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Ireland T.A.,Queensland University of Technology | Irvine M.,Lady Cilento Childrens Hospital
Australasian Physical and Engineering Sciences in Medicine | Year: 2016

With the current preference for digital radiographic detectors in modern radiology facilities, there has been increasing demand for baseline technical data for equipment comparison and benchmarking. Key system parameters were monitored in 12 individual digital detectors over a 6 months period following installation, to establish baseline performance fluctuations for current generation indirect digital detectors. Performance criteria monitored included exposure index consistency, detector uniformity, system transfer function, artifact presentation, automatic exposure control reproducibility and dose area product consistency. Two indirect digital detector models were included, with the final set of measurements for each detector taken after routine detector calibrations were completed by technical staff. Suggested performance limits are presented based on observed temporal fluctuations, as well as national and international standards, where applicable. © 2016 Australasian College of Physical Scientists and Engineers in Medicine


Pearn J.,Lady Cilento Childrens Hospital | Pearn J.,Australian Defence Force Academy
South African Medical Journal | Year: 2016

Prof. Peter Beighton has given a professional lifetime to helping patients and their families who have been afflicted by inherited disease. His clinical skills have brought certainty, confidence and support to those confronted with some of the most difficult decisions in life’s progress. Prof. Beighton’s research has led to the discovery of new syndromes and the elucidation of accurate genetic risks in many diseases. This in turn has empowered patients and their families to make informed decisions and has provided doctors with the scientific knowledge to help patients. On the occasion of this festschrift, I join with so many members of Peter’s international professional family to pay tribute to his leadership and service – not only in medical genetics – but also in the broadest domains of healthcare. © 2016, South African Medical Association. All Rights Reserved.


Robertson J.D.,Lady Cilento Childrens Hospital
Journal of Thrombosis and Haemostasis | Year: 2015

Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long-term quality of life. Unfortunately, there remains a general paucity of pediatric-specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens. © 2015 International Society on Thrombosis and Haemostasis.


Clark D.,Materials Childrens Hospital | Clark D.,Womens and Childrens Hospital | Riney K.,Materials Childrens Hospital | Riney K.,Lady Cilento Childrens Hospital | Riney K.,University of Queensland
Journal of Clinical Neuroscience | Year: 2016

The aim of this study was to review population autopsy data on epilepsy-related deaths (ERD) in Queensland, Australia, to establish the incidence of autopsy-confirmed sudden unexpected death in epilepsy (SUDEP), explore factors associated with SUDEP, and determine if complete autopsy examinations of SUDEP were performed. All autopsy reports for a 5 year period in Queensland were electronically searched for the terms 'epilepsy' or 'seizure'. The identified reports were reviewed, and data were extracted for all ERD. In the study period, 175 ERD were identified from autopsy records (123 SUDEP, 34 accident-related, 3 due to status epilepticus). From data available on the prevalence of epilepsy in Queensland (National Health Survey), the incidence of autopsy-confirmed SUDEP was 0.7 per 1000 person years (95% confidence interval 0.5-1.2 per 1000 person years). The factors associated with SUDEP were male sex (for those >18 years) and subtherapeutic anticonvulsant medication levels (found in 55%). Where recorded, the majority of deaths happened in the person's usual residence (90%), were overnight (70%) and unwitnessed (87%), with the person found prone (74%), in or adjacent to their bed (49%) and with signs of proximate seizure (60%). A complete autopsy was undertaken for only 59% of cases, the majority in urban locations. This study provides support for an unwitnessed overnight seizure being a key factor in autopsy-confirmed SUDEP in Queensland. © 2015 Elsevier Ltd. All rights reserved.


O'Brien A.J.,Royal Melbourne Hospital | Brady R.M.,Lady Cilento Childrens Hospital
Journal of Paediatrics and Child Health | Year: 2016

Point-of-care ultrasound (POC US) is an adjunct to clinical paediatric emergency medicine practice that is rapidly evolving, improving the outcomes of procedural techniques such as vascular access, nerve blocks and fluid aspiration and showing the potential to fast-track diagnostic streaming in a range of presenting complaints and conditions, from shock and respiratory distress to skeletal trauma. This article reviews the procedural and diagnostic uses, both established and emerging, and provides an overview of the necessary components of quality assurance during this introductory phase. © 2016 The Authors. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).


Wright N.,Sheffield Childrens Hospital | Wales J.,Lady Cilento Childrens Hospital
Archives of Disease in Childhood | Year: 2016

Approximately 3% of children and adolescents in the UK have severe obesity. The incidence of cardiovascular risk factors such as hypertension, hyperinsulinism and hyperlipidaemia approaches 20% in such individuals. Lifestyle intervention programmes and pharmacotherapy are effective in some individuals, but the relapse rate is high. In exceptional cases, bariatric surgery is effective. This review outlines the scale of the problem, highlights those at risk and discusses referral, current services, appropriate screening and therapeutic interventions. © 2016 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.


Heussler H.S.,University of Queensland | Heussler H.S.,Lady Cilento Childrens Hospital
Current Opinion in Psychiatry | Year: 2016

Purpose of review Sleep disorders in individuals with developmental difficulties continue to be a significant challenge for families, carers, and therapists with a major impact on individuals and carers alike. This review is designed to update the reader on recent developments in this area. Recent findings A systematic search identified a variety of studies illustrating advances in the regulation of circadian rhythm and sleep disturbance in neurodevelopmental disorders. Specific advances are likely to lead in some disorders to targeted therapies. There is strong evidence that behavioural and sleep hygiene measures should be first line therapy; however, studies are still limited in this area. Nonpharmacological measures such as exercise, sensory interventions, and behavioural are reported. Behavioural regulation and sleep hygiene demonstrate the best evidence for improved sleep parameters in individuals with neurodisability. Summary Although the mainstay of management of children with sleep problems and neurodevelopmental disability is similar to that of typically developing children, there is emerging evidence of behavioural strategies being successful in large-scale trials and the promise of more targeted therapies for more specific resistant disorders. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Skellern C.Y.,Lady Cilento Childrens Hospital
Journal of Paediatrics and Child Health | Year: 2015

It has been 50 years since Kempe et al. published 'The Battered Child Syndrome', describing harm from inflicted injury mechanisms derived from parents and care givers. Since then, there has emerged a rapidly expanding literature on paediatric forensic medicine and child protection, which has offered new insights into injury mechanisms, informed us of the sequelae of abuse and neglect, aided diagnosis and guided clinical practice in the treatment and management of children who become involved in the child protection system. Through the scrutiny of government inquiries and at times uncomfortable media exposure, there have been improvements in child protection and forensic practices resulting in recognition of need for specialised forensic training, improved funding, development of resources and development of professional standards that support accountable, objective, safe and robust practice. From the perspective of an Australian child protection paediatrician, this paper chronicles some of the most significant and at times controversial research in the last 50 years in child protection that have played a key role in shaping our current understanding of child abuse and neglect. © 2014 The Author. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).


Skellern C.,Lady Cilento Childrens Hospital | Skellern C.,University of Queensland
Journal of Forensic and Legal Medicine | Year: 2015

In the rules of evidence in all legal jurisdictions, medical experts are required to maintain objectivity when providing opinions. When interpreting medical evidence, doctors must recognise, acknowledge and manage uncertainties to ensure their evidence is reliable to legal decision-makers. Even in the forensic sciences such as DNA analysis, implicit bias has been shown to influence how results are interpreted from cognitive and contextual biases unconsciously operating. In cases involving allegations of child abuse there has been significant exposure in the media, popular magazines, legal journals and in the published medical literature debating the reliability of medical evidence given in these proceedings. In these cases judges have historically been critical of experts they perceived had sacrificed objectivity for advocacy by having an investment in a 'side'. This paper firstly discusses the issue of bias then describes types of cognitive biases identified from psychological research applied to forensic evidence including adversarial bias, context bias, confirmation bias and explains how terminology can influence the communication of opinion. It follows with previously published guidelines of how to reduce the risk of bias compromising objectivity in forensic practices then concludes with my own recommendations of practices that can be used by child protection paediatricians and within an organisation when conducting forensic evaluations of suspicious childhood injury to improve objectivity in formulation of opinion evidence. © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.


McBride C.A.,Lady Cilento Childrens Hospital | McBride C.A.,University of Queensland | Kimble R.M.,Lady Cilento Childrens Hospital | Kimble R.M.,University of Queensland | Stockton K.,University of Queensland
Trials | Year: 2015

Background: For children requiring split-thickness skin grafting for burn injury, the optimum donor site dressing is an ongoing subject of debate. The most common dressings in use, both regionally and worldwide, are calcium alginates. We will compare an alginate with two other dressings, all of which are in current use in the Pegg Leditschke Paediatric Burns Centre (PLPBC), to determine which dressing performs the best. Methods/Design: This is a randomised, prospective single center parallel three-arm trial comparing three donor site wound (DSW) dressings: Algisite™ M, a calcium alginate dressing; Cuticerin™, a smooth acetate gauze impregnated with water-repellent ointment (petrolatum, paraffin and Eucerite®) and Sorbact®, a gauze mesh coated with a dialkylcarbamoyl chloride (DACC) and amorphous hydrogel. Discussion: This study will provide comprehensive short- and long-term data on DSW dressings in pediatric split-thickness skin grafting. The best-performing dressing will become the preferred dressing for the PLPBC. We will provide rigorous data against which other dressings can be compared in future, recognising that alginates are the most common DSW dressing currently in use. Our study design replicates a real-world scenario in order to identify clinically significant differences between the three dressings. © 2015 McBride et al.

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