Frankston Hospital

Frankston, Australia

Frankston Hospital

Frankston, Australia

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With an upcoming publication in the Worldwide Leaders in Healthcare, Nyree L. Parker, RN/Clinical Nurse Specialist, Dip. Health Science, BN, Graduate Certificate of Health Education, Graduate Certificate Health Promotion, Graduate Diploma Critical Care/Emergency, MN, Master Degree in Disaster Health, joins the prestigious ranks of the International Nurses Association. She is a Registered Nurse with twenty-four years of experience in her field and extensive expertise in all facets of nursing, including emergency care and Disaster Health. Nyree is currently serving patients as Clinical Nurse Specialist in the Emergency Department and Emergency Management and BCP Consultant in the Facilities Management Department at Peninsula Health in Victoria, Australia. This involves policy and procedure/plan writings for i.e. mass casualties incidents, CBR decontamination processes, pandemics, heatwaves, bushfires and severe weather impacting on the public hospital organisation. Furthermore, she works as Assistance in Care Emergency Volunteer Coordinator in the Emergency Departments at Peninsula Health Frankston Hospital in Frankston, Victoria, Australia. Nyree acquired her graduate diploma in applied sciences in 1991 at Monash University, where she also received her bachelor degree of nursing in 1992. She also obtained a diploma of critical care nursing majoring in Emergency care (1997), a master degree of nursing (2001), and a Master Degree in emergency Disaster Health (2013) at Monash University. In 1998, Nyree earned a postgraduate certificate in health promotion from Deakin University. She is a Clinical Nurse Specialist and was a Trauma Nursing Core Course Instructor as well as a member of the Australian College of Emergency Nursing, the Victoria Hospital Management Forum, the Royal College of Nursing Australia, the Australian Nurses Federation, and an active member of the Nursing Section of the World Association of Disaster Emergency Medicine. Furthermore, she was honoured with the Dux of Group Award in 2009 and was a volunteers with St. John’s Ambulance. Nyree credits her success to being a third generation nurse in her family. She also has acted as a Clinical Instructor of Emergency Management and Critical Care at Monash University. Nyree is aiming to commence her PhD in Disaster Health looking at topics of climate change implications on emergency nurses and the role of an Emergency Management Consultant in the hospital environment. In her spare time, Nyree enjoys reading the Great Hospital Emergency Disaster Relief Journal and the Emergency Medicine News Journal. She also dedicates to dog walking and antique shopping and driving her 1948 Morris car! Learn more about Nyree here: http://inanurse.org/network/index.php?do=/4125803/info/ and read her upcoming publication in the Worldwide Leaders in Healthcare.


Pilgrim C.H.C.,Alfred Hospital | Pilgrim C.H.C.,Frankston Hospital | McIntyre R.,Frankston Hospital | Bailey M.,Alfred Hospital | Bailey M.,Monash University
Diseases of the Colon and Rectum | Year: 2010

Purpose: There is little evidence regarding the prevalence or incidence of parastomal hernia, but it is thought to be common. Repair of parastomal hernia can be troublesome, and methods of repair need to be validated based on reduced incidence following surgery. The true rate of parastomal herniation needs to be determined prospectively, and risk factors for developing such hernias need to be more clearly defined. Methods: To determine prevalence and associated risk factors, prospective data were collected regarding initial stoma surgery, presence of parastomal hernia, and comorbidities. Results: Ninety patients were prospectively audited. For stomas formed at emergency or elective surgery, regardless of surgical indication, the overall rate of parastomal hernia was 33%. Aperture size and patient age were independently predictive of parastomal hernia in multivariate analysis. For every millimeter increase in aperture size, the risk of developing a hernia increased by 10% (odds ratio, 1.10 (CI, 1.03-1.18); P = .005). For every additional year of patient age, the risk of developing a hernia increased by 4% (odds ratio, 1.04 (CI, 1.00 -1.08); P = .04). There was a significantly higher prevalence of hernia following sigmoid colostomy than following ileostomy (45.9% vs. 22%; P < .05). The hernia rate was higher but did not reach statistical significance in patients with disseminated malignancy, body mass index >35 kg/m2, diabetes, prostate hypertrophy, ascites, or chronic constipation. Conclusion: This study of carefully and prospectively collected data shows the prevalence of parastomal herniation to be 33%. This rate was higher with larger aperture size and increased age in multivariate analysis. © 2009 The ASCRS.


Haji D.L.,Frankston Hospital | Haji D.L.,University of Melbourne | Royse A.,Royal Melbourne Hospital | Royse C.F.,Royal Melbourne Hospital
EMA - Emergency Medicine Australasia | Year: 2013

There is increased realisation of the emerging role of point-of-care transthoracic echocardiography (TTE) as 'ultrasound-assisted examination', given the low sensitivity of clinical examination for cardiovascular pathologies and the time-critical nature of these pathologies. There is evidence that point-of-care TTE provides higher accuracy in patient assessment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. Point-of-care TTE is increasingly used by non-cardiologists, as a diagnostic, screening or monitoring tool. The literature shows that TTE identifies new clinical findings, and conversely can accurately rule out clinically important pathologies. Recent reports have examined more advanced ultrasound devices and patients in the critical care settings of emergency medicine, intensive care and anaesthesia. The diagnostic capability of new portable devices is improving rapidly and outdating its predecessors, thereby improving confidence in echocardiography findings. © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.


Summary Osteoporosis affects many people and has a large impact on health. As the condition is known to be poorly managed, a project was undertaken to improve treatment results in a hospital setting. The project succeeded in improving management of osteoporosis in patients who are admitted to hospital with broken bones. Purpose Osteoporosis is an inadequately managed condition around the world with high mortality and morbidity resulting from major fractures. Assessment and treatment rates for this condition are low, including hospital settings after minimal trauma fractures. The PRO-OSTEO project was set up to improve assessment and treatment rates of osteoporosis in patients admitted to Frankston Hospital's (Peninsula Health) orthopaedic ward with minimal trauma fractures. Method An osteoporosis assessment and treatment algorithm was introduced into inpatient practice in March 2010. This was accompanied by a multifaceted intervention, which included posters, presentations promoting the project and one on one academic detailing to ward pharmacists, orthopaedic, endocrinology and aged care junior medical staff. Three time periods were retrospectively reviewed to determine assessment and treatment rates, before and after the introduction of the algorithm, as well as 3 months following the introduction of the algorithm, to observe the sustainability of the intervention in a new group of doctors who had not received academic detailing. Results Initially, the introduction of the algorithm increased treatment and assessment rates from 19.7% and 50% at baseline to 71.6% and 87.8%, respectively (p<0.0005), with the results declining in the following period, 3 months after initial intervention and after medical/surgical staff change over, to 47.8% and 54.3%, respectively (p<0.0005). Conclusion An algorithm-based approach linked with academic detailing and education of the multidisciplinary team in acute hospital environment provides a clinically significant and effective strategy to improve osteoporosis management of patients with minimal trauma fractures. © International Osteoporosis Foundation and National Osteoporosis Foundation 2011.


Rupasinghe J.,Frankston Hospital | Jasinarachchi M.,Frankston Hospital
Journal of Clinical Neuroscience | Year: 2011

Valproic Acid (VPA) in overdose is known to cause encephalopathy with or without cerebral odema, hyperammonaemia, hepatotoxicity, bone marrow suppression and non gap acidosis. Most of these conditions are reversible. We report a 45-year-old man who suffered permanent disability from the non reversible effects of cerebral odema and infarctions associated with Valproate overdose which would have been aggravated by Diazepam. This patient's presentation emphasizes the role of early detection and therapy of cerebral odema in Valproate and Diazepam overdose. © 2010 Published by Elsevier Ltd. All rights reserved.


Tiruvoipati R.,Frankston Hospital | Sultana N.,Frankston Hospital | Lewis D.,Frankston Hospital
EMA - Emergency Medicine Australasia | Year: 2012

Objective: Patients with sepsis often have elevated cardiac troponin I even in the absence of coronary artery disease. The prognostic value of cardiac troponins in critically ill patients with sepsis remains debatable. Our objective was to evaluate the prognostic value of cardiac troponin I in critically ill patients with severe sepsis. Methods: In this retrospective study, we included patients with severe sepsis who had troponin assayed within 12h of admission to intensive care over a 6year period. Patients who had myocardial infarction at intensive care admission in the setting of sepsis were excluded. Included patients were classified into two groups based on their serum troponin I levels: low troponin group (troponin ≤ 0.1μg/L) and elevated troponin group (troponin > 0.1μg/L). The primary outcome of interest was hospital mortality. The secondary outcome measures included intensive care mortality, intensive care and hospital length of stay. Results: A total of 382 patients were admitted to intensive care with sepsis. Of these, 293 patients were included in analyses. There was a statistically significant difference in hospital (15% vs 36.1%; P < 0.01) and intensive care (11% vs 25%; P < 0.01) mortality, but not in intensive care and hospital duration of stay. Logistic regression analysis revealed temperature, simplified acute physiology score II and serum lactate to be independent predictors of hospital mortality. Cardiac troponin I was not an independent predictor of hospital mortality. Conclusion: Critically ill patients with severe sepsis who had elevated troponin had increased hospital and intensive care mortality. However, cardiac troponin I did not independently predict hospital mortality. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.


Tiruvoipati R.,Frankston Hospital | Lewis D.,Frankston Hospital | Haji K.,Frankston Hospital | Botha J.,Frankston Hospital
Journal of Critical Care | Year: 2010

Purpose: Oxygen delivery after extubation is critical to maintain adequate oxygenation and to avoid reintubation. The delivery of oxygen in such situations is usually by high-flow face mask (HFFM). Yet, this may be uncomfortable for some patients. A recent advance in oxygen delivery technology is high-flow nasal prongs (HFNP). There are no randomized trials comparing these 2 modes. Methods: Patients were randomized to either protocol A (n = 25; HFFM followed by HFNP) or protocol B (n = 25; HFNP followed by HFFM) after a stabilization period of 30 minutes after extubation. The primary objective was to compare the efficacy of HFNP to HFFM in maintaining gas exchange as measured by arterial blood gas. Secondary objective was to compare the relative effects on heart rate, blood pressure, respiratory rate, comfort, and tolerance. Results: Patients in both protocols were comparable in terms of age, demographic, and physiologic variables including arterial blood gas, blood pressure, heart rate, respiratory rate, Glasgow Coma Score, sedation, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores. There was no significant difference in gas exchange, respiratory rate, or hemodynamics. There was a significant difference (P = .01) in tolerance, with nasal prongs being well tolerated. There was a trend (P = .09) toward better patient comfort with HFNP. Conclusions: High-flow nasal prongs are as effective as HFFM in delivering oxygen to extubated patients who require high-flow oxygen. The tolerance of HFNP was significantly better than in HFFM. © 2010.


Taverner M.G.,Frankston Hospital | Ward T.L.,Frankston Hospital | Loughnan T.E.,Frankston Hospital
Clinical Journal of Pain | Year: 2010

Objective: Our study was designed to determine if transcutaneous-pulsed radiofrequency treatment (TCPRFT) was able to reduce the pain experienced by patients awaiting total knee joint replacement (TKJR). We conducted a randomized, double-blinded, placebo controlled trial of TCPRFT in patients referred for TKJR to our hospital's Orthopedic Outpatient Clinic. Methods: Patients on the waiting list for assessment for TKJR were invited to participate and were examined in the clinic if they satisfied the inclusion criteria. Patients were randomized to receive active or sham TCPRFT. The alteration in pain and function of the treated knee after a single TCPRFT was assessed at examination at 1 and 4 weeks using visual analog pain score (VAS) at rest and after 20 and 400m walks. Results: The results of 50 patients showed a statistically significant reduction in VAS at 1 and 4 weeks compared with baseline in the group who received active treatment. We also demonstrated what is considered a clinically significant improvement in this group that became more pronounced at week 4 compared with week 1 and also more after a 400m walk compared with a 20m walk. Maximum improvement observed in group data was 19/100 VAS. Patients receiving sham treatment showed no statistically significant improvement. Discussion: We believe this to be the first report of a controlled study of TCPRFT. This pilot study shows a benefit of the technique that justifies future research. © 2010 by Lippincott Williams & Wilkins.


Taverner M.,University of Vic | Taverner M.,Frankston Hospital | Loughnan T.,University of Vic | Loughnan T.,Frankston Hospital
Pain Practice | Year: 2014

Shoulder pain is the third most common musculoskeletal problem and accounts for 5% of general practitioner consultations. Although many treatments are described, there is no consensus on optimal treatment and up to 40% of patients still have pain 12 months after initially seeking help for pain. Previously, the effect of transcutaneous pulsed radiofrequency treatment (TCPRFT) was evaluated in a retrospective audit that showed good pain relief for a mean 395 days and justified this randomized sham controlled trial. In this study, 51 patients entered into a randomized double-blinded, placebo controlled study of TCPRFT. Patients were assessed at 4 and 12 weeks by a blinded observer and compared with baseline. We observed sustained reductions in pain at night, pain with activity, and functional improvement at 4 and 12 weeks with active but not sham TCPRFT. The 25 subjects who received active treatment showed statistically significant reductions of 24/100 in pain at night and 20/100 of pain with activity at 4 weeks and 18/100 and 19/100, respectively, at 12 weeks from baseline. Statistically significant lower Brief Pain Inventory pain and function scores (4 and 12 weeks), improved pain self-efficacy (4 weeks), Oxford Shoulder scores (12 weeks), and internal rotation (12 weeks) were seen. Pain at both rest and shoulder elevation were not improved by active treatment. No complications were seen. This study of a simple, low risk, outpatient treatment confirms the findings of our earlier study of TCPRFT for knee pain and shoulder pain audit that transcutaneous pulsed radiofrequency treatment may help some people with painful shoulders. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.


Smoll N.R.,Frankston Hospital | Hamilton B.,Frankston Hospital
Neuro-Oncology | Year: 2014

Background: The purpose of this study was to investigate the relationship between age and the incidence and relative survival of anaplastic astrocytoma (AA). Methods: Data from the Surveillance, Epidemiology and End Results database were used to identify 3202 patients with AA. These data were analyzed to assess incidence rates, relative survival, and the standardized mortality ratio across age groups. Time trends were modeled using delayed-entry modeling. Results: The overall incidence of AA was an age-adjusted rate of 3.5 per million person/years. The overall age-standardized 5- and 10-year relative survival rates of populations with AAwere 23.6% and 15.1%, respectively. The overall standardized mortality ratio for the entire cohort was 46 (95% confidence interval: 45, 48). Conclusions: Patients with a diagnosis of AA are 46 times more likely to die than persons matched for age/sex/year of the general population. The effect of age on survival is present for only the first 2 years postdiagnosis. Measuring the effect of age on survival for populations with an AA is not amenable to using models with proportional hazards as an assumption because of the presence of a reverse fork-type interaction. © The Author(s) 2014.

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