Townsville General Hospital Research Articles

Voyages in time

AbstractWhile working at Townsville General Hospital in 1999, I was approached by the local museum to x‐ray some artefacts from two shipwrecks. The excavated artefacts, mostly covered in coral and barely recognisable, were from the historically and scientifically significant shipwrecks of the Bounty and Pandora. With the aid of radiography, the conservator was better able to assess, handle and restore these valuable artefacts, which helps further research and education into maritime archaeology. With this material evidence, archaeologists can draw more accurate conclusions about a variety of issues regarding life in the 18th century, while we retain a permanent display to show people the importance of archaeological conservation in the role of history.

Going home from hospital: The postdischarge experience of patients and carers in rural and remote Queensland

This paper reports on a study of the experiences of patients and carers discharged from the Townsville General Hospital into rural and remote communities in North Queensland. The findings presented in this paper are drawn from post-discharge in-depth, qualitative interviews of both patients and carers. The findings indicate the importance of examining the lived experience of both patients and carers in attempting to understand the impact of current discharge practices. We conclude that carers are providing the bulk of post-discharge care of patients - a difficult role in which the difficulties are exacerbated when the patient or the carer or both is a long way from the home community.

Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes

To assess the long-term benefits of medication, needle acupuncture, and spinal manipulation as exclusive and standardized treatment regimens in patients with chronic (>13 weeks) spinal pain syndromes. Extended follow-up (>1 year) of a randomized clinical trial was conducted at the multidisciplinary spinal pain unit of Townsville's General Hospital between February 1999 and October 2001. Of the 115 patients originally randomized, 69 had exclusively been treated with the randomly allocated treatment during the 9-week treatment period (results at 9 weeks were reported earlier). These patients were followed up and assessed again 1 year after inception into the study reapplying the same instruments (ie, Oswestry Back Pain Index, Neck Disability Index, Short-Form-36, and Visual Analogue Scales). Questionnaires were obtained from 62 patients reflecting a retention proportion of 90%. The main analysis was restricted to 40 patients who had received exclusively the randomly allocated treatment for the whole observation period since randomization. Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit: 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups. In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.

Hospital and after: experience of patients and carers in rural and remote north Queensland, Australia

This article reports a study of patients and carers discharged from the Townsville General Hospital into rural and remote communities in north Queensland, Australia. The findings indicate the importance of focusing on the experiences of patients and carers in attempting to understand the impact of discharge procedures. The four stories and their implications exist within a particular healthcare context that impacts disproportionately on rural patients and their carers. Economic rationalism has shaped contemporary healthcare policy in Australia, creating a system that is encouraged to conform to market principles. The costs borne by individuals, groups and communities have been increasingly privatised. Later admission and earlier discharge from hospital is now the norm. Concern about the impact of this policy context on the lives of rural and remote patients and carers prompted the study, which aimed to: (1) examine, from the patient and carer perspective, the social, economic, cultural and emotional cost of hospitalisation away from home communities; (2) identify the needs of rural and remote patients and their carers before, during and after hospitalisation a long way from home; and (3) make recommendations for improved policies and practices concerning the continuum of care: from admission planning, through hospitalisation, discharge-planning, and post-discharge support, in the context of rural and remote location. The experiences presented highlight the depth of the challenges faced by patients and their carers who live in rural and remote communities. Both quantitative and qualitative methodologies were used to obtain insight into the complexity of patients and carers' lives. The four vignettes presented in this paper are taken from in-depth, qualitative interviews with 12 patients and 12 carers. The four stories described reveal the high financial and emotional costs, for patients and carers, of negotiating a healthcare system a long way from home. Challenges faced included inadequate admission planning, excessive accommodation and transport costs, and lack of post-discharge support services in home communities, as well as business failure, marital and family strain. There was an over-reliance on carers who lacked medical caring expertise, had other major commitments (family and work) and who may have had a tenuous and uncertain relationship with the patient. Recognition of these complex circumstances, exacerbated by rural location, during the discharge planning process should mean that attention to ensuring patients and their carers are linked to adequate support services in their communities is of the highest priority. The communication and dissemination of information to patients and carers is also vital. Information on hospital admission, travel benefits, accommodation options, care requirements post-discharge are particular recommendations. To summarise, the experiences highlighted in this study suggest that patients and carers in rural and remote communities have not benefited from adequate discharge planning, and are struggling to cope in a policy context that encourages later admission, earlier discharge and over reliance on family and friends as carers.

Patient satisfaction, characteristics, radiology, and complications associated with attending a specialized government-funded multidisciplinary spinal pain unit

Objective To prospectively document the satisfaction of a random sample of patients attending a specialized multidisciplinary spinal pain unit in the Australian public health care system and to collect associated data on patient characteristics, radiological findings, treatment modalities used, and any significant complications. Design and setting Spinal pain syndrome patients attended the specialized Multidisciplinary Spinal Pain Unit at Townsville General Hospital and the Kirwan Community Health Centre (Queensland, Australia) for diagnosis and management (ie, chiropractic spinal manipulation, medication, or needle acupuncture). A patient satisfaction questionnaire was sent to a random sample of patients in this Queensland Government funded service that was approved by the health authority’s Ethics Committee. Results A total of 1775 new patients (949 men, 826 women; aged 10 to 91 years; average age = 43 years) visited the unit. Medical referral accounted for 40% of patients, chiropractic for 2%, osteopathy for 1%, and other referrals for 0.7%; 40.3% were self-referred and 16% were specifically referred for a medicolegal consultation and examination following work-related or motor vehicle accident injuries. Thirty-nine patients (2.2%) were found to have acute pain (< 28 days). Of 941 patients who could accurately recall when symptoms first began, 69 (7.3%) presented with subacute pain (4 to 12 weeks duration), and 872 (92.7%) presented with chronic spinal pain syndrome (>12 weeks duration). Following extensive investigations, 1474 patients (83%) had radiologically identifiable abnormalities, including osseous or soft tissue anomalies. There was only 1 significant complication (pneumothorax) out of 7831 acupuncture treatment sessions, representing 0.01% of patients and 0.006% of a total of 16,936 examinations and treatments administered at the unit. The patient satisfaction questionnaire resulted in an extremely high satisfaction score. Conclusion A public hospital or community health center based specialized spinal pain syndrome unit is useful for referring clinicians who wish to obtain a further opinion for challenging spinal pain syndrome patients in the lower socioeconomic group that cannot afford private health care.

Deep burn due to an unusual cause—boiling blood!

Emma Igras a, Dilip Gahankari b,∗, Carlo Yuen c, Michael Fish d, Stuart Pegg e,1 a Royal Brisbane Hospital, Queensland, Brisbane, Australia b Royal Brisbane Hospital, Brisbane, 44/89 Scott Road, Queensland, Herston 4006, Australia c Nambour General Hospital, Queensland, Nambour, Australia d Townsville General Hospital, Townsville, Queensland, Australia e Burns Unit, Royal Brisbane Hospital, Brisbane, Australia

Acute subdural haematomas and enoxaparin

Townsville General Hospital (TGH) has 285 beds and serves a population of approximately 500,0000 in North Queensland. In the period November 1998 until December 1999 there were three acute subdural haematomas (ASDH) related to therapeutic doses of enoxaparin. These culminated in death or severe neurological disability. Unfractionated heparin (UFH) is probably used equivalently in TGH. There were no intracranial haemorrhages in this period with UFH. It is well known low molecular weight heparins (LMWH) have a proven place in the management of deep vein thrombosis (DVT) and ischaemic heart disease (IHD). There may however be some concerns regarding the haemorrhagic complications of therapeutic doses of enoxaparin in the central nervous system.

Spinal Schistosomiasis

A 23 year old female presented to Townsville General Hospital seven months after a positive urine test for Schistosomiasis with conus modularize signs. MRI confirmed a conus medullaris enhancing lesion. Serology was positive for Schistosoma IgG:IgM, 3.4:1.8. Urine screening for ova, stool sample, rectal biopsy and diagnostic investigations were negative. She was treated empirically for Schistosoma without biopsy with marked resolution of her symptoms and signs. She remains neurologically well one year after presentation. Serological identification from the Centre of Disease Control and Prevention in Atlanta Georgia by western blot has shown positive IgG for Schistosoma haematobium and mansoni. Schistosoma myelopathy is a rare cause of transverse myelitis, conus medullaris syndrome, anterior spinal artery occlusion and radiculopathy in Australia. It should however be included in the differential diagnosis in a patient who has been in or presenting from an endemic area.

Mandibular fractures in Townsville, Australia: incidence, aetiology andtreatment using the 2.0 AO/ASIF miniplate system

In 1995 a total of 114 patients presented with 154 mandibular fractures at the Townsville General Hospital, Australia. Fifty-eight (51%) were white, 50 (44%) aboriginal, and six (5%) of other or unknown race. One-hundred-and-twenty-four of the fracture<$>s (81%) occurred in male and 30 (19%) in female patients. Most fractures (n= 128, 83%) resulted from fights. The rest being a result of road traffic accidents (10%), falls (3%), accidents caused by falling objects (3%) and sport accidents (2%). The mandibular angle (n= 66, 43%) and the symphyseal area (n= 40, 26%) were the most common fracture sites. Combined fractures were found in 30% patients (26%). Of all angle fractures, 97% were related to third molars. One-hundred-and-five patients had open reduction by an intraoral approach and stabilization by 2.0 AO/ASIF titanium miniplates and nine closed reduction. Complications included temporary sensory deficit of the mental nerve (3%), minor malocclusion (2%) and infection or dehiscence (5%). We conclude that osteosynthesis of mandibular fractures by the 2.0 AO/ASIF titanium miniplate system is reliable.

Renal Home Support Scheme quality initiative.

In 1995 the practice of visiting home dialysis patients was challenged. In order to justify this practice, a benchmarking approach was adopted comprising a literature search, surveys of all relevant patients and their primary health carers, as well as all dialysis units in Australia. The results favoured the home visits and facilitated the establishment of a baseline standard of one home visit at least every 6 months. This standard was audited and reviewed annually. In 1996, Queensland Health launched the Renal Home Support Scheme which was targeted at improving the delivery of health care in the home, leading to efficiencies in the delivery of care to specific groups within the community such as the indigenous population. Successful submissions had to identify objectives, strategies and performance indicators that demonstrated the likelihood of success. The Renal Unit at Townsville General Hospital successfully tendered a submission to Queensland Health and the scheme was implemented in November 1996.

Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation

Objective: To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes. Design: Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial. Setting: Specialized spinal pain syndrome outpatient unit at Townsville General Hospital, Queensland, Australia. Subjects: Seventy-seven patients (without contraindication to manipulation or medication) were recruited. Interventions: One of three separate, clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation. Main Outcome Measures: Main outcome measures were changes (4 weeks vs initial visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. Results: Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P < .001). Neither of the other interventions showed any significant improvement on any of the outcome measures. Conclusions: The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine. (J Manipulative Physiol Ther 1999;22:376–81)

Ceiling fan injuries: the Townsville experience.

From 1 April 1995 to 31 March 1997, 50 people presented to Townsville General Hospital with injuries caused by ceiling fans. Injuries ranged from grazes to compound skull fractures, and seven patients required admission to hospital for ongoing treatment. Most of these injuries could have been avoided. Current safety guidelines for the use of ceiling fans are inadequate.

Melioidosis presenting to the emergency department

ABSTRACTMelioidosis is a well recognised disease in the tropics. During the wet season of 1990/91, of 14 patients with melioidosis presenting the Townsville General Hospital, three were identified as presenting through the Emergency Department. These cases demonstrated the necessity for emergency physicians in the tropics to be vigilant for the disease.

Strongyloidiasis in North Queensland: re‐emergence of a forgotten risk group?

To describe the clinical presentation, diagnosis and management of strongyloidiasis in northern Queensland, and to identify predisposing factors for this infection. A five-year retrospective study of medical records of all cases diagnosed in a regional hospital microbiology laboratory, with follow-up by interview where possible. The Townsville General Hospital. A total of 14 cases of strongyloidiasis were identified, with patients ranging in age from 7 months to 59 years. Infected patients included nine Aborigines and two Vietnamese refugees, both high-risk groups. Of three Caucasians diagnosed, one was a war veteran, but the other two did not have significant travel histories; all three had lived or worked under insanitary conditions. In only one case was strongyloidiasis suspected; in most, it was diagnosed because of diarrhoea or blood eosinophilia which could not be related to the presenting illness. Thiabendazole treatment was effective in most cases. In northern Australia, strongyloidiasis can be acquired locally by Caucasians who live in unhygienic circumstances. It should be suspected in any person with unexplained abdominal pain, diarrhoea, cutaneous symptoms or blood eosinophilia, and the laboratory must be informed of the provisional diagnosis.

PYOGENIC PSOAS ABSCESS

In a 12-month period, five cases of pyogenic psoas abscess presented to the Townsville General Hospital. These cases are presented, together with a review of the literature to illustrate the clinical features of this condition and the therapeutic challenge it may pose.

Invasive disease due to Salmonella virchow: a North Queensland problem

Salmonella virchow is the second most commonly isolated salmonella serotype from human sources in Australia, and overseas studies indicate that S. virchow is a significant cause of extraintestinal salmonellosis. The successful management of three infants, two with septicaemia and one with leptomeningitis and septicaemia due to S. virchow, is described. A review of the Townsville General Hospital laboratory records (1978-1988) showed that, among other aspects, S. virchow accounted for 46% of all salmonella septicaemias, further exemplifying the invasive propensity of this serotype. Information obtained from various sources, after crude analyses, demonstrates that more than 90% of S. virchow infections in humans in Australia occur in Queensland, and that most (greater than 78% in 1987) of those infections in Queensland come from a coastal zone north of Bundaberg, with the highest concentration (0.4 per 1000 persons) occurring in the Cairns region.

An almost fatal case of marine stinger (sea wasp, box jelly-fish or chironex fleckeri)

A brief review of previous literature indicates that Townsville region has the largest number of reported deaths in the world due to box jelly-fish which abound in Australasian oceans. A 20-yr-old white pregnant female was sitting in Rowes Bay, Townsville, (shallow water), on 19 March 1979. Suddenly she screamed with pain and became irrational. According to bystanders respiratory arrest occurred and pulse was absent. A nurse who was on the beach gave her mouth-to-mouth artificial resuscitation. The owner of the caravan park, nearby, doused her with ‘metho” and “stingose’, literally within minutes. She was rushed to Townsville General Hospital in an ambulance. On examination at 12.30 pm she was unconscious, very restless and agitated, with wheezy respirations. She was treated by intubation, O2, I.V. morphine, antivenene. Extensive dark pink-red weal marks appeared on left thigh, hand, forearm and lower abdomen with oedema and blistering, total WBC count was 32,700 with 9% basophils, 1% metamyelocytes and toxic granulations. Nematocysts were obtained from the skin lesions and the diagnosis was established. She delivered a normal baby in May 1979. A brief review of previous literature indicates that Townsville region has the largest number of reported deaths in the world due to box jelly-fish which abound in Australasian oceans. A 20-yr-old white pregnant female was sitting in Rowes Bay, Townsville, (shallow water), on 19 March 1979. Suddenly she screamed with pain and became irrational. According to bystanders respiratory arrest occurred and pulse was absent. A nurse who was on the beach gave her mouth-to-mouth artificial resuscitation. The owner of the caravan park, nearby, doused her with ‘metho” and “stingose’, literally within minutes. She was rushed to Townsville General Hospital in an ambulance. On examination at 12.30 pm she was unconscious, very restless and agitated, with wheezy respirations. She was treated by intubation, O2, I.V. morphine, antivenene. Extensive dark pink-red weal marks appeared on left thigh, hand, forearm and lower abdomen with oedema and blistering, total WBC count was 32,700 with 9% basophils, 1% metamyelocytes and toxic granulations. Nematocysts were obtained from the skin lesions and the diagnosis was established. She delivered a normal baby in May 1979.

THE ORGANIZATION OF A HUMAN MILK BANK IN A NORTH QUEENSLAND HOSPITAL

The development of a human milk bank with nursing mothers as donors of human milk is described. Breast milk is collected manually, and as aseptically as possible, by the mother in the privacy of her home, and the milk is transported frozen to the milk bank by a member of the Nursing Mothers' Association of Australia. A sample of expressed milk is also collected and sent to the Microbiology Department of the Australian Government Health Laboratory for bacteriological examination. The milk bank is suitably located in the paediatric ward of the Townsville General Hospital. Human milk which has been classed as bacteriologically safe is given untreated to hospitalized infants in preference to formula milk. The result is a human milk bank which is administered under medical and microbiological control.