Epworth Hospital

Melbourne, Australia

Epworth Hospital

Melbourne, Australia
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Ibrahim E.F.,Wexham Park Hospital | Richardson M.D.,Epworth Hospital | Nestel D.,Monash University
Medical Education | Year: 2015

Context: Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery.Objectives: This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training.Methods: Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis.Results: Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure.Conclusions: Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. © 2015 John Wiley & Sons Ltd.

Dahm J.,Monash University | Wong D.,Monash University | Ponsford J.,Monash University | Ponsford J.,Epworth Hospital | Ponsford J.,National Trauma Research Institute
Journal of Affective Disorders | Year: 2013

Background: Anxiety and depression following traumatic brain injury (TBI) are associated with poorer outcomes. A brief self-report questionnaire would assist in identifying those at risk, however validity of such measures is complicated by confounding symptoms of the injury. This study investigated the validity of the Depression Anxiety Stress Scales (DASS) and Hospital Anxiety and Depression Scale (HADS), in screening for clinical diagnoses of anxiety and mood disorders following TBL Methods: One hundred and twenty-three participants with mild to severe TBI were interviewed using the SCID (Axis I) and completed the DASS and HADS. Results: The DASS, DASS2I and HADS scales demonstrated validity compared with SCID diagnoses of anxiety and mood disorders as measured by Area Under ROC Curve, sensitivity and specificity. Validity of the DASS depression scale benefited from items reflecting symptoms of devaluation of life, self- deprecation, and hopelessness that are not present on the HADS. Validity of the HADS anxiety scale benefited from items reflecting symptoms of tension and worry that are measured separately for the DASS on the stress scale. Limitations: Participants were predominantly drawn from a rehabilitation centre which may limit the extent to which results can be generalized. Scores for the DASS2I were derived from the DASS rather than being administered separately. Conclusions: The DASS, DASS2I and HADS demonstrated validity as screening measures of anxiety and mood disorders in this TBI sample. The findings support use of these self-report questionnaires for individuals with TBI to identify those who should be referred for clinical diagnostic follow-up. © 2013 Elsevier B.V. All rights reserved.

Williams G.,Epworth Hospital | Willmott C.,Monash University
Brain Injury | Year: 2012

Introduction: Participation rates and quality-of-life (QoL) have been a major focus of rehabilitation programmes and outcome studies following traumatic brain injury (TBI). The extent to which mobility limitations impact on participation rates and QoL has not been thoroughly explored. The main aim of this study was to investigate the relationship between mobility limitations, participation rates and QoL following TBI. Methods: Thirty-nine people who had sustained an extremely severe TBI were recruited from a major rehabilitation facility. Mobility was quantified using the high-level mobility assessment tool (HiMAT). The Brain Injury Community Rehabilitation Outcome (BICRO-39) and Community Integration Questionnaire (CIQ) were used to measure participation rates and the shorter version of the World Health Organization Quality of Life (WHOQoL-BREF) and Assessment of Quality-of-Life (AQoL-2) were used to measure QoL. Results: Mobility was most strongly correlated with the total BICRO-39 score (r=-0.60, p<0.001) and the mobility domain (r=-0.59, p<0.001) of the BICRO-39. Although mobility had a significant relationship with health-related QoL, AQoL-2 (r=-0.60, p<0.001), it was most strongly related to the AQoL-2 independent living domain (r=0.79, p<0.001). Conclusion: Greater capacity to mobilize was associated with higher participation rates and better QoL. © 2012 Informa UK Ltd.

Manoharan G.,Royal Victoria Hospital | Walton A.S.,Epworth Hospital | Brecker S.J.,St Georges Hospitallondon | Pasupati S.,Waikato Hospital | And 3 more authors.
JACC: Cardiovascular Interventions | Year: 2015

Objectives The purpose of this study was to prospectively evaluate the safety and clinical performance of the CoreValve Evolut R transcatheter aortic valve replacement (TAVR) system (Medtronic, Inc., Minneapolis, Minnesota) in a single-arm, multicenter pivotal study in high- or extreme-risk patients with symptomatic aortic valve stenosis. Background Although outcomes following TAVR are improving, challenges still exist. The repositionable 14-F equivalent CoreValve Evolut R TAVR system was developed to mitigate some of these challenges. Methods Suitable patients (n = 60) underwent TAVR with a 26- or 29-mm Evolut R valve. Primary safety endpoints were mortality and stroke at 30 days. Primary clinical performance endpoints were device success per the VARC-2 (Valve Academic Research Consortium-2) and the percent of patients with mild or less aortic regurgitation 24 h to 7 days post-procedure. Results Patients (66.7% female; mean age 82.8 ± 6.1 years; Society of Thoracic Surgeons Score 7.0 ± 3.7%) underwent TAVR via the transfemoral route in 98.3%, using a 29-mm valve in 68.3% of patients. All attempts at repositioning were successful. No death or stroke was observed up to 30 days. The VARC-2 overall device success rate was 78.6%. Paravalvular regurgitation post TAVR was mild or less in 96.6%, moderate in 3.4%, and severe in 0% at 30 days. Major vascular complications occurred in 8.3%, and permanent pacemaker implantation was required in 11.7% of patients. Conclusions The repositionable 14-F equivalent Evolut R TAVR system is safe and effective at treating high-risk symptomatic aortic stenosis patients. Repositioning was successful when required in all patients, with low rates of moderate or severe paravalvular aortic regurgitation and low permanent pacemaker implantation. (The Medtronic CoreValve™ Evolut R™ CE Mark Clinical Study; NCT01876420). © 2015 American College of Cardiology Foundation.

Khoo A.,Epworth Hospital | Oziemski P.,Epworth Hospital
Heart Lung and Circulation | Year: 2011

Chlorhexidine, a bisbiguanide, is widely used as an antiseptic agent in medical practice as it has the greatest residual antimicrobial activity.Central venous catheters coated extraluminally with chlorhexidine have been made to reduce extraluminal contamination. By using both the chlorhexidine-alchohol skin preparation and antimicrobial-coated catheters during vascular cannulation, it can reduce catheter related bloodstream significantly [1]. The reduction in infection rate is especially vital in critically ill patients who require long-term vascular access.Adverse reactions to chlorhexidine are rare and uncommon, and have been under-recognised as a cause of anaphylaxis. There are several reports of allergic reactions following exposure to chlorhexidine. We report of a case of anaphylaxis shock requiring cardiopulmonary resuscitation during the placement of a chlorhexidine impregnated central venous catheters. © 2010.

Montalto M.,Royal Melbourne Hospital | Montalto M.,Epworth Hospital
Medical Journal of Australia | Year: 2010

• The Victorian Department of Health reviewed its Hospital in the Home (HIH) program in 2009, for the first time in a decade. Annual reimbursements to all Victorian hospitals for HIH care had reached $110 million. • Nearly all Victorian hospitals have an HIH program. Collectively, these units recorded 32 462 inpatient admissions in 2008-09, representing 2.5% of all inpatient admissions, 5.3% of multiday admissions and 5% of all bed-days in Victoria. If HIH were a single entity, it would be a 500-bed hospital. • Treatment of many patients with acute community- and hospital-acquired infections or venous thromboembolism has moved into HIH. There is still capacity for growth in clinical conditions that can be appropriately managed at home. • The review found evidence of gaming by hospitals through deliberate blurring of boundaries between acute HIH care and postacute care. • The Victorian HIH program is a remarkable success that has significantly expanded the overall capacity of the hospital system, with lower capital resources. It suggests HIH with access to equivalent hospital remuneration is necessary for a successful HIH policy. • Hospitals should invest in HIH medical leadership and supervision to expand their HIH services, including teaching. • HIH is a challenge to the traditional vision of a hospital. Greater community awareness of HIH could assist in its continued growth.

Perera E.,Epworth Hospital | Sinclair R.,University of Melbourne
Australian Family Physician | Year: 2013

Background: Hyperhidrosis and bromhidrosis are two common conditions, which are troublesome for patients and carry a significant psychosocial burden. Objective: This article details an approach to the assessment and management of hyperhidrosis and bromhidrosis, and outlines current treatment options. Discussion: Hyperhidrosis can be either generalised or focal. Generalised hyperhidrosis may be primary and idiopathic or secondary to systemic disease. Treatment may require oral anticholinergic agents. Focal hyperhidrosis is usually primary and responds to topical measures. Specialist referral for botulinum toxin A, iontophoresis or sympathectomy should be considered for severe cases. Bromhidrosis usually responds to antiperspirants, fragrance and antibacterial agents.

There is no situation in medicine where outcome is so utterly dependent on time than in the treatment of patients with S-T elevation myocardial infarction. This life-threatening situation accounts for 30% of acute coronary syndromes. Prompt myocardial reperfusion saves lives, but health services need to be thoroughly organised to achieve this outcome. Unfortunately, a minority of patients in Australia present within 2h of symptom onset and most patients receive reperfusion 3-4h after. So health professionals begin at a disadvantage. A novel approach to this problem has been to give thrombolysis at first contact with the patient, before admission to hospital. A French study has assessed this practice against the gold standard treatment for S-T elevation myocardial infarction with some very interesting results. The implications of this study now challenge well-entrenched guidelines for the management of patients with this condition. © 2012 Royal Australasian College of Physicians.

Hip arthroplasty failure secondary to septic or aseptic loosening is common, but periprosthetic loosening caused by metastasis of a distant primary lesion is unusual and seldom described in the literature. In this report, we present the case of a 78-year-old woman with bipolar hemiarthroplasty implant loosening secondary to metastatic spread of papillary ovarian carcinoma. We also review the literature and describe the factors that could possibly predispose to metastatic seeding in patients with hip arthroplasty. In addition, we highlight the radiologic features that might help differentiate such loosening from other, more common causes at an early stage of presentation.

Whitbourn R.,St Vincents Hospital | Harding S.A.,Wellington Hospital | Walton A.,Epworth Hospital
EuroIntervention | Year: 2015

Aims: The aim of this study was to test the safety and performance of the Symplicity™ multi-electrode radiofrequency renal denervation system which was designed to reduce procedure time during renal denervation. Methods and results: The multi-electrode radiofrequency renal denervation system feasibility study is a prospective, non-randomised, open label, feasibility study that enrolled 50 subjects with hypertension. The study utilises a new renal denervation catheter which contains an array of four electrodes mounted in a helical configuration at 90 degrees from each other to deliver radiofrequency energy simultaneously to all four renal artery quadrants for 60 seconds. The protocol specified one renal denervation treatment towards the distal end of each main renal artery with radiofrequency energy delivered for 60 seconds per treatment. Total treatment time for both renal arteries was two minutes. The 12-month change in office systolic blood pressure (SBP) and 24-hour SBP was -19.2±25.2 mmHg, p<0.001, and -7.6±20.0 mmHg, p=0.020, respectively. There were three patients with access-site complications, none of which was related to energy delivery; all were treated successfully. No new renal artery stenosis or hypertensive emergencies occurred. Conclusions: The Symplicity multi-electrode radiofrequency renal denervation system was associated with a significant reduction in SBP at 12 months and minimal complications whilst it also reduced procedure time. © Europa Digital & Publishing 2015. All rights reserved.

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