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Hart R.,University of Western Australia | Doherty D.A.,University of Western Australia | Doherty D.A.,Women and Infants Research Foundation
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: The polycystic ovary syndrome (PCOS) is the commonest endocrine abnormality in women of reproductive age. Objective: To determine the rate of hospital admissions for women with PCOS in Western Australian population in comparison to women without PCOS. Design: A population-based retrospective cohort study using data linkage in a statewide hospital morbidity database system. Setting: All hospitals within Western Australia. Participants: A total of 2566 women with PCOS hospitalized from 1997-2011 and 25 660 randomly selected age-matched women without a PCOS diagnosis derived from the electoral roll. Main Outcome Measures: Hospitalizations by ICD-10-M diagnoses from 15 years were compared. Results: Hospitalizations were followed until a median age of 35.8 years (interquartile range, 31.0-39.9). PCOS was associated with more nonobstetric and non-injury-related hospital admissions (median, 5 vs 2; P < .001), a diagnosis of adult-onset diabetes (12.5 vs 3.8%), obesity (16.0 vs 3.7%), hypertensive disorder (3.8 vs 0.7%), ischemic heart disease (0.8 vs 0.2%), cerebrovascular disease (0.6 vs 0.2%), arterial and venous disease (0.5 vs 0.2% and 10.4 vs 5.6%, respectively), asthma (10.6 vs 4.5%), stress/anxiety (14.0 vs 5.9%), depression (9.8 vs 4.3%), licit/illicit drug-related admissions (8.8 vs 4.5%), self-harm (7.2 vs 2.9%), land transport accidents (5.2 vs 3.8%), and mortality (0.7 vs 0.4%) (all P < .001). Women with PCOS had a higher rate of admissions for menorrhagia (14.1 vs 3.6%), treatment of infertility (40.9 vs 4.6%), and miscarriage (11.1 vs 6.1%) and were more likely to require in vitro fertilization (17.2 vs 2.0%). Conclusion: PCOS has profound medical implications for the health of women, and health care resources should be directed accordingly. Copyright © 2015 by the Endocrine Society. Source

Russell T.,King Edward Memorial Hospital | Ng L.,King Edward Memorial Hospital | Nathan E.,Women and Infants Research Foundation | Debenham E.,King Edward Memorial Hospital
Anaesthesia | Year: 2014

The presence of a facemask leak significantly reduces the effectiveness of pre-oxygenation and increases the risk of post-induction hypoxia. We randomly assigned 24 healthy volunteers to a six-period crossover trial with and without a simulated facemask leak. Pre-oxygenation was performed using a standard anaesthesia machine circuit supplemented either by nasal prong oxygen or by anaesthesia machine flush oxygen. Each intervention was completed with both 3-min tidal breathing and 8 deep breath techniques: end-tidal oxygen fraction was used as the measure of preoxygenation effectiveness. The presence of a stimulated mask leak significantly reduced the effectiveness of preoxygenation regardless of the breathing method used. With a simulated facemask leak introduced, the mean (SD) end-tidal oxygen fraction with the 3-min tidal breath technique was 74.7 (9.3)% compared with 57.5 (6.2%) for the 8 deep breath technique with 3-min tidal breathing and a leak. End-tidal oxygen fractions increased by 11.0% (95% CI 7.8-14.3%) (p < 0.0001) with the addition of nasal prong oxygenation and 16.8% (13.6-20.0%) (p < 0.0001) with machine oxygen flush compared with standard pre-oxygenation. When a leak is present, 3-min tidal breathing with either nasal prong or anaesthesia machine flush oxygenation is an effective pre-oxygenation method, and preferable to the 8 deep breath method. © 2014 The Association of Anaesthetists of Great Britain and Ireland. Source

Schulzke S.M.,University of Western Australia | Hall G.L.,University of Western Australia | Nathan E.A.,Women and Infants Research Foundation | Simmer K.,University of Western Australia | And 2 more authors.
Journal of Pediatrics | Year: 2010

Objective: To assess whether lung volume and ventilation inhomogeneity in preterm infants at 15-18 months corrected age, and the change in these outcomes from the newborn period to 15-18 months corrected age, depend on gestational age (GA) at birth and the severity of neonatal lung disease. Study design: Preterm (GA range, 23-32 weeks) and term healthy control infants were studied in quiet sedated sleep at 15-18 months corrected age by multiple breath washout with 5% sulfur hexafluoride using an ultrasonic flowmeter. Valid measurements were obtained from 58 infants. Multivariate and multilevel regression was used to analyze outcomes. Results: Functional residual capacity (FRC), lung clearance index, and first and second to zeroeth moment ratios were calculated. After accounting for body size at test, FRC at follow-up, and the increase in FRC from the newborn period to 15-18 months corrected age were positively associated with GA and negatively associated with the duration of endotracheal ventilation. Indices of ventilation inhomogeneity were unaltered by GA and the duration of endotracheal ventilation. Conclusions: In very preterm infants, GA and the duration of endotracheal ventilation are independently associated with reduced lung volume and lung growth during infancy, although the effect size of these findings is small. © 2010 Mosby, Inc. Source

Miu M.,King Edward Memorial Hospital for Women | Paech M.J.,King Edward Memorial Hospital for Women | Paech M.J.,University of Western Australia | Nathan E.,Women and Infants Research Foundation
International Journal of Obstetric Anesthesia | Year: 2014

Background Difficult epidural insertion and accidental dural puncture are more likely in the obese pregnant population. Low-level evidence suggests that the risk of post-dural puncture headache declines as body mass index increases.Methods We retrospectively reviewed prospective data on 18 315 obstetric epidural and combined spinal-epidural insertions, identifying 125 (0.7%) accidental dural punctures or post-dural puncture headaches between 2007 and 2012. The audit record and patient medical record were examined to determine patient body mass index, headache characteristics and use of a therapeutic epidural blood patch. Women were classified into two groups: non-obese (body mass index <30 kg/m2, Group <30) or obese (body mass index ≥30 kg/m2, Group ≥30). Statistical analysis was by chi-square or Fisher exact tests, with P < 0.05 considered significant.Results Compared to Group <30 (n = 65), women in Group ≥30 (n = 60) did not significantly differ in the incidence of post-dural puncture headache (82% vs 80%, P = 0.83); its intensity (severe 36% vs. 23%, P = 0.34); or the need for epidural blood patch (57% vs. 54%, P = 0.81). Groups also did not differ significantly when confining analysis to those who had a witnessed accidental dural puncture (n = 93) or to women with a body mass index >40 kg/m2 (n = 10) vs. Group <30.Conclusion This retrospective study found no evidence that women of higher body mass index are less likely to develop a post-dural puncture headache or that the characteristics of the headache and use of epidural blood patch were different. © 2014 Elsevier Ltd. All rights reserved. Source

Shah P.,KEM Hospital for Women | Nathan E.,Women and Infants Research Foundation | Doherty D.,Women and Infants Research Foundation | Patole S.,KEM Hospital for Women | Patole S.,University of Western Australia
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013

Background: Prolonged exposure to antibiotics (PEA) is associated with increased risk of necrotising enterocolitis (NEC), late onset sepsis (LOS) and death in preterm neonates. Aim: To evaluate PEA (≥4 d) for suspected (blood culture negative) sepsis and its association with NEC, LOS and death in extremely preterm (EP: Gestation <28 weeks) neonates. Methods: Data on demographic characteristics, antibiotic exposure for early onset sepsis (EOS) or LOS and outcomes to discharge/death were collected for 216 EP neonates admitted between 1/1/2009 and 31/12/2010. Results: All 216 neonates received antibiotics for suspected EOS; 120/216 (56%) had PEA. 137/216 who survived first 72 h of life, had suspected LOS [range 1-8 episodes], treated with antibiotics for median (IQR) duration of 8 (5-14) days. 89/216 had proven (blood culture positive) LOS [range 1-3 episodes], treated with antibiotics for median (IQR) duration of 10 (7-18) days. The incidence of and death due to ≥Stage II NEC was 17/216 (7.8%) and 5/17 (29.4%) respectively. PEA for suspected EOS was associated with proven LOS (OR: 2.1, 95% CI: 1.2-3.7, p = 0.013) after adjusting for gestation and IUGR, but not with NEC/death. Conclusion: PEA for ≥4 d for suspected EOS was associated with increased odds for proven LOS. © 2013 Informa UK Ltd. Source

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