Flinders Medical Centre Research Articles

Subsequent investigation and management of patients with intermediate-category and -probability ventilation-perfusion scintigraphy.

The authors wished to determine the proportion of patients with intermediate-category and intermediate-probability ventilation-perfusion scintigraphy (IVQS) who proceed to further imaging for investigation of thromboembolism, to identify the defining clinical parameters and to determine the proportion of patients who have a definite imaging diagnosis of thromboembolism prior to discharge from hospital on anticoagulation therapy. One hundred and twelve VQS studies performed at the Flinders Medical Centre over a 9-month period were reported as having intermediate category and probability for pulmonary embolism. Medical case notes were available for review in 99 of these patients and from these the pretest clinical probability, subsequent patient progress and treatment were recorded. Eight cases were excluded because they were already receiving anticoagulation therapy. In the remaining 91 patients the pretest clinical probability was considered to be low in 25; intermediate in 30; and high in 36 cases. In total, 51.6% (n = 47) of these patients (8% (n = 2) with low, 66% (n = 20) with intermediate, and 69.4% (n = 25) with high pretest probability) proceeded to CT pulmonary angiography (CTPA) and/or lower limb duplex Doppler ultrasound (DUS) evaluation. Of the patients with IVQS results, 30.7% (n = 28) were evaluated with CTPA. No patient with a low, all patients with a high and 46% of patients with an intermediate pretest probability initially received anticoagulation therapy. This was discontinued in three patients with high and in 12 patients with intermediate clinical probability prior to discharge from hospital. Overall, 40% of patients discharged on anticoagulation therapy (including 39% of those with a high pretest probability) had a positive imaging diagnosis of thromboembolism The results suggest that, although the majority of patients with intermediate-to-high pretest probability and IVQS proceed to further imaging investigation, CTPA is relatively underused in this group. Most patients with a high pretest clinical probability receive anticoagulation therapy irrespective of imaging findings, and less than half of all patients discharged from hospital on anticoagulation therapy have a positive imaging diagnosis of thromboembolism.

Total laparoscopic tube hysterectomy: a safer option?

Objective To compare outcomes in women undergoing total laparoscopic hysterectomy performed with the assistance of a colpotomizing tube (TLTH), with those in women in whom a laparoscopically assisted hysterectomy (LAH) procedure was performed. Design A retrospective review of consecutive patients. Setting State health service patients were treated at Flinders Medical Centre, Adelaide, South Australia, and private patients were treated by the same surgeons in three private hospitals in metropolitan Adelaide. Subjects A total of 227 women who underwent operation between January 1996 and August 1999. Interventions The women involved in the first two years of this study exclusively underwent an LAH, whilst those in the latter 18 months underwent a TLTH. Main outcome measures These included intraoperative complications, including significant haemorrhage, ureteric, bladder, vascular and bowel injury; postoperative complication rates for vault infection, late bowel and ureteric injury, and miscellaneous febrile morbidity. Also documented were the operating time, nonautologous blood transfusion, operation–discharge interval, and readmission with a complication. Results The women having the TLTH procedure had significantly fewer intraoperative complications (χ2 = 8.07, P = 0.004) in comparison with the LAH group; postoperative complications were not statistically different. The mean operating times and readmission rates with surgical complications were equivalent for the two groups. The hospital stay was shorter by 1.5 days for the women having a TLTH (t = 8.39, P < 0.001), and the estimated blood loss was less than half of that for the LAH patients (t = 8.94, P < 0.001); nonautologous blood transfusion was not needed in either group. Conclusion Total laparoscopic hysterectomy utilizing the nondisposable colpotomizing tube and uterine manipulator has both fewer intraoperative complications and reduced blood loss when compared with laparovaginal hysterectomy, and is a safe alternative to LAH.

If you want the surgery done well, get a woman to do it!

Medical EducationVolume 34, Issue 8 p. 598-599 If you want the surgery done well, get a woman to do it! Judy Searle, Judy Searle AustraliaSearch for more papers by this author Judy Searle, Judy Searle AustraliaSearch for more papers by this author First published: 25 December 2001 https://doi.org/10.1046/j.1365-2923.2000.00735.xCitations: 4 Judy Searle Dr Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders University of South Australia, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia Read the full textAboutPDF 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 Volume34, Issue8August 2000Pages 598-599 RelatedInformation

Behavioural psychotherapy training for nurses in Australia: a pilot program.

This paper describes a pilot program that examined the feasibility of training for qualified mental health nurses in behavioural psychotherapy in response to the perceived need for improved client access to services. A 6-month course was conducted with four nurses from the in-patient mental health unit at Flinders Medical Centre, South Australia. They received a combination of workshop training and supervised practice by qualified and experienced nurse behavioural psychotherapists and were assessed throughout the period for clinical competency and level of knowledge in the subject. All four nurses completed the training satisfactorily. Each trainee treated four clients who presented with a range of anxiety disorders. The implications for further training of suitably qualified mental health professionals in the area are discussed.

An association between length of stay and co-morbidity in chronic airflow limitation.

To examine factors which impact on the length of stay and readmission for patients with chronic airflow limitation at a South Australian hospital from December 1996 until March 1998. Discharges from Flinders Medical Centre for patients aged > or = 18 years, where chronic airflow limitation was an active problem, and including a subset with a primary diagnosis of chronic airflow limitation, were identified, retrospectively, by the center's Clinical Coding Service from the hospital's in-patient separation database. Flinders Medical Centre, Adelaide, South Australia. Length of stay; number of co-morbidities; readmission within 28 days. Five-hundred and twenty discharges (male:female, 258:262) with a primary diagnosis of chronic airflow limitation (ANDRG-3 177, chronic obstructive airways disease) were identified. Readmission within 28 days was related to the number of co-morbidities and to age. A relationship between length of stay and the number of co-morbidities was identified. A mean length of stay of 6.39 days was found for patients with less than five co-morbidities, 5.36 at their first admission to Flinders Medical Centre and 3.25 at their first admission to Flinders Medical Centre with no co-morbidities. These mean lengths of stay fall below overseas data previously published and are consistent with Kong's estimate of an ideal mean length of stay of 3.2 days when a clinical management guideline is used in low-risk chronic airflow limitation patients. Length of stay and readmission to hospital within 28 days of patients with a primary diagnosis of chronic airflow limitation is at least partly related to the number of co-morbidities and to age. The study has highlighted the difficulty of relying on changes to aggregate data as outcome measures for these patients.

A COMPARISON OF THE PERFORMANCE OF DIFFERENT TECHNIQUES FOR THE DETERMINATION OF A ONCE DAILY GENTAMICIN DOSE.

1. Flinders Medical Centre, 2. Royal Adelaide Hospital, 3. Institute for Medical and Veterinary Science, Adelaide, Australia. (introduced by R Morris)

Lymphoscintigraphy of a patient with secondary leg lymphoedema provides evidence for the existence of axillo-inguinal anastomotic pathways

Medical Imaging Division and Department of Public Health, Flinders Medical Centre, Adelaide, SA, Australia

The Role of the Medical Examination in Assessment of Child Sexual Abuse in South Australia

ABSTRACT The Child Protection Service at Flinders Medical Centre has a philosophy of being child oriented, treating the child as a person and not an object from which evidence can be extracted. This extends to the medical examination which may not yield any physical evidence for sexual abuse, but still has a significant role in the overall assessment. The medical examination assists the child in seeing themselves as more than a victim, and understanding that healing can occur. The role of the medical examination in assessing allegations of child abuse and neglect should be one of integration with those providing the psychosocial assessment. Clear communication between doctors and non-medical professionals is essential to ensure that medical findings are correctly interpreted.

Perinatal Death Associated With Planned Home Birth in Australia

Blackwood, Australia; Department of Obstetrics and Gynaecology, Flinders University of South Australia, Flinders Medical Centre, Adelaide, Australia; Australian Institute of Health and Welfare, National Perinatal Statistics Unit, University of New South Wales, Australia Br Med J 1998;317:384-388

Improving the ease and safety of laparoscopy: a technique for open insertion of the umbilical trocar.

Sharp cannulation of the abdominal cavity for laparoscopy occasionally causes life-threatening injury to major vessels. A technique of open cannulation is described to minimize this risk. In over 2000 general surgical laparoscopies performed the Flinders Medical Centre, there were no major vessel injuries and only one bowel injury (prior to laparotomy). We advocate the use of open technique to minimize injuries caused by abdominal cannulation for laparoscopy.

Minerals in animals and vegetables

Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia Correspondence to Rosemary L. Ryall, Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia 5042

Experiencing EQuIP (Evaluation and Quality Improvement Program) at Flinders Medical Centre.

Experiencing EQuIP (Evaluation and Quality Improvement Program) at Flinders Medical Centre.

Urgency, disposition and age groups: a casemix model for emergency medicine

AbstractAimTo evaluate the performance of Urgency and Disposition Groups and Urgency Related Groups, and to develop other casemix systems for use in emergency departments based on easily collected variables.SettingEmergency Department, Flinders Medical Centre, a general metropolitan teaching hospital in Adelaide, South Australia.MethodsCost data from a prospective analysis of 17,819 emergency patient attendances were used to construct casemix systems by evaluating the cost drivers urgency, outcome, age and diagnosis.ResultsUrgency Related Groups were good predictors of costs (55.32% trimmed for outliers), but the least easy system to construct, and not particularly clinically relevant. Urgency and Disposition Groups were useful predictors of costs (43.90% trimmed), with the advantage of being easy to collect and clinically relevant. However, the same advantages are true of the newly developed Urgency, Disposition and Age Groups, which incorporate age as a partitioning variable, and were found to predict 51.23% (trimmed) of total costs.ConclusionUrgency, Disposition and Age Groups can be used as a simple, cost‐efficient method of costing patient attendances to emergency departments. Evaluation of Urgency, Disposition and Age Groups in other emergency departments in Australasia is recommended.

Epidural analgesia in labour using intermittent doses determined by midwives

Since 1985 midwives have been responsible for choice of drug and timing of epidural top-up doses for women in labour at Flinders Medical Centre. The midwife may choose from one of three different prescribed preparations, namely: bupivacaine 12.5 mg plus pethidine 25 mg, bupivacaine 25 mg, and bupivacaine 50 mg - each made up in a volume of 10 ml. This prospective study examined the incidence of adverse effects and level of patient satisfaction with midwife-managed epidural analgesia. Between 1987 and 1992, 6935 women received midwife-managed epidural analgesia. The pethidine/bupivacaine mixture was generally used for the first dose (75% of women) with a shift towards bupivacaine 25 mg or 50 mg for subsequent top-ups. Sixty-one per cent of women had normal vaginal deliveries, 25% instrumental and 14% caesarean deliveries. The most common side-effects were shivering, hypotension and itch. Shivering occurred following 11% of bupivacaine, and 2% of bupivacaine/pethidine top-ups. Itching was more common after bupivacaine/pethidine (3%) than after bupivacaine (1%). Women reported a high level of satisfaction with the overall experience of childbirth, though this was lower for instrumental and caesarean deliveries than for vaginal deliveries. On the other hand, satisfaction with pain relief provided by the epidural was greater in women who had caesarean or instrumental deliveries. The most commonly cited benefits of epidurals were good pain relief (83%), ability to cope (74%), feeling relaxed (67%), and being aware (60%), while feeling numb (23%) and experiencing severe pain at delivery (17%) were the most common causes of dissatisfaction.

Use of inpatient hospital services by people aged 90-99 years.

To examine the use of inpatient hospital services by people aged 90-99 years. Retrospective case note review. Flinders Medical Centre, a 516-bed university teaching hospital in Adelaide, South Australia. All patients aged 90-99 years on the separation register for 1995. Patient demographic characteristics, principal diagnosis, length of hospital stay and outcome, including destination at discharge. In 1995, 317 separations involved 214 patients aged 90-99 years; 148 patients (69%) were admitted to hospital once, 43 (20%) twice and 23 (11%) three times or more. In 54% of separations, patients came from the community, and these were less likely to be emergency admissions (72%) than were admissions from hostels (87%) and nursing homes (93%). Patients had a wide range of acute medical and surgical problems and a median of five documented comorbidities. Patients survived to leave hospital in 290 separations (91%) and returned directly to their previous living circumstances in 212 (67%). Median hospital stay was 5.0 days, and in 25% of separations stay was one day or less. Patients admitted under the care of geriatricians had more emergency admissions (98%) and longer mean hospital stays (8.9 days) than those admitted under surgeons (69%; 5.9 days) or other physicians (66%; 5.0 days). Despite the acute nature of their illnesses and their multiple medical problems, most hospitalised nonagenarians in this study returned directly to their previous living circumstances after short hospital stays.

The identification of costs associated with emergency department attendances

AbstractAimsTo calculate the cost of patient attendances to an emergency department and to identify the cost drivers of those attendances.SettingThe Emergency Department, Flinders Medical Centre, a metropolitan teaching hospital in Adelaide, South Australia.MethodsA prospective analysis of all attendances presenting over a five month period, incorporating detailed costings of staff and resource usage. The effects of four cost drivers were evaluated: urgency, outcome, age and diagnosis.ResultsThe mean measured cost for each patient attendance was $103.79, varying from $36 for discharged category 5 patients to $429 for admitted category 1 patients. The mean total cost was $191.29, which included non‐measured and overhead components of $87.50.ConclusionThis study identifies the costs associated with treating emergency department patients. We believe this study will be reproducible in other emergency departments. The variables that we predicted would influence the cost of clinical activities (urgency, outcome, age and diagnosis) were all found to be important determinants of the cost of emergency department attendances.

A dose response study of arachidonic acid in formulas containing docosahexaenoic acid in term infants: Gibson R, Makrides M, Neumann M, Hawkes J, Pramuk K, Lien E, Euler A; Paediatrics, Flinders Medical Centre, Adelaide, AU; Wyeth Nutritionals International, Radnor, PA, USA

A dose response study of arachidonic acid in formulas containing docosahexaenoic acid in term infants: Gibson R, Makrides M, Neumann M, Hawkes J, Pramuk K, Lien E, Euler A; Paediatrics, Flinders Medical Centre, Adelaide, AU; Wyeth Nutritionals International, Radnor, PA, USA

Optimising brain phospholipid DHA levels in piglets by lowering the LA:ALA ratio: Gibson RA, Blank C, Neumann MA, Makrides M. Dept. Paediatrics, Flinders Medical Centre, Adelaide 5042, Australia

Optimising brain phospholipid DHA levels in piglets by lowering the LA:ALA ratio: Gibson RA, Blank C, Neumann MA, Makrides M. Dept. Paediatrics, Flinders Medical Centre, Adelaide 5042, Australia

Trendstar at Flinders Medical Centre.

Trendstar provides Flinders Medical Centre with a reliable management tool that facilitates appropriate resource allocation and ensures that those resources are utilised efficiently. The system supports our aim to provide high quality, cost effective care for our clients.

Six alternative methods to the lecithin/sphingomyelin ratio in amniotic fluid for assessing fetal lung maturity.

During the last trimester of human fetal gestation, lung surfactant is synthesized and secreted into the alveolar space, and becomes detectable in amniotic fluid. Pulmonary surfactant is composed of phospholipids, neutral lipids including cholesterol, and specific apoproteins, and functions to lower surface tension and facilitate gas exchange in the lung. A deficiency of surfactant is associated with respiratory distress syndrome, which can be life-threatening in premature infants. As a test for fetal lung maturity, the most widely accepted method remains the analysis of amniotic fluid for surfactant-derived lecithin expressed as a ratio to sphingomyelin. 1 This tes~ has a high sensitivity and specificity, but employs thin-layer chromatography which is laborious and time-consuming. The potential exists to estimate other components of lung surfactant in amniotic fluid, such as the apoprotein, fatty acid or phospholipid components, or to measure physical properties of surfactant-containing lamellar bodies, such as their number or size. The aim of this study was to examine six methods as more practical alternatives to the lecithin/sphingomyelin (L/S) ratio for the estimation of fetal lung maturity from the analysis of amniotic fluid. In keeping with current trends in clinical laboratory practice, of particular interest were methods that could be automated and/or took less than 1h to produce a result. Forty-four amniotic fluid specimens received by two Adelaide hospitals (Queen Victoria Maternity Hospital and the Flinders Medical Centre) over a I year period were entered into the study. Each of the samples was obtained from an individual patient by transabdominal