Royal Adelaide Hospital Adelaide

Adelaide, Australia

Royal Adelaide Hospital Adelaide

Adelaide, Australia
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Reid J.,University of Adelaide | Smith R.,University of Adelaide | Borg M.,Genesis Centre | Dobbins C.,Royal Adelaide Hospital Adelaide | And 4 more authors.
Journal of Medical Imaging and Radiation Oncology | Year: 2017

Introduction: The role and timing of postoperative radiotherapy (PORT) in the management of retroperitoneal sarcoma (RPS) remains controversial. Method: This is a retrospective cohort review of patients undergoing curative resection for RPS at a single institution between January 2011 and July 2016. Patient selection was through the South Australian Soft Tissue Tumour Multidisciplinary Group (MDT) based at Royal Adelaide Hospital. An individualised approach, including assessment of resectability, histopathological grade and subtype, and radiotherapy considerations, was taken for each patient. Patients offered preoperative radiotherapy or palliation were excluded. A saline-filled spacer was inserted following operative resection. Radiotherapy commenced postoperatively. Patients underwent laparotomy to remove the device approximately 6 weeks post completion of PORT. Primary endpoints were technical feasibility, perioperative morbidity and radiation toxicity. Secondary endpoints were local recurrence (LR), distant recurrence (DR) and death. Results: During the study period, 40 patients with RPS were managed through the MDT. Twelve patients (ages 33-78) underwent PORT utilising spacers. Radiotherapy toxicity was reported in four patients and extensive adhesions observed in another four patients during spacer removal. Median follow-up was 35 months (range 4-60). Seven patients remain alive and disease free. Four patients developed LR, three developed DR. Three patients died; two with DR and one with LR. Two patients with recurrent/progressive disease are alive; one with DR and one with LR. Conclusion: Use of intraoperative spacers to facilitate PORT is feasible, with acceptable toxicity following resection of RPS. Patient selection for this approach remains to be determined. © 2017 The Royal Australian and New Zealand College of Radiologists.

Bacchi S.,University of Adelaide | Chim I.,University of Adelaide | Patel S.,Royal Adelaide Hospital Adelaide
Journal of Medical Imaging and Radiation Oncology | Year: 2017

Progressive supranuclear palsy (PSP) is a neurodegenerative condition that can only be diagnosed conclusively on pathological examination. Currently, the diagnosis is based upon the National Institute of Neurological Disorders and Stroke and the Society for PSP criteria. These criteria consist of purely clinical findings. Elements of brain MRI that are being investigated for this role include identifying structural features on conventional MRI, volume changes, signal abnormalities and diffusion changes. The aim of this study is to conduct a systematic search to identify which MRI findings have evidence to support their sensitivity/specificity/accuracy in the diagnosis of PSP. A search was conducted of Pubmed and Medline on July 5th-6th 2016 using the medical subject headings progressive supranuclear palsy and MRI. Seventy articles were identified which assessed the sensitivity/specificity/accuracy of MRI signs for the diagnosis of PSP. There were 13 studies that identified MRI features that had ≥95% sensitivity and specificity for the diagnosis of PSP. Four of these studies identified the magnetic resonance parkinsonism index as highly sensitive and specific. There were only four studies which assessed how effective given MRI features are at predicting the pathological diagnosis of PSP. Several markers, such as the magnetic resonance parkinsonism index, have been demonstrated to be both specific and sensitive for PSP. However, many studies assessing these markers have common weaknesses including small sample size and lacking autopsy correlation. © 2017 The Royal Australian and New Zealand College of Radiologists.

Somogyi A.A.,University of Adelaide | Somogyi A.A.,Royal Adelaide Hospital Adelaide | Phillips E.,Vanderbilt University | Phillips E.,Murdoch University
Australian Prescriber | Year: 2017

A person’s genetic make-up, including their ethnicity, can affect how they respond to a drug. It can also contribute to drug toxicity and efficacy. Pharmacogenomic testing is now inexpensive, relatively fast and can enhance patient care. Pre-emptive tests for azathioprine and abacavir are subsidised by Medicare. A national regulatory system including standardised reporting and guidelines for interpreting test results is urgently needed. Improved education for GPs and pharmacists at postgraduate and undergraduate levels is also needed. © 2017, Australian Government Publishing Service. All rights reserved.

Warren J.M.,Royal Adelaide Hospital Adelaide | Irish G.L.,Royal Adelaide Hospital Adelaide | Purbrick B.,Royal Darwin Hospital Tiwi | Li J.J.,University of Adelaide | And 3 more authors.
Australian Journal of Rural Health | Year: 2016

Objective: To describe and evaluate a programme where medical students designed and implemented Indigenous health placements for students with an interest in rural/Indigenous health. Design, setting and participants: In 2011, a student-led programme at the University of Adelaide was set up to give medical students the opportunity to undertake outreach trips and clinical placements in remote Indigenous communities. Twenty-four medical students attended trips to remote communities between 2012 and 2014. Here we evaluate our programme using a single-arm experimental design. Main outcome measures: Responses to questionnaire items before and after attending an outreach placement, scored on 6-point Likert scales. Results: Following their remote Indigenous health placement, participants expressed a significantly higher mean likelihood of working in an Indigenous community in the future (3.17 (2.69-3.64) versus 4.00 (3.65-4.35); P < 0.007). Furthermore, after their placement participants felt better prepared to work in Indigenous communities (mean 1.79 (1.44-2.14) versus 3.21 (2.88-3.54); P < 0.001). Conclusions: A placement programme initiated and run by medical students can provide meaningful exposure to Indigenous health. Implementation of this student-led model in other medical schools may encourage nationwide development of the Indigenous health workforce. © 2016 National Rural Health Alliance Inc.

PubMed | University of Salford, University of Adelaide and Royal Adelaide Hospital Adelaide
Type: Journal Article | Journal: Journal of medical radiation sciences | Year: 2015

Action research is a form of research that investigates and describes a social or work situation with the aim of achieving a change which results in improvement. This article emphasizes the potential for action research to be a useful research method in radiography. A search was conducted to determine the extent to which action research has been utilized in radiography. Although action research has been used in a number of health-care settings, there are no published examples of action research being utilized in a clinical medical imaging department. Action research is discussed in detail, along with an example guide for an action research study. Action research has been identified as a useful way to affect change, to involve radiographers in the research process, and to introduce evidence-based practice to radiography.

Harley S.,Royal Adelaide Hospital Adelaide | Dutschke J.,University of Adelaide | van den Berg A.,University of Adelaide | Dobbins C.,Royal Adelaide Hospital Adelaide
ANZ Journal of Surgery | Year: 2016

Background: The aim of this study was to determine if wearing a bicycle helmet during ladder use could reduce the incidence and severity of head injury in the event of a fall. Methods: A headform model with inbuilt accelerometers was used to determine the Head Injury Criterion (HIC) score of head impact by dropping 41 helmeted and unhelmeted headforms from eight heights. These results were compared. Results: There was a statistically significant difference between averaged HIC scores in helmeted and unhelmeted drops (P < 0.001). Unhelmeted HIC scores ranged from 387 at 0.25m to 2121 at 0.6m. Helmeted HIC scores ranged from 29 at 0.25m to 1199 at 2.5m. At a height of 0.5m, the risk of severe brain injury (AIS ≥4) from direct frontal head impact is predicted to reduce from >50% to <5% with helmet use. Conclusion: There was a significant decrease in the HIC scores when helmets are used and it is likely that the benefits would be seen in the clinical setting. These results provide an argument for the use of a bicycle helmets by all ladder users, in particular those over age 50 who are at increased risk of head injuries. We recommend that bicycle helmet use be incorporated into ladder injury prevention strategies. © 2016 Royal Australasian College of Surgeons.

Chaptini C.,Flinders Medical Center Adelaide | Sidhu S.,Royal Adelaide Hospital Adelaide
Australasian Journal of Dermatology | Year: 2014

We report two cases of adults with urticarial dermatitis who could not be managed by a variety of treatments but who obtained good control with mycophenolate mofetil (MMF). A clinical response was seen 6-8 weeks from treatment onset and they were maintained on MMF 1g twice daily (case 1), and MMF 1g omni mane and 500mg omni nocte (case 2), with no major exacerbations for many years. MMF is an immunosuppressive agent, which is currently used off-label for many dermatological conditions. To date, there have been no studies investigating the use of MMF as a treatment for urticarial dermatitis. The cases we present suggest that MMF is an effective treatment for this condition, and we recommend that MMF be considered as a treatment option. © 2014 The Australasian College of Dermatologists.

PubMed | Royal Adelaide Hospital Adelaide and University of South Australia
Type: Journal Article | Journal: Pharmacy practice | Year: 2014

The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to an Emergency Department (ED). The elderly, in particular those residing in Residential Aged Care Facilities and those with a non-English speaking background, have been identified as patient groups vulnerable to medication analyse the incidence of discrepancies in medication histories in these demographic groups when pharmacist elicited medication histories were compared with those taken by ED physicians. It also aimed to investigate the incidence of medication related ED presentations.The study was conducted over a six week period and included 100 patients over the age of 70, who take five or more regular medications, have three or more clinical co-morbidities and/or have been discharged from hospital in three months prior to the study.Twenty four participants were classified as language barrier; 12 participants were from residential aged care facilities, and 64 participants were classified as general. The number of correctly recorded medications was lowest in the language barrier group (13.8%) compared with 18% and 19.6% of medications for general patients and patients from residential aged care facilities respectively. Seven of the patients (29.2%) with language barrier; 1 from a residential aged care facility (8.3%) and 13 of the (20.3%) patients from the general category were suspected as having a medication related ED presentation.This study further highlights the positive contribution an ED pharmacist can make to enhancing medication management along the continuum of care. This study also confirms the vulnerability of patients with language barrier to medication misadventure and their need for interpreter services at all stages of their hospitalisation, in particular at the point of ED presentation.

Smith W.B.,Royal Adelaide Hospital Adelaide
Australian Prescriber | Year: 2014

Allergen immunotherapy reduces the symptoms of allergic disease by inducing tolerance to specific allergens. It can be given sublingually or by subcutaneous injection. Immunotherapy is the only form of treatment which modifies abnormal immune reactivity to a specific allergen, rather than simply suppressing symptoms. It may alter the natural history of atopic disease. Allergen immunotherapy is effective for respiratory allergy (rhinitis and asthma) and venom allergy such as bee stings. Currently immunotherapy has no role in the routine management of food allergy, but research is ongoing.

Wallett A.,Royal Adelaide Hospital Adelaide | Newland K.,Royal Adelaide Hospital Adelaide | Foster-Smith E.,SA Pathology Adelaide
Australasian Journal of Dermatology | Year: 2016

Neurological involvement is a rare extracutanenous manifestation of Sweet's syndrome. We present a novel case of radiation therapy-induced neuro-Sweet disease in a patient receiving treatment for an oral squamous cell carcinoma. © 2016 The Australasian College of Dermatologists.

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