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Georgiou C.,University of Wollongong | Georgiou C.,Wollongong Hospital
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

Objective To investigate the proposed mechanism by which intrauterine balloons achieve their tamponade effect of creating an 'intrauterine pressure that is greater than the systemic arterial pressure'. Design To determine the intraluminal pressures within a Bakri balloon during the establishment of a positive 'tamponade test' in the management of postpartum haemorrhage. To correlate these intraluminal pressures with contemporaneous readings of blood pressure recordings as documented from the operating theatre anaesthetic charts. Setting An obstetric unit (approximately 2400 births) in Wollongong, New South Wales, Australia. Sample Two women in whom first-line uterotonics were unsuccessful and who required a Bakri balloon to control postpartum haemorrhage secondary to an atonic uterus. Methods A DigiMano (Netech Corporation, Farmingdale, NY, USA) pressure recorder was attached via a three-way tap to a Bakri balloon. Anaesthetic charts of the two cases were reviewed retrospectively. Main outcome measures Intraluminal pressure readings were recorded after each 50-ml aliquot of normal saline had been insufflated into the balloon whilst the next aliquot was being prepared. Results There is a curvilinear relationship between the intraluminal pressure and the balloon volume. The pressure does not exceed the systolic blood pressure of the patient at the time of establishment of a positive tamponade test. Conclusions The intraluminal pressure within the tamponade balloon does not exceed the systolic blood pressure of the patient when a positive tamponade test is established. © 2009 RCOG BJOG An International Journal of Obstetrics and Gynaecology.


Feros D.L.,Wollongong Hospital | Lane L.,Wollongong Hospital | Ciarrochi J.,University of Wollongong | Blackledge J.T.,University of Wollongong
Psycho-Oncology | Year: 2013

Background This preliminary study examined the effectiveness of an Acceptance and Commitment Therapy (ACT) intervention at improving the quality of life among cancer patients. It was hypothesised that over the course of the intervention, patients would report increased psychological flexibility through acceptance of unpleasant thoughts and feelings, and that increased psychological flexibility would lead to improvements in distress, mood, and quality of life. Method Forty-five cancer patients participated in an ACT intervention. Outcome measures included self-reported distress, mood disturbance, psychological flexibility, and quality of life. Data were collected at pre, mid, and post-intervention and at 3-month follow-up. Results The data showed significant improvements on outcome measures from pre to post and from pre to follow-up. Regression analyses showed that changes in psychological flexibility predicted changes in quality of life, distress, and mood. Conclusions ACT effect sizes were comparable to those obtained in studies examining the effectiveness of other psychological therapies, such as cognitive behaviour therapy, at improving quality of life among individuals with cancer. This supports further research into ACT as an effective intervention for cancer patients. Copyright © 2011 John Wiley & Sons, Ltd.


Georgiou C.,University of Wollongong | Georgiou C.,Wollongong Hospital
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2014

This manuscript describes five cases of pregnancies and births in women that have previously required the uterine-specific Bakri™ balloon in the management of postpartum haemorrhage. In addition, this manuscript reviews the impact on menses, fertility and subsequent pregnancies as potential surrogate effects on the myometrium and endometrium, when balloon tamponade technology is used as a 'uterine-sparing' second-line approach in the management of postpartum haemorrhage. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.


Pai N.B.,University of Wollongong | Laidlaw M.,Wollongong Hospital | Vella S.-L.,University of Wollongong
Acta Psychiatrica Scandinavica | Year: 2012

Objective: Refractory schizophrenia (SZ) affects approximately 30% of people with SZ. Clozapine (CLZ) is the gold standard treatment; however, there are still patients who are non-responsive or partially responsive to treatment. Although a lack of evidence exists in reality, these patients are treated with a combination of agents in addition to CLZ. Therefore, this article reviews the prevalence of the augmentation of CLZ with additional agents. Method: This study was cross-sectional; physicians in a region of Australia in May 2011 were contacted to provide details of their patients on CLZ and any additional agents. The data set consists of 84 patients. Results: The majority of the patients 84.5% were taking at least one additional agent. Of those taking additional agents, they derived from the following classes' antipsychotics (72%), antidepressants (30%), mood stabilisers (17%), antimetabolic agents (13%), benzodiazepines (7%), anticholinergics (4%) and miscellaneous agents (12.5%). Conclusion: It is apparent that CLZ is routinely augmented with other agents despite the lack of an evidence base. However, concerning was the lack of augmentation with antimetabolic agents despite the paucity of literature reporting the detrimental impact of antipsychotic treatment upon patients metabolic indices. The findings are discussed in the context of the current recommendations and empirical literature. © 2012 John Wiley & Sons A/S.


Balli E.P.,Aristotle University of Thessaloniki | Venetis C.A.,Aristotle University of Thessaloniki | Miyakis S.,Aristotle University of Thessaloniki | Miyakis S.,Wollongong Hospital
Antimicrobial Agents and Chemotherapy | Year: 2014

Limited therapeutic options exist for the treatment of vancomycin-resistant Enterococcus (VRE) bacteremia; the most commonly used are daptomycin and linezolid. We attempted a systematic review and meta-analysis of the comparative efficacy of those two agents. Studies comparing daptomycin to linezolid treatment for VRE bacteremia, published until August 2012, were identified from the MEDLINE, EMBASE, CENTRAL, ISI Web of Science, and SCOPUS databases. All comparative studies on patients older than 18 years of age that provided mortality data were considered eligible for this systematic review and meta-analysis. he primary outcome of the meta-analysis was 30-day all-cause mortality. Ten retrospective studies including 967 patients were identified. Patients treated with daptomycin had significantly higher 30-day all-cause mortality (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.08 to 2.40) and infection-related mortality (OR, 3.61; 95% CI, 1.42 to 9.20) rates than patients treated with linezolid. When data from all 10 studies were combined, overall mortality was also significantly increased among patients treated with daptomycin (OR, 1.41; 95% CI, 1.06 to 1.89). These findings were confirmed when odds ratios adjusted for potential confounders were pooled. Relapse rates among patients treated with daptomycin were also higher (OR, 2.51; 95% CI, 0.94 to 6.72), although this difference did not reach statistical significance. Adverse event rates were not significantly different between the two groups. Notwithstanding the absence of randomized prospective data, available evidence suggests that mortality rates may be higher with daptomycin than with linezolid among patients treated for VRE bacteremia. Copyright © 2014, American Society for Microbiology. All Rights Reserved.


Huber D.,Wollongong Hospital
Wounds UK | Year: 2013

Approximately 25% of heel and ankle pressure injuries begin in the operating theatre. These injuries can be prevented simply by offloading, but elevating the heel can cause other problems, mainly popliteal vein compression. Elevating the heel and allowing the knee to drop back unsupported, will result in popliteal vein compression in 64% of patients who are supine and anaesthetised. Popliteal vein compression increases the likelihood of deep vein thrombosis and can be overcome by flexing the knee around 5°. It must be done without putting pressure in the popliteal fossa.


Trajkovski T.,St Michaels Hospital | Pinsker E.,St Michaels Hospital | Cadden A.,Wollongong Hospital | Daniels T.,St Michaels Hospital
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: Preoperative talar varus deformity increases the technical difficulty of total ankle replacement and is associated with an increased failure rate. Deformity of >20° has been reported to be a contraindication to arthroplasty. We determined whether clinical outcomes of total ankle replacement in patients with ankle arthritis and preoperative talar varus deformity of ge;10° were comparable with those of patients with varus deformity of <10°. Methods: Thirty-six ankles with preoperative coronal-plane tibiotalar varus deformity of ge;10° (''varus'' group) and thirtysix prospectively matched ankles with varus deformity of <10° (''neutral'' group) underwent total ankle replacement. Preoperative and postoperative evaluations included AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot scores, Ankle Osteoarthritis Scale (AOS) scores, Short Form (SF)-36 scores, and radiographic measurements of coronalplane deformity. Results: The cohorts were similar with respect to age, sex, operatively treated side, body mass index, and components used, and the mean duration of clinical follow-up was 34.7 months. Eighteen (50%) of the ankles in the varus group had a preoperative varus deformity of ge;20°. Patients in the varus group underwent more ancillary procedures during the index surgery to achieve a plantigrade foot. The AOFAS score improved by a mean of 57.2 points in the varus group and 51.5 points in the neutral group. The AOS pain and disability component scores decreased significantly in both groups. The improvement in AOS and SF-36 scores did not differ significantly between the groups at the time of the final follow-up. Tibiotalar deformity improved significantly toward a normal weight-bearing axis in the varus group. Thirteen ankles in the varus group and six in the neutral group underwent additional procedures at a later date. Conclusions: Satisfactory results can be achieved in patients with varus malalignment of ge;10°, which should not be considered a contraindication to total ankle replacement. Complication rates can be reduced by utilizingmeticulous surgical technique and taking care to address all causes of the varus deformity, particularly through osteophyte debridement, correction of cavus deformity, and soft-tissue balancing. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence. © 2013 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.


Cadden A.R.,Wollongong Hospital
Seminars in Musculoskeletal Radiology | Year: 2012

Total ankle replacement is becoming a more popular option in the treatment of end-stage ankle arthritis. Appropriate imaging plays an important role in surgical planning, considering the overall foot alignment for optimal outcomes after surgery. Preoperative imaging includes weightbearing views of the foot and ankle, as well as an adjunct computed tomography scan. Imaging the painful ankle postsurgery often involves multiple modalities to define the underlying pathology and determine the appropriate management. Suggested imaging sequences are discussed. Copyright © 2012 by Thieme Medical Publishers, Inc.


Parker D.,Wollongong Hospital
Australian Family Physician | Year: 2013

Background Osteoporosis is a major contributor to morbidity and mortality in Australia, and is predicted to accelerate as the population grows and increases in age. The aim of this study was to audit 10 general practitioners for their identification of patients with risk factors for osteoporosis, and appropriate screening, treatment and follow up care. Method Patient medical records over a 12 year period from 10 GPs at a rural medical centre were retrospectively audited using the PENCAT software. The management of osteoporosis was compared with guidelines from The Royal Australian College of General Practitioners. Results The study included 402 patients, both men and women, aged 60-95 years, with at least one risk factor in addition to age. Only 35% of all patients had been scanned for osteoporosis, and the percentage varied with age, gender, and number and type of risk factors. Overall, 66% of patients with osteopenia, and 26% with osteoporosis, were receiving no medical treatment. Additionally, 48% of those with previous low bone mineral density scans had not had recommended follow up scans. Recommendations General practitioners are the healthcare hubs of our communities, including for prevention of diseases such as osteoporosis. The low level of concordance with the guidelines suggests that in this general practice community, passive screening for osteoporosis has been less than effective. Active surveillance, such as the PENCAT tool used in this study, would offer an alternative approach. Further studies could then evaluate whether incorporating this into the usual practice audit process leads to improved patient outcomes.


Alnawaf H.,Wollongong Hospital
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2012

Epson Desktop scanners have been quoted as devices which match the characteristics required for the evaluation of radiation dose exposure by radiochromic films. Specifically, models such as the 10000XL have been used successfully for image analysis and are recommended by ISP for dosimetry purposes. This note investigates and compares the scanner characteristics of three Epson desktop scanner models including the Epson 10000XL, V700, and V330. Both of the latter are substantially cheaper models capable of A4 scanning. As the price variation between the V330 and the 10000XL is 20-fold (based on Australian recommended retail price), cost savings by using the cheaper scanners may be warranted based on results. By a direct comparison of scanner uniformity and reproducibility we can evaluate the accuracy of these scanners for radiochromic film dosimetry. Results have shown that all three scanners can produce adequate scanner uniformity and reproducibility, with the inexpensive V330 producing a standard deviation variation across its landscape direction of 0.7% and 1.2% in the portrait direction (reflection mode). This is compared to the V700 in reflection mode of 0.25% and 0.5% for landscape and portrait directions, respectively, and 0.5% and 0.8% for the 10000XL. In transmission mode, the V700 is comparable in reproducibility to the 10000XL for portrait and landscape mode, whilst the V330 is only capable of scanning in the landscape direction and produces a standard deviation in this direction of 1.0% compared to 0.6% (V700) and 0.25% (10000XL). Results have shown that the V700 and 10000XL are comparable scanners in quality and accuracy with the 10000XL obviously capable of imaging over an A3 area as opposed to an A4 area for the V700. The V330 scanner produced slightly lower accuracy and quality with uncertainties approximately twice as much as the other scanners. However, the results show that the V330 is still an adequate scanner and could be used for radiation dosimetry purposes. As such, if budgetary requirements are limited, the V700 scanner would be the recommended option at a price eight times cheaper than the 10000XL; however, the V330 produces adequate results at a price which is 2.5 times cheaper again. This may be a consideration for smaller institutions or individuals working with radiochromic film dosimetry.

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