Royal Perth Hospital Perth

Perth, Australia

Royal Perth Hospital Perth

Perth, Australia
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Bourke A.G.,University of Western Australia | Taylor D.B.,University of Western Australia | Westcott E.,University of Western Australia | Hobbs M.,Royal Perth Hospital Perth | Saunders C.,University of Western Australia
ANZ Journal of Surgery | Year: 2016

Background: The aim of this study was to confirm that radio-guided occult lesion localization using low activity iodine 125 (I-125) seeds (ROLLIS) could be safely and accurately used for localization and guided excision of impalpable breast lesions in different multidisciplinary settings and to prepare staff for a randomized controlled trial. Method: Preoperative image-guided localization of 102 lesions using one or two I-125 seeds with hook-wire back-up was performed in 99 participants at two tertiary hospitals. Preoperative core biopsy in 24 lesions was benign or indeterminate (Group A) and malignant in 78 lesions (Group B). Imaging and histopathology findings and re-excision rates were recorded. Training requirements for new staff and seed handling protocols were refined. Results: All seeds and lesions were successfully removed. In five of 23 Group A participants, malignancy on final pathology required definitive surgery for positive margins. The re-excision rate in Group B was 17%. Overall re-excision rate was 18%. Thirty-seven clinical staff members were trained. Sentinel node localization was successful in all 76 cases. Seeds of low activity were successfully used. Conclusion: The ROLLIS technique using a lower dose (∼2MBq) seed is safe, effective and can easily be adopted in a large multi-disciplinary setting. © 2016 Royal Australasian College of Surgeons.

Heslop K.,Curtin University Australia | Heslop K.,Royal Perth Hospital Perth | Ross C.,Royal Perth Hospital Perth | Osmond B.,Royal Perth Hospital Perth | Wynaden D.,Curtin University Australia
International Journal of Mental Health and Addiction | Year: 2013

Up to sixty percent of people admitted to acute mental health services in Australia present with a clinically significant co-occurring drug and/or alcohol problem. These individuals experience poorer health outcomes when compared to the general population and to those people who have a mental illness but have no co-morbid alcohol and drug problems. Anecdotal evidence also suggests that many nurses working in the area do not have the knowledge and skills and confidence to work effectively with this patient population. Drug and alcohol assessment tools, considered the gold standard, generally assess only one substance at a time or provide little specific information on the particular substance of use or abuse. An amended version of the World Health Organisation, (WHO) Alcohol Smoking and Substance Involvement Screening Test Version 3 (ASSIST V3.0) and associated brief interventions was implemented following an in-vivo education program at an acute mental health inpatient unit in Western Australia. This before and after intervention' study utilised a self-rating questionnaire and a knowledge quiz to assess nurses' knowledge of drug and alcohol issues as well as their level of confidence to work with people who have a mental illness and co-occurring drug and alcohol problems. Translation of acquired knowledge into patient care was also evaluated through a review of patient medical records. Significant improvement in nurses' knowledge was reported along with increased clinical confidence and skills to identify, assess, and manage this group of patients and to provide them with information and referral to appropriate agencies in the community. © 2013 Springer Science+Business Media New York.

Dissanayake S.,Western Hospital | Dissanayake D.,Royal Perth Hospital Perth | Taylor D.B.,Royal Perth Hospital Perth | Taylor D.B.,University of Western Australia
Journal of Medical Radiation Sciences | Year: 2015

Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 (125I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT. © 2015 Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology.

PubMed | Royal Perth Hospital Perth and University of Western Australia
Type: Journal Article | Journal: Journal of medical radiation sciences | Year: 2015

Preoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL.Fifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins.Accurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases.ROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

PubMed | Sir Charles Gairdner Hospital Perth, University of Western Australia, Queen Elizabeth Medical Center Perth and Royal Perth Hospital Perth
Type: Journal Article | Journal: New microbes and new infections | Year: 2014

The epidemiology of Clostridium difficile infection (CDI) has changed over time and between countries. It is therefore essential to monitor the characteristics of patients at risk of infection and the circulating strains to recognize local and global trends, and improve patient management. From December 2011 to May 2012 we conducted a prospective, observational epidemiological study of patients with laboratory-confirmed CDI at two tertiary teaching hospitals in Perth, Western Australia to determine CDI incidence and risk factors in an Australian setting. The incidence of CDI varied from 5.2 to 8.1cases/10000 occupied bed days (OBDs) at one hospital and from 3.9 to 16.3/10000OBDs at the second hospital. In total, 80 patients with laboratory-confirmed CDI met eligibility criteria and consented to be in the study. More than half (53.8%) had hospital-onset disease, 28.8% had community-onset and healthcare facility-associated disease and 7.5% were community-associated infections according to the definitions used. Severe CDI was observed in 40.0% of these cases but the 30-day mortality rate for all cases was only 2.5%. Besides a shorter length of stay among cases of community-onset CDI, no characteristics were identified that were significantly associated with community-onset or severe CDI. From 70 isolates, 34 different ribotypes were identified. The predominant ribotypes were 014 (24.3%), 020 (5.7%), 056 (5.7%) and 070 (5.7%). Whereas this study suggests that the characteristics of CDI cases in Australia are not markedly different from those in other developed countries, the increase in CDI rate observed emphasizes the importance of surveillance.

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