Box Hill Hospital Research Articles

Obituary

Dr. Ron Strahan died peacefully in the early morning of Saturday 3 July 2010 in Box Hill Hospital, Melbourne, aged 87. He is survived by his wife Pamela Strahan Conder, whom he married after his first wife, Helen Burns, died. He is also survived by two of his three children from his first marriage (Alison and Fiona), two grandchildren, (Tara and Minette) and one great grandchild (Saffron) - and three cats, Huxley, Sybill and Chui. His son, Kingsley, died in 2005.

Prognostic Validation of Treadmill Stress Echocardiography in an Unselected Australian Population

Objectives: The prognostic value of treadmill stress echocardiography (TSE) has been validated in large trials conducted at large centres overseas.We aimed to evaluate the prognostic value in a real-world context in Australia, at a public hospital with an open access referral system. Methods: Epidemiological data and clinical outcomes were evaluated for all patients who underwent TSE at Box Hill Hospital between January and June 2006. Data linkage with records from the National Death Index was performed. Results: Follow-up was obtained for 530/892 patients, with mean (±SD) time to follow-up 736± 106 days. Mean age was 60± 12 years, and 52% patients of male gender. Two or more cardiovascular risk factors were present in 36%ofpatients. Seventy-fivepercentwere referredbyGPs and the remainder by specialists or emergency departments.

Options for an ISMP Affiliate in Australia

Journal of Pharmacy Practice and ResearchVolume 38, Issue 1 p. 51-54 Pharmacy Practice Options for an ISMP Affiliate in Australia Melita A Van de Vreede BPharm, GradDipHospPharm, MHSM, Corresponding Author Melita A Van de Vreede BPharm, GradDipHospPharm, MHSM Quality Use of Medicines Manager Address for correspondence: Melita Van De Vreede, Pharmacy Department, Box Hill Hospital, Box Hill Vic. 3128, Australia E-mail: melita.vandevreede@easternhealth.org.auSearch for more papers by this author Melita A Van de Vreede BPharm, GradDipHospPharm, MHSM, Corresponding Author Melita A Van de Vreede BPharm, GradDipHospPharm, MHSM Quality Use of Medicines Manager Address for correspondence: Melita Van De Vreede, Pharmacy Department, Box Hill Hospital, Box Hill Vic. 3128, Australia E-mail: melita.vandevreede@easternhealth.org.auSearch for more papers by this author First published: 13 April 2015 https://doi.org/10.1002/j.2055-2335.2008.tb00797.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume38, Issue1March 2008Pages 51-54 RelatedInformation

Rotational Acquisition as Compared Normal Acquisition Reduces the Ionisizing Radiation and Contrast Dosage During Elective Diagnostic Coronary Angiography

89 Rotational Acquisition as Compared Normal Acquisition Reduces the Ionisizing Radiation and Contrast Dosage During Elective Diagnostic Coronary Angiography Margaret Arstall, Joe Valente ∗, Mark Corkill Lyell McEwin Hospital, Eleizabeth Vale, SA, Australia Background: Exposure to Ionising Radiation (IR) during Coronary Angiography in relative terms is subsequently higher than other imagingmodalities. Legislation dictates to radiationworkers toadhere to theALARA(as lowas reasonably achievable) principle. The effects of IR have been well documented, and being a new cardiovascular interventionsuite, akeyareaofourequipment selectioncriteria was the reduction of radiation exposure, i.e. dose affective product (DAP) to patients and staff. It has been previously hypothesized that rotational acquisition offered a substantial dose reduction coupledwithmaintaininggood practice and inbuilt primary beamfiltration.With reduced runs we also hypothesized that this method of acquisition would reduce the quantity of intravenous contrast used; therefore decreasing the risk of contrast induced renal toxicity. Method: We undertook an audit of 49 patients, 34 with rotation, and 15 with “normal” non-rotational acquisition. We analysed the data from four cardiologists with similar technique. Patients were to be elective, diagnostic coron w r u R 3 C T t a C e a C n c s t P d t p p d 90 Clinical outcomes following stress echocardiography within an open-access referral system in Australia Jennifer Coller ∗, Alex Adel, Celia Ting, Louise Roberts, Gishel New, Jennifer Cooke, P.M. Srivastava Box Hill Hospital, Victoria, Australia Objectives:Multiple large international trials have shown exercise stress echocardiography (ESE) to be a powerful predictor of future adverse cardiac events. Our aim is to validate the prognostic value of ESEwithin an open access referral system for cardiac investigation. Methods: We identified 897 consecutive patients referred for ESE at Box Hill Hospital from January to June 2006. To date, outcomes for 196 patients have been determined via clinical records review, telephone contact andNational Death Index. Mean (±S.D.) time to follow up was 693± 28 days. Clinical events were defined as myocardial infarction, revascularization, cardiac and non-cardiac death. Results: There were equal numbers of male and female patients enrolled, at a mean age of 60± 12 years. Risk factors includeddiabetes (10%), smoking (35%),hypertension (47%), hypercholesterolaemia (41%) and family history of ischaemic heart disease (25%). A prior history of revascularisation was present in 19% of patients. There was a low event rate and no deaths occurred during the period of follow-up. The negative predictive value (NPV=98.8%) c l

Measurement of Platelet Inhibition with Ultegra-Rapid Platelet Function Analyser (RPFA) and Vasodilator-Stimulated Phosphoprotein (VASP) in Patients Undergoing Elective PCI

primary PCI service has existed for 5 years at BoxHillHospital where approximately 150 primary interventions are performed per year. Methods: Data was collected for all patients requiring primary PCI at Box Hill Hospital from July 2002 until December 2007. This included patients presenting to Box Hill Hospital and SHIPEM patients transferred from nearby facilities. Results: The mean (±S.D.) age was 64± 12 in the primary PCI group and 60± 13 years in the SHIPEM group. The mean (±S.D.) door-to-balloon (DTB) times were 89± 76 and 137± 86min in the primary and SHIPEM groups, respectively. No patients required transfer to a surgical centre due to complications of PCI. Patients Primary n= 698 SHIPEM n= 197 MI 3 (0.04%) 1 (0.05%) TVR 6 (0.09%) 3 (1.5%) Death 32 (4.6%) 7 (3.6%) Death excl. cardiogenic shock 18 (2.8%) 3 (1.5%) Total MACE 59 (8.5%) 11 (5.6%) MACE excl. cardiogenic shock 27 (3.9%) 7 (3.6%) Stroke 7 (1.0%) 0 (0%) Conclusions: Our data confirms that primary PCI may be performed safely and effectively at a primary PCI facility without on-site surgical services. Therewere no complications requiring urgent transfer to a cardiothoracic surgical f c

Annular purpura and ulcerative colitis: Response to infliximab

Image of the Month Annular purpura and ulcerative colitis: Response to infliximab V. Tan a,b,c, M. Bartlett a,b,c, P. Hosking a,b,c, P.R. Gibson a,b,c,∗ a Department of Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia b Department of Pathology, Box Hill Hospital, Box Hill, Victoria, Australia c Monash University Department of Medicine, Box Hill Hospital, Box Hill, Victoria, Australia

PERCUTANEOUS CHOLECYSTOSTOMY IN THE MANAGEMENT OF ACUTE CHOLECYSTITIS

Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis. Retrospective review of case notes of patients who underwent PC at Box Hill Hospital, Melbourne, Australia between July 1997 and December 2002. Sixteen patients (mean age 75 years; range 50-96) underwent PC. Indications for PC were significant comorbidities (n = 6), failure of conservative treatment (n = 4), bile duct malignancy (n = 2), sepsis of unknown origin (n = 2), patient declined surgery (n = 1) and local perforation (n = 1). Technical success rate was 94%. Clinical response to PC was observed in 15 patients. Overall mortality was 18% (3/16) with one death caused by PC failure. Interval cholecystectomy was performed in seven patients (44%). Percutaneous cholecystostomy is a useful alternative means of treating non-resolving acute cholecystitis in circumstances where emergency surgery is hazardous. It also offers effective palliation in patients not suitable for subsequent surgery.

Preoperative Use of Herbal Medicines and Vitamin Supplements

There has been a definite increase in the popularity and use of complementary and alternative medicines, including herbal medicines, in the last ten years. The aim of this study was to determine the prevalence and patterns of use of herbal medicines and vitamin supplements by patients in the preoperative period. A questionnaire was offered to all patients attending the pre-admission clinics at St. Vincent's Hospital and Box Hill Hospital, Melbourne, over an eight-month period in 2002. In all, 1102 questionnaires were completed (91.8% response rate). The prevalence of herbal medicine use was 14.3%, with an average user age of 54.0 years and 61.4% female predominance. The five most popular herbs were Garlic, Evening Primrose, Gingko, St. John's Wort and Echinacea. The commonest reasons for herbal medicine use were acute and chronic medical conditions. 63.2% of patients had self-prescribed. 27.8% of herbal remedy users had informed the hospital doctors and 41.8% had notified their general practitioner The prevalence of vitamin supplement use was 20.4%, with an average user age of 54.8 years and 66.2% female predominance. The five most popular vitamins were multivitamins, followed by vitamin B, C, E and D. The commonest reasons for vitamin use were maintenance of general well-being and health. The use of herbal medicines and vitamin supplements preoperatively by patients is common. Clinicians should endeavour to familiarize themselves with the more popular and significant herbal medications and, as part of the routine preoperative assessment, ask all their patients about their consumption of herbal remedies.

Influence of building construction work on Aspergillus infection in a hospital setting.

Aspergillus fumigatus is a major pathogen causing nosocomial infections. Hospital outbreaks of invasive aspergillosis have been associated with the renovation and construction of buildings. Building construction work for fire safety upgrading was undertaken during a 16-week period in 2001 at Box Hill Hospital. This study was designed to examine the effect of construction on invasive aspergillosis when using standard and additional protective measures. Baseline air sampling was conducted in 18 areas. The validity of the air sampling was assessed by comparing the ability of two air samplers to detect Aspergillus conidia. Surveillance of nosocomial Aspergillus infection was conducted by reviewing the records of patients with a sputum culture positive for Aspergillus and those prescribed amphotericin or itraconazole for the period of construction activity and the same period the previous year. Aspergillus was isolated infrequently and there was no statistically significant difference in the levels of viable pathogenic fungi between areas w here construction work was undertaken and areas where it wasnot undertaken. A moderate agreement was observed between the two air samplers (kappa = 0.4; P < .05). There was no difference in the incidence of invasive aspergillosis between 2000 and 2001 (incidence density ratio, 1.2; 95% confidence interval, 0.3 to 4.1). The influence of construction work performed with protective measures needs to be examined in an environment with higher levels of airborne fungi to confirm the findings of this study.

Emergency department attendances associated with drug-related problems in paediatrics.

To determine the frequency and characteristics of paediatric emergency department attendances associated with drug-related problems (DRP) at three Victorian hospitals. All paediatric medical patients attending the emergency department of the Royal Children's Hospital, Geelong Hospital or Box Hill Hospital were considered for inclusion. The investigator and attending medical practitioners screened eligible patients. A multidisciplinary panel reviewed collated data. Causality, preventability and clinical significance classifications were established by the panel. Combining data from the three hospitals, over 18 weeks of data collection, a total of 8601 patients met the eligibility criteria. Of these, 280 (3.3%, 95% CI 2.9-3.7%) were determined to have emergency department attendances associated with DRP. Of the 187 cases assessed for preventability, 51.3% were judged to be preventable. Emergency department attendances are associated with DRP in paediatrics. Given that the need to prevent DRP in adults is recognized, it is now time to act to reduce the consequences of DRP in paediatrics.

Apoptosis: Molecular Control of Placental Function—A Workshop Report

B. Huppertz, N. S. Rote, D. M. Nelson, F. Reister, S. Black and J. S. Hunt a Department of Anatomy, University of Technology, Aachen, Germany b Departments of Biological Sciences and Obstetrics & Gynecology, Wright State University School of Medicine, Dayton, Ohio 45435, USA c Washington University School of Medicine, St Louis, MO, USA d Department of Obstetrics and Gynecology, University of Technology, Aachen, Germany e Monash University, Box Hill Hospital, Box Hill, Australia f Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, USA

The Ras/Erk Pathway Induces Primitive Endoderm but Prevents Parietal Endoderm Differentiation of F9 Embryonal Carcinoma Cells

The formation of parietal endoderm (PE) is one of the first differentiation processes during mouse development and can be studied in vitro using F9 embryonal carcinoma (EC) cells. Treatment of F9 EC cells with retinoic acid (RA) induces differentiation toward primitive endoderm (PrE), while differentiation toward PE is induced by subsequent addition of parathyroid hormone (PTH) or PTH-related peptide (PTHrP). The signal transduction mechanisms involved in this two-step process are largely unclear. We show that the RA-induced differentiation toward PrE is accompanied by a sustained increase in Ras activity and that ectopic expression of oncogenic Ha-Ras is sufficient to induce PrE differentiation. Ras activity subsequently decreases upon PTH-induced differentiation toward PE. This is a necessary event, since expression of oncogenic Ha-Ras in PrE-like cells prevents PTH-induced PE differentiation. Expression of active PKA in PrE-like F9 cells mimics PTH-induced PE differentiation and is again prevented by oncogenic Ha-Ras. The effect of oncogenic Ras on both differentiation steps is abolished by the MEK inhibitor PD98059 and can be mimicked by constitutively active forms of Raf and MEK. In conclusion, our data suggest that activation of the Ras/Erk is sufficient to induce differentiation to PrE and to prevent subsequent differentiation toward PE. Activation of PKA down-regulates Ras activity, resulting in disappearance of this blockade and transmission of signal(s) triggering PE differentiation.

Box Hill Hospital resuscitation trolley.

A resuscitation trolley has been designed to meet the following requirements. Continuous oxygen supply from the trolley for the duration of the emergency; medical suction of similar strength to that of an ICU treatment bay and provision of equipment and drugs in a modular form, which is uniform across the institution, and which allows immediate replacement from stock. These requirements have been fulfilled whilst maintaining a total trolley weight and manoeuvrability similar to that of commercially manufactured trolleys available in Australia.

Laparoscopic Assisted Vaginal Hysterectomy, Setting Up a Service at a Peripheral Teaching Hospital

The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit.

Smoking — another cause of palmar erythema?

Medical Journal of AustraliaVolume 156, Issue 1 p. 71-71 Letter to the Editor Smoking — another cause of palmar erythema? G McArthur MB BS, G McArthur MB BS Postgraduate Scholar Walter and Eliza Hall Institute of Medical Research, PO Box Royal Melbourne Hospital. VIC 3050.Search for more papers by this authorB G Firkin MB BS, FRACP, FRCPA, B G Firkin MB BS, FRACP, FRCPA Professor of Medicine Department of Medicine, Box Hill Hospital. Nelson Road, Box Hill, VIC 3128Search for more papers by this author G McArthur MB BS, G McArthur MB BS Postgraduate Scholar Walter and Eliza Hall Institute of Medical Research, PO Box Royal Melbourne Hospital. VIC 3050.Search for more papers by this authorB G Firkin MB BS, FRACP, FRCPA, B G Firkin MB BS, FRACP, FRCPA Professor of Medicine Department of Medicine, Box Hill Hospital. Nelson Road, Box Hill, VIC 3128Search for more papers by this author First published: 01 January 1990 https://doi.org/10.5694/j.1326-5377.1992.tb126405.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume156, Issue1January 1990Pages 71-71 RelatedInformation

Liver trauma in a major peripheral hospital: analysis of management and mortality in 74 patients.

The management of liver trauma has improved considerably over the past 2 decades. However, much of the evidence for this improvement has emanated from major trauma centres. Little information is available from peripheral hospitals which deal with much of the trauma seen in Australia. This study set out to examine the management of liver trauma in Box Hill Hospital over the past 2 decades; 74 patients were treated for liver trauma during 1967-86, and the factors considered contributory to mortality rate were analysed. The overall mortality rate was 33.8%, but each 5-year period saw a reduction in mortality rate (25% in the 1982-86 period). The patient's age, associated injuries, transfusion requirements, degree of liver injury and postoperative haemorrhage all contributed to a higher mortality rate. This study indicated that management of liver trauma in a peripheral hospital results in mortality rates that are comparable with major trauma centres. Moreover, by highlighting treatment deficiencies through self-audit, improved treatment protocols should further enhance survival prospects.

SEVERE HYPOFIBRINOGENAEMIA COMPLICATING LATE ABORTION

Medical Journal of AustraliaVolume 2, Issue 2 p. 59-63 Original Article SEVERE HYPOFIBRINOGENAEMIA COMPLICATING LATE ABORTION James P. O'Neill F.R.C.S. (Ed.), F.R.A.C.S., M.R.C.O.G., James P. O'Neill F.R.C.S. (Ed.), F.R.A.C.S., M.R.C.O.G. Box Hill and District Hospital, MelbourneHonorary Obstetrician and Gynæcologist.Search for more papers by this author James P. O'Neill F.R.C.S. (Ed.), F.R.A.C.S., M.R.C.O.G., James P. O'Neill F.R.C.S. (Ed.), F.R.A.C.S., M.R.C.O.G. Box Hill and District Hospital, MelbourneHonorary Obstetrician and Gynæcologist.Search for more papers by this author First published: 01 July 1966 https://doi.org/10.5694/j.1326-5377.1966.tb73405.xCitations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume2, Issue2July 1966Pages 59-63 RelatedInformation