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Hames K.,Epworth Healthcare
Healthcare Infection | Year: 2013

Background Inappropriate disposal of clinical waste has a considerable environmental and financial impact. Other studies have shown substantial opportunities for improvement in healthcare waste disposal. This study aims to show these opportunities through a clinical waste audit and to gain a greater understanding into approaches required for successful waste disposal behaviour change. Methods A clinical waste audit was conducted in an eight-bed intensive care unit in Melbourne. A baseline audit was followed by a questionnaire and education (in-services and signage). A follow up audit was performed to analyse the effect of education. Results Results of the initial clinical waste audit showed 41% clinical waste, 44% general waste and 14% sharps waste. Post-education, clinical waste was slightly greater than general waste and sharps waste had markedly decreased to 3.5%, however, study limitations were present. The marked decline in sharps waste appears to mainly be due to the clarification of a misnomer regarding disposal of glass. Questionnaires showed a lack of knowledge but a desire to learn, and a preference for learning through signage and in-services. Conclusion The study shows that more than one in-service and increased signage is needed for successful behaviour change. This supports findings that active staff involvement is essential to achieve sustainable waste management.© 2013 Australasian College for Infection Prevention and Control. Source


Semple B.D.,National Health Research Institute | Semple B.D.,Monash University | Kossmann T.,Epworth Healthcare | Morganti-Kossmann M.C.,National Health Research Institute | Morganti-Kossmann M.C.,Monash University
Journal of Cerebral Blood Flow and Metabolism | Year: 2010

Chemokines and their receptors have crucial roles in the trafficking of leukocytes, and are of particular interest in the context of the unique immune responses elicited in the central nervous system (CNS). The chemokine system CC ligand 2 (CCL2) with its receptor CC receptor 2 (CCR2), as well as the receptor CXCR2 and its multiple ligands CXCL1, CXCL2 and CXCL8, have been implicated in a wide range of neuropathologies, including trauma, ischemic injury and multiple sclerosis. This review aims to overview the current understanding of chemokines as mediators of leukocyte migration into the CNS under neuroinflammatory conditions. We will specifically focus on the involvement of two chemokine networks, namely CCL2/CCR2 and CXCL8/CXCR2, in promoting macrophage and neutrophil infiltration, respectively, into the lesioned parenchyma after focal traumatic brain injury. The constitutive brain expression of these chemokines and their receptors, including their recently identified roles in the modulation of neuroprotection, neurogenesis, and neurotransmission, will be discussed. In conclusion, the value of evidence obtained from the use of Ccl2-and Cxcr2-deficient mice will be reported, in the context of potential therapeutics inhibiting chemokine activity which are currently in clinical trial for various inflammatory diseases. © 2010 ISCBFM All rights reserved. Source


Mealings M.,La Trobe University | Douglas J.,La Trobe University | Olver J.,Epworth Healthcare | Olver J.,Epworth Monash Rehabilitation Medicine Unit
Brain Injury | Year: 2012

Primary objective: This paper aims to (i) present a systematic review of the literature exploring students' perspectives of their educational experiences following TBI and (ii) identify important themes arising from this material which may assist clinicians and educators in improving support services and outcomes for their clients. Methods and procedures: A systematic search was conducted of appropriate databases as well as manual searches of key references and expert authors. Search criteria included: (i) presence of TBI and (ii) student as informant. No restrictions were placed on severity or age at injury, type of schooling, time since injury or return to school. Main outcomes and results: Search results identified over 400 articles, eight of which met the relevance criteria. These studies showed large variations across informant characteristics and research designs. Despite this, a number of recurring themes outlining the students' perspectives were evident. These included: 'difficulties identified', 'impact of difficulties on study', 'things that helped' and 'things that were not helpful'. Conclusions: Whilst some aspects of the students' stories resonated with the expert opinions widely published, there were further important insights. In particular, themes related to the concept of identity suggest that clinical approaches need to broaden and include tools that can assist students in the reconstruction of their lives. © 2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted. Source


Richardson M.,Epworth Healthcare | Asadollahi S.,Westmead Hospital | Richardson L.,University of Melbourne
International Journal of Shoulder Surgery | Year: 2013

Purpose: A new and simple operative technique has been developed to provide internal fixation for midshaft clavicle fractures. This involves the use of a large fragment Herbert Screw that is entirely embedded within the bone. Screw fixation is combined with bone grafting from intramedullary reamings of the fracture fragments. The purpose of this report is to assess the outcomes following treatment of midshaft clavicular fracture using this method. Materials and Methods: One hundred and fourteen patients with acute displaced midshaft fracture were identified between 2002 and 2007. All patients were followed until fracture union. Patients′ medical records were reviewed. Disability of the Arm, Shoulder, and Hand questionnaire (DASH), and American Shoulder and Elbow Surgeons Elbow form (ASES) were posted to all patients. Outcome measures included union rate, time to union, implant removal rate, DASH, and ASES scores. Results: Patients′ median age was 29.5 years (interquartile range, 19-44 years). The most common injury mechanism was sports injury (28%). The median time from injury to surgery was 5 days (interquartile range, 2-9 days). Union occurred in an average of 8.8 weeks. Non-union occurred in three cases (2.6%). The re-operation rate for symptomatic hardware prominence screw was 1.7%. The median DASH score was 0.83 and the median ASES was 100 (n = 35). Conclusions: Intramedullary fixation using cannulated Herbert screw can be used as an effective approach for operative management of midshaft clavicular fractures. Using this method, an appropriate outcome could be achieved and a second intervention for implant removal could be avoided in great majority of cases. Level of Evidence: Level III. Source


Webster K.E.,La Trobe University | Feller J.A.,La Trobe University | Leigh W.B.,La Trobe University | Richmond A.K.,Epworth Healthcare
American Journal of Sports Medicine | Year: 2014

Background: Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. Purpose: To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. Results: Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29%sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. Conclusion: Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined. © 2013 The Author(s). Source

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