PubMed Health⌕ Search

Biomedical subjects

A E Young

Publications and source records attributed to A E Young.

At least 19 recordsLinked to original sources
PubMed2004

Services provided following compensable work-related tetraplegia.

DESIGN: Descriptive study. OBJECTIVE: To describe and compare the medical services provided following work-related tetraplegic spinal cord injury (SCI). SETTING: Workers' compensation claims database. METHODS: The administrative database of a workers' compensation provider was searched for work-related tetraplegia claims with dates of injury between 1 January 1989 and 31 December 1999. In total, 62 cases were identified and grouped by impairment category. Medical payment data were extracted and assigned to service categories. RESULTS: Although the level of services was directly related to the severity of impairment, patterns were similar across categories; for example, the largest proportions of payments were associated with durable medical equipment (DME) and attendant care in each impairment category. DME, readmissions and attendant care services varied considerably from year to year and within impairment category. Payments for physician care and medications/supplies showed the least variation within impairment categories. Workers' compensation payments were similar to National Spinal Cord Injury Database (NSCID) payments for the first year following injury; however, in subsequent years, workers' compensation figures were much higher. CONCLUSIONS: Differences in annual medical payment and services by impairment category appear to be primarily due to variations in DME, attendant care and readmission. Payment differences in relation to National SCI figures may be related to better capture of payments by the workers' compensation administrative database. In addition, results suggest broader coverage by workers' compensation for medical services and items related to independent living.

Accidents, Occupational↗
PubMed2001

Risk management.

Explore the source record for details and available documents.

General Surgery↗
PubMed2001

Rural career choice issues as reported by first year medical students and rural general practitioners.

Governments have recently instituted several programmes designed to attract medical students to rural practice. Questions may be raised as to whether interventions based around issues identified as important to practising rural general practitioners (GPs) are equally applicable to undergraduate medical students. The results of two studies on the importance of personal and practice issues as ascribed by Australian rural GPs and Victorian medical students are analysed. The effect of the students' gender, place of origin and intended location of practice is assessed. Findings suggest that practising GPs may have resolved many of the student issues and may be well placed to advise students on perceived hurdles to rural practice. Furthermore, students may be seeking a practice style similar to that sought by female GPs. The present paper concludes that while there are similarities between the groups, the differences identified support caution when basing student programmes on research performed on rural GPs.

Adult↗
PubMed2001

The surgical management of early breast cancer.

Definitive surgical treatment should never be undertaken without a histological confirmation of the diagnosis. For operable disease primary treatment is normally breast-conserving surgery or mastectomy, in association with axillary surgery. Patients with larger technically operable tumours may be treated with primary chemotherapy to try to shrink the tumour so that less radical surgery can be undertaken. The objective of surgery is clearance of local and regional disease with a margin of clear tissue, and to achieve an acceptable cosmetic outcome. Clinical assessment of the axilla is unreliable and because of the prognostic significance of the axillary nodal status this has to be determined histologically. Patients with single tumours < or = 4 cm are suitable for conservation therapy but this will depend on breast size. After excision with clear margins and subsequent radiotherapy the breast recurrence rate should not exceed 5-10% at 10 years. Patients will require mastectomy because of disease extent, breast size, or for personal reasons. The usual operation is a total mastectomy with axillary clearance but small islands of breast tissue may persist subcutaneously as potential sites for future disease. Good breast-conserving surgery is invariably better than reconstruction but, in the event of a mastectomy, reconstruction is offered either as an immediate or a delayed procedure. Complications of any form of surgery include haematoma, wound sepsis and wound flap necrosis. Specific complications are collections of serous fluid in the axilla or in the wound itself (seroma), shoulder stiffness and cording caused by distal thrombosis of lymphatics or veins after axillary dissection. The intercostobrachial nerve is often divided during surgery, causing numbness of the inner upper arm. Some degree of lymphoedema of the arm occurs in 10-15% of patients treated with axillary surgery. It is usually mild and may become rare as more patients have sentinel node biopsies.

Axilla↗
PubMed2000

Role of surgery in mild primary hyperparathyroidism in the elderly.

BACKGROUND: The appropriate management of elderly patients with mild hyperparathyroidism is the subject of much debate. METHODS: A Medline literature search was conducted using the keywords 'hyperparathyroidism', 'asymptomatic' and 'elderly'. The references of the primary sources were examined for further citations. Personally collected cullings from journals and abstracts from journals were used as an additional source of data. RESULTS AND CONCLUSION: No prospective randomized controlled trial comparing parathyroidectomy with conservative management for patients with mild or asymptomatic hyperparathyroidism has been published. There are a number of longitudinal studies that attempt to characterize the natural history of hyperparathyroidism, but most do not stratify patients according to age when assessing outcome. None the less, it is clear that elderly patients present with a different spectrum of problems, particularly indistinct neuropsychiatric and musculoskeletal symptoms, and these are likely to be improved by surgery. The evidence allows the conclusion that the truly asymptomatic elderly patient can be successfully managed conservatively; there is a good prospect of benefit from surgery for those with symptomatic disease, and such patients should not be denied an operative option.

Aged↗
PubMed2000

Behaviour of near-infrared light in the adult human head: implications for clinical near-infrared spectroscopy.

To test theoretical assumptions supporting the use of near-infrared spectroscopy (NIRS) in clinical practice, we examined the behaviour of NIR light transmission and attenuation in the human head. Sterile probes for emitting and detecting NIR light at a fixed separation of 40 mm were placed in turn on intact skin, skull, dura and cerebral cortex of 10 patients undergoing elective neurosurgery. In the first five patients, the detecting probe was moved through successive extracerebral layers with the emitter on the skin surface. In the second five patients, the process was reversed, with the emitting probe moved and the detector in the same place on the scalp. NIR intensity was measured at each tissue interface and compared with the intensity measured at the skin surface with all layers intact. Removal of bone and dura from the light path caused a significant reduction in detected intensity. The largest mean reduction in light intensity was a 14-fold decrease with removal of bone (unadjusted P < 0.0001; paired t test). The assumptions that extracerebral tissues contribute little to attenuation of NIR light in the adult head and that most of this attenuation occurs superficially in the scalp are drawn into question by this study. We postulate that the skull and/or its interface with other layers may act as an optical 'channel', distorting the behaviour of NIR light in the human head.

Adult↗
PubMed1999

A simple, inexpensive device for teaching the loop electrosurgical excision procedure.

OBJECTIVE: To develop an inexpensive and practical inanimate model to teach the loop electrosurgical excision procedure in a resident clinic. TECHNIQUE: A vaginal speculum is inserted into one end of a cardboard tube. At the opposite end, a piece of knockwurst sausage is inserted into the cardboard tube. A grounding pad is attached to the distal end of the sausage. The teaching session proceeds using a colposcope or direct visualization. After the training session, the excised and uncut portions of sausage can be examined. EXPERIENCE: Faculty found this inanimate model an excellent way to teach residents how to use the loop electrode, and the resident staff appreciated its merits as a useful prelude to treating cervical disease in women. The house staff adapted to the confines of the vagina and transferred skills acquired from working with the cardboard tube, where instruction and constructive criticism can be given without the presence of apprehensive patients. CONCLUSION: A simple, inexpensive, inanimate model has been developed to teach the loop electrosurgical excision procedure. The materials required to construct it are available to any colposcopy clinic.

Electrosurgery↗
PubMed1999

Monitoring and management of the paediatric neurosurgical patient.

Head injury remains the most common cause of death in children, and tumours of the central nervous system are the most common solid tumour encountered. There is little class 1 evidence on which to base the monitoring and management of the paediatric patient with these conditions, management strategies commonly being extrapolated from those in use for adults. However, the clinical outcome for these conditions appears to be improving, with evidence suggesting that this improvement is being achieved by the management of these children in specialist centres.

Journal Article↗
PubMed1998

Spinal cord injury rehabilitation outcomes: a comparison of agricultural and non-agricultural workers.

This study of Victorian workers who sustained a spinal cord injury aimed to: (i) define the proportion of this population who were employed in an agricultural setting prior to sustaining their injury; (ii) explore the preinjury characteristics and postinjury vocational achievements of agricultural workers; and (iii) compare these with those of non-agricultural workers. Respondents were sampled from patients presenting for review at the participating spinal unit over the 9 months study period (N = 150 with a participation rate of 71%). Results indicated that while those working in agricultural occupations account for between 4 and 4.5% of Victorian workers, 13.3% of respondents reported working in agricultural occupations at the time of their injury. In spite of the physically demanding nature of their workplace many agricultural workers returned to farming postinjury. The rehabilitation experiences and return to work outcomes achieved by the agricultural workers were found to be very similar to those of other workers, despite the additional barriers they were expected to have encountered.

Accidents, Occupational↗
PubMed1998

[11C]Methionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism after surgery.

OBJECTIVE: Reoperation in patients with recurrent hyperparathyroidism usually requires localisation of abnormal glands. Current imaging techniques are not always successful in this group of patients. An evaluation of [11C]methionine positron emission tomography (PET) has been made to assess the ability of the technique to localise abnormal glands in patients with hyperparathyroidism after previous surgery. SUBJECTS AND METHODS: Eight patients (five with primary, and three with tertiary hyperparathyroidism) who had undergone one to three previous surgical explorations were studied. [11C]methionine PET scans of the neck and mediastinum were performed in all patients. All had recent technetium-99m (99mTc)-labelled sestamibi (n = 7) or thallium-201 (201Tl)/99mTc subtraction (n = 1) parathyroid scans available for comparison. Subsequent surgical correlation was available in all cases. RESULTS: [11C]methionine PET correctly located an abnormal site of uptake in all five patients with primary hyperparathyroidism compared with only one when conventional nuclear medicine methods were used. In the patients with tertiary hyperparathyroidism, [11C]methionine PET correctly located one, confirmed the absence of cervical or mediastinal abnormality in a patient with an autotransplanted forearm autonomous gland, and failed to demonstrate an abnormality in a third. 99mTc-labelled sestamibi scans were negative in all three patients. CONCLUSION: [11C]methionine PET correctly locates abnormal parathyroid glands in the majority of patients with persistent or recurrent hyperparathyroidism after surgery in whom conventional non-invasive nuclear medicine imaging has failed.

Adenoma↗