 0.9).Conclusions: The accuracy of coding in the Queensland Trauma Registry is sufficiently high to ensure that quality data are available for research, audit and review.
Oesophagogastric variceal bleeding in portal hypertension
Authors: Branicki Frank James 
Published: March 2003

This article reviews substantial progress made in the past decade in the management of patients with portal hypertension who present with major upper gastrointestinal bleeding. Variceal and portal pressure measurements and endoscopy facilitate a reasoned approach to management, and several treatment options are available to gain control of ongoing or recurrent haemorrhage. These encompass endoscopic therapy (sclerotherapy, endoscopic variceal ligation), radiological intervention with transjugular intrahepatic systemic shunt (TIPS) procedures, and a variety of surgical procedures for devascularization or shunting from the high‐pressure portal system to low‐pressure systemic venous connections. In most prospective randomized trials endoscopic variceal ligation has proved superior to sclerotherapy, and TIPS has found a role in the salvage of patients with further haemorrhage, sparing them surgical intervention. Advances in pharmacotherapy for the control of initial bleeding and secondary prophylaxis hold promise. Liver transplantation has become an option for selected patients with end‐stage liver disease.
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Neuroendoscopy in pineal region tumor with obstructive hydrocephalus
Authors: Chan () Danny Tat‐Ming , Lam () Joseph Ming‐KuenLam , Poon (;) Wai‐Sang 
Published: March 2003

Objective: Pineal region tumours are composed of a variety of tumour pathologies, for example germinoma, teratoma, pinealocytoma, pinealoblastoma, meningioma and benign pineal glial cyst. They commonly present with mass effect causing obstructive hydrocephalus or Parinaud’s Syndrome. This paper reviews seven patients with pineal region tumour who presented with obstructive hydrocephalus and who received neuroendoscopy as part of the management of their clinical condition. Method: Neuroendoscopic techniques include endoscopic third ventriculoscopy (ETV) and endoscopic third ventriculo‐cisternostomy (ETVC). Diagnostic ETV allows direct visualization, localization and biopsy of the lesion, as well as sampling of cerebrospinal fluid (CSF). Endoscopic third ventriculo‐cisternostomy allows CSF diversion for relief of obstructive hydrocephalus. Results and Conclusion: Four out of seven of the third ventriculoscopy cases had lesions successfully located and biopsy was performed in two cases. Endoscopic third ventriculo‐cisternostomy was performed in all 7 patients. Two patients with unknown pathology relied on ETVC as the only therapeutic procedure. Three patients were followed with subsequent definitive treatment (radiotherapy or surgery). All these patients showed clinical improvement or radiological relief of obstructive hydrocephalus. Minimal complications were recorded among these cases.
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Endoscopic ultrasonography in pancreatitis
Authors: Liu () Chi‐Leung , Lo () Chung‐Mau , Fan () Sheung‐Tat 
Published: March 2003

Endoscopic ultrasonography (EUS) is a useful imaging modality in the investigation of pancreatitis which provides a high‐resolution image of the pancreas and adjacent structures. In patients with ‘idiopathic’ pancreatitis diagnosed by conventional radiologic methods, EUS may help to identify the aetiology by detecting occult pancreatic neoplasm, biliary sludge and microlithiasis. In patients with biliary pancreatitis, EUS was found to be highly sensitive in detecting choledocholithiasis. Therefore, EUS can be used to select patients with choledocholithiasis for therapeutic endoscopic retrograde cholangiopancreatography (ERCP), thus avoiding unnecessary diagnostic endoscopic intervention and the morbidity associated with ERCP in more than one‐half of patients. In addition, EUS can reliably distinguish oedematous from necrotizing acute pancreatitis, and an EUS score appears to have prognostic significance in patients with acute pancreatitis. Clinical studies also suggest that EUS is at least as sensitive as ERCP for diagnosis of chronic pancreatitis, without the risk of causing or worsening pancreatitis as in ERCP. An EUS‐guided, fine‐needle aspiration may be useful in differentiating pancreatic pseudocysts from neoplastic cystic lesions of the pancreas. Also, EUS‐guided or assisted endoscopic drainage of a pseudocyst resulting from pancreatitis is an accepted alternative to surgery in selected patients.
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Initial experience with laparoscopic ultrasonography in the staging of liver for colorectal cancer: A prospective study
Authors: Chan () Eva Sze‐Wah , Chung () Chi‐Chiu , Tsang () Wilson Wen‐Chieng , Li () Michael Ka‐Wah 
Published: March 2003

Objective: Studies on the use of laparoscopic ultrasonography (LUS) in the staging of colorectal cancer are still scanty despite increasingly performed laparoscopic colorectal resection. We conducted a prospective study to compare and evaluate the sensitivity of LUS and preoperative ultrasound in the detection of liver metastases from colorectal primary. Method: From June 1998 to December 1999, 72 patients admitted for laparoscopic resection of colorectal cancer were studied. Laparoscopic ultrasonography was successfully performed in 63 patients. The results were compared with the preoperative transabdominal ultrasound. Results: The results showed that LUS was more sensitive than preoperative transabdominal ultrasound in detecting liver metastases and located the lesions with a greater degree of precision. More benign and malignant hepatic lesions were demonstrated by LUS than by preoperative imaging. In four patients (6%) the surgical plan and the subsequent management were altered as a result of the LUS findings. Conclusion: Laparoscopic ultrasonography should be included as a standard component and essential step in laparoscopic colorectal resection. A large‐scale, prospective comparative study is warranted to confirm this.
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Current issues in xenotransplantation
Authors: Chui () Albert Ka‐Keung 
Published: March 2003

The possibility of using animal organs in transplantation has been attractive for a long time. Most experts believe that the pig will provide the most suitable solid organs and tissues for needy human recipients. Although porcine organs are known to be rapidly rejected by the process ‘hyperacute rejection’, there is now hope that several therapeutic strategies that are already available will overcome this problem. However, there are remaining hurdles to overcome. Delayed immune reaction, ethical concerns, physiological incompatibility and animal viruses will determine whether xenotransplantation will become a practical solution to the chronic shortage of allografts in clinical transplantation.
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EFFECTS OF PRESSURE GARMENT ON PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY — A PROSPECTIVE RANDOMIZED TRIAL
Authors: Lam C.Y.W. , Lim B.H. , Chiu P.W.Y. , Lee S.W. , Wu M. , Chow T.L. , Kwok S.P.Y. 
Published: March 2003

Introduction: The treatment of choice for breast cancer is modified radical mastectomy or in selected case breast conserving surgery. Typically, patient will have a long hospital stay after surgery due to the collection of lymph. Premature removal of drain will incur seroma formation and may predispose to wound infection. Review of literature shows that there has not been adequate address to this condition, particularly the use of pressure garment in reducing lymph output. We report our experience in an interim analysis of a randomized controlled study. The aim of the study is to evaluate the effects of pressure garment on early removal of drains, shortening of hospital stay and reducing the incidence of seroma formation.Methodology: From September 1999 to November 2000, 44 consecutive patients undergoing modified radical mastectomy for breast cancer were invited to participate in this study. Our occupational therapist arranged for tailor made pressure garments. Soft foam mimicking the external mammary prosthesis was fashioned so that appropriate pressure was applied on to the operative site to prevent lymph accumulation. They were randomized into two groups (1) with pressure garment (2) without pressure garment. The single surgeon performing the mastectomy was blinded until the completion of surgery when the result of randomization was sought from the principal investigator. The occupational therapist inspected daily to ensure the vest was filled satisfactorily. OPD assessments were arranged at 2 weeks and 8 weeks.Results: (range in parentheses) Conclusion: Use of breast pressure garment did not prevent seroma formation but reduced the volume of drainage and facilitated early removal of drains resulting in a significant reduction in the length of hospital stay of 2.7 days. Such breast vest has great impact on the hospital economy.
VENTRICULOSTOMY‐RELATED CEREBROSPINAL FLUID INFECTIONS: THE EFFECT OF CATHETER EXCHANGE. A RANDOMIZED CONTROLLED CLINICAL TRIAL
Authors: Wong G.K.C. , Poon W.S. , Wai S. 
Published: March 2003

Introduction: External ventricular drains (EVD) are used for intracranial pressure monitoring and temporary cerebrospinal fluid drainage in neurosurgery. Cerebrospinal fluid infection is the major complication. Previous prospective epidemiological study from Mayhall (1) had recommended that the EVD should be changed every 5 days to reduce CSF infection. However, subsequent different retrospective series had yielded conflicting results.Hypothesis: The aim was to test whether the practice of exchange of EVD every five days could reduce the CSF infection rate and subsequently improve outcome in terms of ICU stay, hospital stay, 3‐month outcome and mortality.Method: We carried out a randomized controlled clinical trial between 11/1998 and 11/2000. 103 patients who needed EVD for more than 5 days and had no evidence of CSF infection on presentation were included. The patients were randomized between change (every five days) and no change of external ventricular drain.Results: Conclusion: The practice of regular exchange of EVD did not reduce CSF infection rate and did not improve outcome. This is in agreement with the current thinking that CSF infection mainly originated from the procedure of ventriculostomy. The associated high cost with regular exchange of EVD (operations and new catheters) did not seem to be justified. Thus, the practice of regular exchange of EVD should be abandoned.(1) Ventriculostomy‐related infections: A prospective epidemiological study. Mayhall CG et al. New England of Journal of Medicine 310(9): 553–559, 1984.
INCIDENCE, DISTRIBUTION AND MECHANISMS OF MICROSATELLITE INSTABILITY IN DIFFERENT COLORECTAL CANCER AGE GROUPS
Authors: Yiu R. , Qiu H. , Lee S. , Rothenberger D.A. , García‐Aguilar J. 
Published: March 2003

The increase in the incidence of colorectal cancer (CRC) is higher for proximal than for distal tumors. As microsatellite instability (MSI) is a feature of proximal tumors, we hypothesize that an increase in MSI tumors may account for the age‐related proximal shift in CRC.Methods: A representative sample of 230 CRCs from 3 age groups was selected from a CRC database. MSI was determined by PCR. MLH1 and MSH2 expression was determined by immunohistochemistry, and the methylation of the MLH1 gene promotor (PM) by methylation‐specific PCR.Results: MSI tumors became more frequent (p < 0.01 chi square) and more proximal in distribution (p = 0.01 loglinear) in the oldest age group. MSI was associated with loss of expression of MSH2 in the young age group. PM and inactivation of MLH1 increased with age. Conclusion: MSI tumors became more frequent and proximal in older patients. This trend was associated with differences in the underlying mechanisms responsible for the MSI phenotype.
THE EFFECT OF SCHEDULED REPEAT ENDOSCOPY ON PEPTIC ULCER REBLEEDING—A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Chiu P.W.Y. , Lam C.Y.W. , Lee S.W. , Kwong K.H. , Lam S.H. , Lee D.T.Y. , Kwok S.P.Y. 
Published: March 2003

Aim: Recurrent bleeding after initial haemostasis in peptic ulcer haemorrhage is an important factor that directly related to increased mortality. Conflicting reports have been published concerning the effectiveness of scheduled repeat endoscopy on ulcer rebleeding. We investigate the use of scheduled repeat endoscopy with subsequent further therapy in peptic ulcer bleeding.Method: From August 1999 to January 2001, we prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel or adherent clot into two groups. Endoscopic therapy was standardized to be adrenaline injection and heater probe application. One group received scheduled second endoscopy 16–24 hours after initial endoscopic haemostasis (Group A), and further therapy applied if endoscopic stigmata persist as above. The other group received close observations (Group B). Those patients in the two groups that develop rebleeding will receive operation if further endoscopic therapy failed. The outcome measures include ulcer re‐bleeding, transfusion, length of stay, and mortality.Results: After initial endoscopic haemostasis, 196 patients were randomized to two groups. 2 patients were excluded after randomization as pathology confirmed carcinoma of stomach. The results were analyzed by using either Chi square or student t tests. Conclusion:A scheduled repeat endoscopy with appropriate therapy 16 to 24 hours after initial endoscopic haemostasis reduce the amount of peptic ulcer rebleeding siginificantly.
Cognitive dysfunction after cardiopulmonary bypass
Authors: Yong Jamy Lap , Chui Wing‐Hung , Chiu Shui‐Wah , Cheung David Lik‐Ching 
Published: March 2003

Cognitive dysfunction remains a significant complication after cardiopulmonary bypass, despite continuous improvement in the overall outcome in open‐heart surgery. Embolization of the atheromatous material, most notably during removal of the aortic clamp, is a major cause. Strategies have been developed to minimize cerebral embolization. Modified surgical techniques include the use of hypothermic circulatory arrest, venting of the left ventricle, minimizing aortic manipulation, and the use of epiaortic ultrasound to locate and avoid trauma to the aortic atheromatous plaque. Use of an intra‐aortic filter has been shown recently to reduce intraoperative cerebral embolic events and improve postoperative neurocognitive outcomes. Off‐pump coronary artery bypass technique has also been claimed to have lower neurological complications, which is probably attributable to the avoidance of aortic cannulation and cardiopulmonary bypass. Its role on cerebral protection is, however, debatable. Chinese Abstract imageimage
Seasonal variation in trachoma and bush flies in north‐western Australian Aboriginal communities
Authors: Da Cruz Lyndon , Dadour Ian R , McAllister Ian L , Jackson Alistair , Isaacs Tim 
Published: March 2003

Abstract Background: Among younger age groups trachoma (Chlamydia
trachomatis) has been identified as a major cause of morbidity
in Australian Aboriginal communities. North‐western Australia has
two seasons, referred to as the wet and the dry, and until recently
most trachoma screening programmes were conducted during the dry season.
This study compared the prevalence of trachoma between three Aboriginal
communities, two in the west and one in the east Kimberleys with
differences in adult bush fly (Musca vetustissima) populations between the wet and dry seasons. Methods: All preschool and school‐aged children in each community were screened for trachoma in February and July 1996 using the World Health Organization method for clinical assessment of trachoma. Flies were trapped fortnightly from September through to May (inclusive) using a wind‐orientated fly trap. Results: Two communities in the west Kimberleys had a significantly higher rate of trachoma during the wet season (14−59% in dry season compared with 46−69% in wet season). One community showed no difference but this was probably due to the reduced re‐screening rate. Further­more, it was demonstrated that fly populations are so low during the dry season that they were untrappable; however, populations of bush fly significantly increased during the wet season (ranging from 6 to 146 flies per hectare per month). Conclusions: If bush fly populations are correlated with increased levels of trachoma, then measures aimed at augmenting public health plans for bush fly control may decrease the cross‐infection rate. Additionally, based on the results of this study, wet season trachoma screening trips should be considered.
Population‐based assessment of refractive error in India: the Andhra Pradesh eye disease study
Authors: Dandona Rakhi , Dandona Lalit , Srinivas Marmamula , Giridhar Pyda , McCarty Catherine A , Rao Gullapalli N 
Published: March 2003

Abstract Purpose: To assess the prevalence, distribution, and demographic associations of refractive error in the population of the southern Indian state of Andhra Pradesh. Methods: From 94 clusters in one urban and three rural areas of Andhra Pradesh, 11 786 persons of all ages were sampled using a stratified, random, cluster, systematic sampling strategy in the Andhra Pradesh Eye Disease Study, a population‐based cross‐sectional study. A total of 10 293 people underwent an interview and detailed dilated eye examination. Refraction was performed by ophthalmic personnel trained in the study procedures. Objective refraction under cycloplegia was assessed for participants ≤ 15 years of age and subjective refraction for those > 15 years of age. Myopia was defined as spherical equivalent worse than ‐0.50 D and hyperopia as spherical equivalent worse than +0.50 D. Results: In the participants ≤ 15 years of age, the prevalence of myopia was 3.19% (95% confidence interval [CI] 2.24−4.13%) and of hyperopia was 62.62% (95% CI 57.10−68.13%). In this age group, myopia increased with increasing age and was more prevalent in the urban study area, and hyperopia prevalence was greater in the participants < 10 years of age. In participants > 15 years of age, the prevalence of myopia was 19.45% (95% CI 17.88−21.02%) and of hyperopia was 8.38% (95% CI 6.91−9.85%). Myopia and hyperopia increased with increasing age. Myopia was more common in males, those with education higher than class 12, those with nuclear cataract, and those living in rural study areas. Hyperopia was more common in females, those with any level of formal education, and those living in the urban area and in the well‐off rural study area. Conclusions: There is significant refractive error in this population. These data on the distribution and associations of refractive error can be useful for the planning of refractive eye‐care services.
Our responsibility in a developing world: from ethics to pragmatism
Authors: La Nauze Jamie 
Published: March 2003

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