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BETHLEHEM, PA--(Marketwired - Feb 15, 2017) - The appropriate use of parenteral nutrition, a topic of growing importance for treating critically ill patients, is the focus for the symposium sponsored by B. Braun Medical Inc. at this year's American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Nutrition Week. B. Braun will present Dr. Gordon S. Doig, a leading researcher in the area of early parenteral nutrition in critically ill patients, at the symposium for continuing education credits on Feb. 19 from 6:30 a.m. - 7:30 a.m. in Grand Ballroom 8A at the Marriott Orlando World Center in Orlando, Fla. The event will be preceded by a breakfast buffet at 6:00 a.m. Doig's research, which has been published in the Journal of the American Medical Association and ClinicoEconomics and Outcomes Research, concludes that the use of parenteral nutrition in critically ill patients with short-term, relative contraindications to enteral nutrition may result in improved patient outcomes and significantly reduce total cost of care. Doig is associate professor of intensive care at the University of Sydney and Royal North Shore Hospital, Sydney, Australia. B. Braun's response to help address malnutrition in the hospitalized and home care patient will be presented throughout Clinical Nutrition Week, Feb. 18-20. B. Braun representatives at booth #201 will be available to discuss the company's new parenteral nutrition program -- PN360. According to the December 2016 Healthcare Cost and Utilization Project (HCUP) statistical brief #218, malnutrition has been associated with longer and more costly hospital stays, as well as a greater likelihood of comorbidity and death among hospitalized patients. Malnutrition may also contribute to post hospital syndrome, described as "an acquired transient period of vulnerability" following hospitalization, which may dramatically increase the risk of readmission, the brief indicated. Also on Feb. 19, from 12:45 p.m. to 1:45 p.m., B. Braun will host a poster session in the exhibit hall on "Understanding the Incidence of Bloodstream Infections and Patient Outcomes by Type of Parenteral Nutrition Preparation Method." B. Braun's poster detailing the session will be on display starting at 6 p.m. on Feb.18. B. Braun also will showcase its new macro and micro APEX® compounding system at booth #201 for health care facilities that need in-house compounding capabilities, and its wide selection of amino acid formulations, standard solutions, and related additives, in containers that are not made with natural rubber latex, PVC or DEHP. About B. Braun B. Braun Medical Inc., a leader in infusion therapy and pain management, develops, manufactures, and markets innovative medical products and services to the health care industry. The company is committed to eliminating preventable treatment errors and enhancing patient, clinician and environmental safety. B. Braun Medical is headquartered in Bethlehem, Pa., and is part of the B. Braun Group of Companies in the U.S., which includes B. Braun Interventional Systems, Aesculap® and CAPS®. Globally, the B. Braun Group of Companies employs more than 56,000 employees in more than 60 countries. Guided by its Sharing Expertise® philosophy, B. Braun continuously exchanges knowledge with customers, partners and clinicians to address the critical issues of improving care and lowering costs. To learn more about B. Braun Medical, visit www.BBraunUSA.com.


BETHLEHEM, PA--(Marketwired - Feb 15, 2017) - The appropriate use of parenteral nutrition, a topic of growing importance for treating critically ill patients, is the focus for the symposium sponsored by B. Braun Medical Inc. at this year's American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Nutrition Week. B. Braun will present Dr. Gordon S. Doig, a leading researcher in the area of early parenteral nutrition in critically ill patients, at the symposium on Feb. 19 from 6:30 a.m. - 7:30 a.m. in Grand Ballroom 8A at the Marriott Orlando World Center in Orlando, Fla. The event will be preceded by a breakfast buffet at 6:00 a.m. Doig's research, which has been published in the Journal of the American Medical Association and ClinicoEconomics and Outcomes Research, concludes that the use of parenteral nutrition in critically ill patients with short-term, relative contraindications to enteral nutrition may result in improved patient outcomes and significantly reduce total cost of care. Doig is associate professor of intensive care at the University of Sydney and Royal North Shore Hospital, Sydney, Australia. B. Braun's response to help address malnutrition in the hospitalized and home care patient will be presented throughout Clinical Nutrition Week, Feb. 18-20. B. Braun representatives at booth #201 will be available to discuss the company's new parenteral nutrition program -- PN360. According to the December 2016 Healthcare Cost and Utilization Project (HCUP) statistical brief #218, malnutrition has been associated with longer and more costly hospital stays, as well as a greater likelihood of comorbidity and death among hospitalized patients. Malnutrition may also contribute to post hospital syndrome, described as "an acquired transient period of vulnerability" following hospitalization, which may dramatically increase the risk of readmission, the brief indicated. Also on Feb. 19, from 12:45 p.m. to 1:45 p.m., B. Braun will host a poster session in the exhibit hall on "Understanding the Incidence of Bloodstream Infections and Patient Outcomes by Type of Parenteral Nutrition Preparation Method." B. Braun's poster detailing the session will be on display starting at 6 p.m. on Feb.18. B. Braun also will showcase its new macro and micro APEX® compounding system at booth #201 for health care facilities that need in-house compounding capabilities, and its wide selection of amino acid formulations, standard solutions, and related additives, in containers that are not made with natural rubber latex, PVC or DEHP. About B. Braun B. Braun Medical Inc., a leader in infusion therapy and pain management, develops, manufactures, and markets innovative medical products and services to the health care industry. The company is committed to eliminating preventable treatment errors and enhancing patient, clinician and environmental safety. B. Braun Medical is headquartered in Bethlehem, Pa., and is part of the B. Braun Group of Companies in the U.S., which includes B. Braun Interventional Systems, Aesculap® and CAPS®. Globally, the B. Braun Group of Companies employs more than 56,000 employees in more than 60 countries. Guided by its Sharing Expertise® philosophy, B. Braun continuously exchanges knowledge with customers, partners and clinicians to address the critical issues of improving care and lowering costs. To learn more about B. Braun Medical, visit www.BBraunUSA.com.


News Article | February 15, 2017
Site: www.newscientist.com

A FAST test for genetic disorders means women could learn about the future health of their baby as early as 6 weeks into pregnancy. The test for single-gene disorders, which are collectively more common than Down’s syndrome, could become available within five years. This would enable prospective parents to choose whether to proceed with a pregnancy if conditions like muscular dystrophy or Huntington’s disease are detected. “This is just sensational – I’m completely blown away,” says Andrew McLennan, a specialist in prenatal diagnosis at Royal North Shore Hospital in Sydney, Australia. Many inherited diseases, including sickle cell anaemia, haemophilia and cystic fibrosis, are caused by mutations within a single gene. We know of 10,000 single-gene conditions and together, they affect about one in 100 births. At the moment, options for prospective parents are limited. Embryos can be screened using pre-implantation genetic diagnosis (PGD), if couples opt for IVF. Those who conceive naturally can have tests like amniocentesis, but these carry a small risk of miscarriage, and detect a limited number of genetic disorders. “Abortion isn’t the only option. Test results could help reduce the effects of a genetic disorder” But the speed and ease of safer tests is improving. The non-invasive prenatal test (NIPT) for Down’s syndrome is available in over 60 countries, including the US and Australia, and it is being trialled in some UK hospitals. Now the team that developed NIPT has found a similar way to detect single-gene diseases. The test, developed by Rossa Chiu at the Chinese University of Hong Kong, and her colleagues, can detect almost any single-gene disorder in the first 6 to 10 weeks of pregnancy. Guided by DNA from parent blood samples, the test looks for increases in the level of mutations associated with a particular condition in the mother’s blood once she is pregnant. In theory, any hospital pathology lab could run the test, producing results in one to two weeks. In a study of pregnant women at risk of having a child with a single-gene disorder, the test accurately predicted the condition in all 12 fetuses whose DNA they were able to test (Clinical Chemistry, doi.org/bv3h). In the UK, the Don’t Screen Us Out campaign has voiced concerns that NIPT for Down’s syndrome could lead to the number of babies born with the condition to decrease by more than 10 per cent. The group says this would have a long-term effect on the Down’s community, and will allow an informal kind of eugenics. Advances in prenatal screening often spark controversy because of concerns that they might promote intolerance of diversity, McLennan says. “But this is not a negative eugenics campaign,” he says. “This is about choice. It’s about being given the opportunity to have information, to have appropriate counselling, and to make decisions.” “Some of the cystic fibrosis community are very against tests that are post-conception because they say ‘my life is pretty good and I wouldn’t exist if that test was around when I was born’,” says Nettie Burke from Cystic Fibrosis Australia. “But there are mothers who have said to me ‘I wish I’d known, because I would have had an abortion’.” But abortion isn’t the only option. In some cases, test results could help reduce the effects of a genetic disorder. Some of the symptoms of congenital adrenal hyperplasia, such as genital ambiguity, can be alleviated if a mother is given a steroid before 9 weeks of pregnancy. Thalassemia blood disorders can be treated with blood transfusions if given soon after birth. “In the future, some disorders may also be treatable in utero using gene therapies,” says Chiu. The test will first be developed for couples with family histories of genetic disorders, but Chiu hopes it will later be incorporated into universal screening programmes. “The potential for this is just phenomenal,” says McLennan. This article appeared in print under the headline “Early fetal gene test”


Gill A.J.,Royal North Shore Hospital | Gill A.J.,University of Sydney
Pathology | Year: 2012

The genes for the succinate dehydrogenase (SDH) subunits SDHA, SDHB, SDHC and SDHD are encoded in the autosome. The proteins are assembled in the mitochondria to form the mitochondrial complex 2, a key respiratory enzyme which links the Krebs cycle and the electron transport chain. Thirty percent of phaeochromocytoma and paraganglioma (PHEO/PGL) are hereditary and perhaps as many as half of these familial cases are caused by germline mutations of the SDH subunits. Negative immunohistochemical staining for the SDHB subunit identifies PHEO/PGL associated with germline mutation of any of the mitochondrial complex 2 components and can be used to triage formal genetic testing of all PHEO/PGL for SDH mutations. PHEO/PGL associated with SDHA mutation also show negative staining for SDHA as well as SDHB. A unique subgroup of gastrointestinal stromal tumours (GISTs) are driven by mitochondrial complex 2 dysfunction. These SDH deficient GISTs can also be definitively identified by negative staining for SDHB and show distinct clinical and morphological features including frequent onset in childhood and young adulthood, gastric location, a tendency to multifocality, absence of KIT and PDGFRA mutations, a prognosis not predicted by size and mitotic rate and a tendency to indolent behaviour of metastases. Some of these SDH deficient GISTs are driven by classical SDH mutations, but the precise mechanisms of tumourigenesis in many (including those associated with the Carney triad) remain unknown. Germline SDHB mutation is associated with a newly recognised type of renal carcinoma which commonly but not always demonstrates distinctive morphology and can also be recognised by negative staining for SDHB. Immunohistochemistry for SDHB therefore has emerged as a useful tool to recognise these distinct neoplasias driven by mito-chondrial complex 2 dysfunction and to triage formal genetic testing for the associated syndromes. © 2012 Royal College of Pathologists of Australasia.


Malhi G.S.,Royal North Shore Hospital
Bipolar disorders | Year: 2013

To review the psychosocial, neuropsychological, and neurobiological evidence regarding suicide and bipolar disorder (BD), to enable the development of an integrated model that facilitates understanding, and to provide a useful framework for future research. A two-stage literature review was conducted. First, an electronic literature search was performed using key words (e.g., bipolar disorder, suicide risk, and neuroimaging) and standard databases (e.g., MEDLINE). Second, theoretical suicide models were reviewed, and their evidence base and relevance to BD were evaluated in order to determine a guiding theoretical framework for contextualizing suicide in BD. Although accumulating clinical, cognitive, and neurobiological correlates of suicide have been identified in BD, extant research has been largely atheoretical. The Cry of Pain (CoP) and an adapted version of the model, the Schematic Appraisals Model of Suicide (SAMS), provide a useful schema for examining vulnerability to suicide in BD, by taking into account biopsychosocial determinants of suicidality. In combination, these also provide a model within which the neural correlates of suicide can be integrated. The proposed Bipolar Suicidality Model (BSM) highlights the psychosocial precursors to suicidality in BD, while recognizing the key role of cognitive deficits and underlying functional neurobiological abnormalities. It usefully integrates our knowledge, and provides a novel perspective that is intended to meaningfully inform future research initiatives, and can lead to a better understanding of suicidality in bipolar disorder. Ultimately, it is hoped that it will facilitate the development of targeted interventions that diminish the risk of suicide in bipolar disorder. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Malhi G.S.,Royal North Shore Hospital
Acta psychiatrica Scandinavica. Supplementum | Year: 2013

To be used in conjunction with 'Psychological management of unipolar depression' [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24-37] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of pharmacological treatments in depression derived from a literature review. Using our previous Clinical Practice Guidelines [Malhi et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):27-46] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience. The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to prescribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps. Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.


Wong M.H.,Royal North Shore Hospital
Cochrane database of systematic reviews (Online) | Year: 2012

Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab, inhibit key pathways in the vicious cycle of bone metastases. To assess the effect of bisphosphonates on skeletal-related events (SREs), bone pain, quality of life (QoL), recurrence and survival in women with breast cancer with bone metastases (BCBM), advanced breast cancer (ABC) without clinical evidence of bone metastases and early breast cancer (EBC).To assess the effect of denosumab on SREs, bone pain and (QoL) in women with (BCBM). We searched the Specialised Register maintained by the Cochrane Breast Cancer Group (CBCGSR), MEDLINE, EMBASE and the WHO International Cancer Trials Registry Platform (WHO ICTRP) on 30 April 2011. We conducted additional handsearching of journals and proceedings of key meetings. We included randomised controlled trials (RCTs) comparing: (a) bisphosphonates and control, or different bisphosphonates in women with BCBM; (b) denosumab and bisphosphonates in women with BCBM; (c) bisphosphonates and control in women with ABC; (d) bisphosphonates and control in women with EBC; and (e) early versus delayed bisphosphonate treatment in women with EBC. Two review authors (MW and NP) independently assessed the trials and extracted the data. We collected toxicity information from the trials. We included thirty-four RCTs. In nine studies (2806 patients with BCBM), comparing bisphosphonates with placebo or no bisphosphonates, bisphosphonates reduced the SRE risk by 15% (risk ratio (RR) 0.85; 95% confidence interval (CI) 0.77 to 0.94; P = 0.001). This benefit was most certain with intravenous (i.v.) zoledronic acid (4 mg) (RR 0.59; 95% CI 0.42 to 0.82); i.v. pamidronate (90 mg) (RR 0.77; 95% CI 0.69 to 0.87); and i.v. ibandronate (RR 0.80; 95% CI 0.67 to 0.96). A direct comparison of i.v. zoledronic acid and i.v. pamidronate confirmed at least equivalent efficacy in a single large study. In three studies (3405 patients with BCBM), compared with bisphosphonates, subcutaneous (s.c.) denosumab was more effective in reducing the risk of SREs (RR 0.78; 95% CI 0.72 to 0.85; P < 0.00001).Bisphosphonates reduced the SRE rate in 12 studies (median reduction 28%, range 14% to 48%), with statistically significant reductions reported in 10 studies. Women with BCBM treated with bisphosphonates showed significant delays in the median time to SREs.


Ward M.,Royal North Shore Hospital
Heart Lung and Circulation | Year: 2015

This discussion paper presents proposed recommendations for myocardial revascularisation in the Australasian clinical setting based on underlying evidence-based principles and an understanding of local factors which may limit the provision of ideal practice. Recommendations are proposed for myocardial revascularisation in common clinical scenarios and also for special categories, such as patients with diabetes, chronic renal impairment, advanced age, chronic total occlusions and Indigenous patients. © 2015.


Sergides I.G.,Royal North Shore Hospital
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2011

The two main methodologies described for the assessment of spinal sagittal alignment are the pelvic radius (PR) technique and that based on measures of the Pelvic Incidence (PI) and Spino-Sacral Angle (SSA). Both methods stress the fundamental relationship between the anatomical position and orientation of the sacrum within the pelvis and the spinal curves above. The aim of the current study was to assess the strengths and potential weaknesses of the PR technique. The PR technique uses measures based on a line (the PR), drawn between the hip axis and the posterior corner of the S1 endplate. The angle formed between the PR line and the sacral endplate, PRS1, is a developmental measure of sacropelvic morphology. Geometrically, PI and PRS1 are approximately complementary angles and both reflect reciprocal alterations in pelvic tilt (for PI) or angulation (for PRS1) and the slope of the S1 endplate. The angle formed between PR and T12, the PR-T12, reflects a combined measure of pelvic morphology and lumbar lordosis. It appears to be a useful measure, which provides a simple and rapid assessment of lumbopelvic sagittal balance, but only in the presence of a congruent thoracic curvature. After reviewing the literature, published measures made using the PR technique were compared to measures taken from a substantial patient population (479 adult patients). Errors can occur using the PR technique if the PRT12 is viewed in isolation from the thoracic kyphosis. We found the ratio of the thoracic kyphosis to lumbar lordosis (T4-T12/T12-S1) to be a useful predictor of congruent sagittal alignment, which may alert the clinician to situations where use of the PR-T12 in isolation may be misleading.


Hunter D.J.,Royal North Shore Hospital
Nature Reviews Rheumatology | Year: 2011

Osteoarthritis (OA) is a prevalent and disabling condition for which few safe and effective therapeutic options are available. Current approaches are largely palliative and in an effort to mitigate the rising tide of increasing OA prevalence and disease impact, modifying the structural progression of OA has become a focus of drug development. This Review describes disease modification and discusses some of the challenges involved in the discovery and development of disease-modifying OA drugs (DMOADs). A variety of targeted agents are in mature phases of development; specific agents that are beyond preclinical development in phase II and III trials and show promise as potential DMOADs are discussed. A research agenda with respect to disease modification in OA is also provided, and some of the future challenges we face in this field are discussed.

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