Advances in hospital outcomes research.
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Data Collection↗
Biomedical subjects
D Sloane
Publications and source records attributed to D Sloane.
Is penetrating injury on the increase in south-western Sydney?
BACKGROUND: Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis. METHODS: Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989-94), NSW Department of Health Hospital Separations (1991-93), and the NSW Bureau of Crime Statistics (1991-93) with reference to the Liverpool and Fairfield Local Government Areas (LGA). RESULTS: The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21-33). Ninety-one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty-five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty-one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south-western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese. CONCLUSIONS: This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south-western Sydney.
Adolescent↗
A prospective study of the performance of the trauma team leader.
This study assessed the performance of the trauma team leader in 50 consecutive trauma resuscitations at Liverpool Hospital over a two-month period. The trauma team consists of intensive care (ICU), emergency, and surgical registrars, three nurses, a wardsman, a radiographer, and a social worker. The team leader position alternates between the ICU and emergency registrar on a fortnightly roster. A panel of specialists experienced in trauma management evaluated 38 aspects of the initial resuscitation. Individual variables received different weightings. The maximum possible score for team leader performance was 80. The mean team leader score was 70.4 +/- 8 (SD). The main deficiencies in the team leader's performances were in their interpersonal communications and in the adequacy of documentation of the history of the injury. In 20% of resuscitations there were failures to completely expose the patient. Medical skills were uniformly well performed. Poor communication with other team members were the main pitfall of the team leader in this study. The team leader score may prove a useful tool in improving the quality of the trauma team.
Clinical Competence↗
Evaluation of the prevalence of drug and alcohol abuse in motor vehicle trauma in south western Sydney.
This study estimated prospectively the prevalence of high drug and alcohol levels in road trauma cases who met the criteria for activation of the Liverpool Hospital's trauma team. Urine analysis of road trauma victims between October 1992 and October 1993 was undertaken for drug and alcohol estimation. A total of 164 drivers were studied. A urine alcohol concentration (UAC) exceeding 0.08 g/dL was detected in 27 drivers (16.5%). Cannabinoids were detected in the urine of 25 drivers (15.2%), in 17 the concentrations exceeded 400 ng/mL. In one instance amphetamine, cocaine and heroin were detected in the same injured driver. Combined use of alcohol with some other drugs was detected in only four drivers. Alcohol and cannabinoid levels were prevalent in the urine of injured drivers in this study, particularly in young males who remain over-represented in the group of injured drivers. In the population surveyed other drugs were rarely detected. The role of cannabinoids in road trauma and the use of cannabinoids in young male drivers will however need to be monitored more extensively.
Accidents, Traffic↗
A modified combination technique for performing diagnostic peritoneal lavage.
Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters, through a small lower midline incision or infra-umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision, with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector. Warmed saline is infused via a cystoscopy infusion set. The time required to perform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 +/- 3.8 min, infusion time 0.75 +/- 0.3 min, effusion time 0.3 +/- 1.7 min, and a median total time of 7.6 +/- 4.2 min (median +/- s.d.). There was no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.
Abdominal Injuries↗
Hypothermia and severe trauma.
During the period from May 1992 until April 1993, 108 patients were admitted to Liverpool Hospital with Injury Severity Scores (ISS) > 15. Temperatures had been recorded in 100. Of these, 17 had a core temperature of less than 35 degrees C documented within 24 h of arrival. The hypothermic group presented with more severe injuries and contained a disproportionate number of females. Hypothermia was found to be more common in the winter months, but it was not associated with a delay in reaching hospital from the time of injury. When injuries were ranked by ISS, both hypothermic and normothermic patients were equally likely to have received a blood transfusion; however, the mean number of units of packed cells transfused was greater for the hypothermic group with ISS < 41 than for the similarly injured normothermic group. Two patients in the hypothermic group had sustained burns, and both of these were hypothermic on arrival. All of the hypothermic patients who required surgery developed hypothermia in the operating theatre.
Accidental Falls↗
Thyroid histopathology in south-west Sydney.
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Adult↗
Prevention and inhibition of oral cancer in the hamster buccal pouch model associated with carotenoid immune enhancement.
Beta carotene, canthaxanthin, and a carotenoid mixture from an extract of algae were shown to prevent or inhibit the gross development of squamous cell carcinoma induced in the hamster buccal pouch by 7,12-dimethylbenz(a)anthracene. The carotenoids, dissolved in mineral oil, were administered by oral ingestion on days alternate to the carcinogen. Animals fed similar amounts of canthaxanthin, beta carotene or algae extract exhibited a statistically significant reduction in the development of tumors, both in number and size. The feeding of carotenoids, besides inhibiting gross tumor development, also produced a histologically unique picture. Microscopic areas of dysplasia, carcinoma in situ histologically unique picture. Microscopic areas of dysplasia, carcinoma in situ, or early carcinoma showed areas of tumor lysis and an inflammatory infiltrate consisting of lymphocytes and histiocytes. Characterization of this infiltrate disclosed a significant increase in cytotoxic lymphocytes, and cytotoxic macrophages producing tumor necrosis factor alpha. To confirm the presence of cytotoxic lymphocytes and macrophages a 51Cr release assay was performed. The results indicate that the immune response of the hamster was directed to the developing areas of dysplasia and carcinoma and was associated with the observations of prevention and inhibition of the growth of oral squamous cell carcinoma.
Administration, Oral↗
Mortality in children and adolescents with sickle cell disease. Cooperative Study of Sickle Cell Disease.
A study of the natural history of sickle hemoglobinopathies was begun in March 1979. By August 1987, a total of 2824 patients less than 20 years of age were enrolled. There have been 14,670 person-years of follow-up. Seventy-three deaths have occurred. Most of the deaths were in patients with hemoglobin SS. The peak incidence of death was between 1 and 3 years of age, and the major cause in these young patients was infection. Cerebrovascular accidents and traumatic events exceeded infections as a cause of death in patients greater than 10 years of age. There was limited success in identifying risk factors for death. Comparison of this study's overall mortality of 2.6% (0.5 deaths per 100 person-years) with previous reports indicates improvement of survival in US patients less than 20 years of age with sickle hemoglobinopathies. This improvement is most likely due to parental education and counseling about the illness and the early institution of antibiotics in suspected infections.
Adolescent↗
The immunological profile of a new immunomodulatory agent, oxamisole.
Oxamisole is a T-cell immunorestorative agent when administered by the oral (p.o.) route. It has little or no effect on the IgM or IgG responses to the T-dependent antigen, sheep erythrocytes (SRBC), in normal mice but augments antibody production in immunodeficient animals. Unlike the response to SRBC, the humoral immunocompetence of both normal and immunosuppressed animals sensitized with the T-independent antigen, trinitrophenyl-lipopolysaccharide (TNP-LPS) was unaffected by oxamisole. Oxamisole restored cellular immunocompetence, as evidenced by an increase in the in vitro proliferative response of normal murine splenocytes to T-cell mitogens, while decreasing B-cell mitogenic responses. This indicates that oxamisole may selectively restore T-cell function. However, oxamisole did not significantly modify the classical T-cell-mediated delayed hypersensitivity responses to either the protein antigen methylated bovine serum albumin or to the contact-sensitizing antigen oxazolone. When assayed in vitro, oxamisole enhanced macrophage chemotactic function but not phagocytic function, suggesting a potential stimulation of the reticuloendothelial system. In vivo studies failed to demonstrate any consistent significant activation of murine macrophage function following oral dosing with oxamisole.
Adjuvants, Immunologic↗
Teleconferencing: innovations promise bright future.
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Canada↗
Mitochondrial binding sites for triiodothyronine.
Metabolic effects upon rat liver mitochondria have been observed by others within 2 min of injection of massive amounts of L-T4. Reported here is the subcellular distribution of 2--5 ng high specific activity [125I]L-T3 2 min after ip injection with and without a loading dose of 30 micrograms unlabeled T3. The loading dose did not change the hormone concentration in the livers of normal or thyroidectomized rats, but it decreased the amount of hormone found in the nuclei in both groups and it increased the mitochondrial hormone only in the normals. The amounts of hormone in the nuclear and mitochondrial fractions were considerably higher in hypothyroid animals than in normals. By chromatography, over 90% of mitochondrial 125I was T3. The 125I content of Triton X-100 extracts of mitochondrial membranes was not affected by stable T3 in vivo or in vitro. It was concluded that specific high affinity, low capacity mitochondrial binding sites could not be found 2 min after hormone injection when specific nuclear binding sites are already evident. Specific binding may not be essential for the rapid effects of thyroid hormones upon rat liver mitochondria.
Animals↗
The significance of serial measurement of serum anti-native DNA antibodies and complement C3 and C4 components in the management of patients with systemic lupus erythematosus.
Serial measurements were made over a period of three years of serum DNA-binding capacity and complement C3 and C4 levels in parallel with documentation of clinical features of disease activity in Glasgow patients with SLE. Raised DNA-binding levels were noted in 27 of the 32 patients over this time period. High levels (over 80%) were found in patients with both renal and non-renal disease. In some patients increases in DNA-binding capacity and decreases in C3 levels were associated with changes in disease activity. This pattern was commonest in patients with renal SLE. In others DNA-binding capacity was elevated without any relationship to SLE disease activity. A fall in serum C3 levels was usually significant while serum C4 levels frequently fell without any change in clinical features of disease activity. Very low serum C4 levels (below 15 mg/dl), however, were usually of clinical relevance. The uses of immunological measurements in the differential diagnosis of a major illness in a patient with SLE are discussed. The finding of such an illness in a patient with normal serum DNA-binding levels made it unlikely that the illness was due to an exacerbation of the SLE and more likely that an alternative cause such as supervening bacteraemia was responsible.
Antibodies↗
Clinical significance of antibodies to native DNA as measured by a DNA binding technique in patients with articular features of rheumatoid arthritis.
The clinical significance of antinative DNA antibodies as measured by the Farr test was investigated in 10 patients with the articular features of rheumatoid arthritis. 5 of these patients also satisfied criteria for a diagnosis of systemic lupus erythematosus (SLE) and might be classified as rheumatoid/lupus overlap syndromes or as rheumatoids with systemic complications. None had evidence of renal disease and 3 of the 5 had Sjgøren's syndrome. The sixth patient had aggressive peripheral arthritis, alopecia, and Sjøgren's syndrome and developed anti-DNA antibodies after treatment with penicillamine. All of the 4 rheumatoid patients with no clinical features typical of SLE had some special disease feature. The first had subclinical liver disease and the other 3 had Sjøgren's syndrome in addition to localized vasculitic skin ulceration (2) and pulmonary fibrosis (1).
Adolescent↗
Trauma outcomes: a death analysis study.
Survival and mortality outcomes for trauma patients admitted to Liverpool Hospital, Sydney were analysed to determine the adequacy of trauma care. TRISS and ASCOT survival probabilities and peer review were utilised to determine if deaths were avoidable. Evaluation methods were compared for assessment of care. During the study period 2205 trauma patients were admitted, 518 of which fulfilled the study entry criteria. There were 38 deaths. The age and Injury Severity Score (ISS) of survivors was 34 +/- 18 years, 9.8 +/- 9 (mean +/- sd) compared to age and ISS for nonsurvivors 37 +/- 22 years and 45 +/- 22*, *p < 0.001. Peer review suggested that 32 deaths were non avoidable, 4 potentially avoidable and 2 were probably avoidable. TRISS and ASCOT survival probabilities were > 0.5 in 16 and 18 patients respectively. TRISS and ASCOT had low positive predictive value (25%) in identifying avoidable deaths. The Z Score was 1.79. The standardised mortality ratio (SMR) was 1.16. The Effectiveness (E) value for outcome was 0.91. Poor communication within the Area Trauma System was the greatest contributor to avoidable deaths. All trauma deaths need peer review rather than solely relying upon ASCOT and TRISS probabilities to identify "unexpected" deaths for detailed review.
Adolescent↗
Psychiatric morbidity following motor vehicle accidents: a review of methodological issues.
Motor vehicle accidents (MVAs), even those of a nonserious nature, appear to increase the risk of severe psychiatric morbidity in survivors. The present review examines the evidence indicating the levels of psychiatric morbidity in MVA survivors. Although no consistent profile has emerged, the most commonly reported symptoms are depression, anxiety, irritability, driving phobia, anger, sleep disturbances, and headache, with rates of posttraumatic stress disorder (PTSD) across studies of 0% to 100%. Variability in the type and severity of psychiatric outcomes may be due, in part, to methodological inadequacies in many studies, particularly the use of biased population samples, inclusion of subjects exposed to varied types of accidents, an absence of a clear definition of PTSD, a reliance on clinical judgment rather than the use of objective psychometric measures, the failure to include ratings of injury severity, and the absence of assessments for past exposure to traumatic events or preexisting posttraumatic reactions. The most important concern relates to the use of nonrepresentative samples, usually patients referred for medicolegal assessment in whom issues of compensation are of central importance. Gender and age differences distinguish the compensation group from the general population of MVA survivors, who therefore may also differ in the vulnerability to posttraumatic morbidity. It is argued that more systematic research on unselected subject samples is critical to establish epidemiological data on the true nature and extent of psychiatric morbidity following MVAs.
Accidents, Traffic↗
Oral allergy syndrome.
The oral allergy syndrome (OAS) is a common adverse reaction to the ingestion of certain "trigger" foods and is especially prevalent in atopic individuals. Although rarely dangerous, the symptoms may concern patients. Severe forms of OAS may resemble or precede food-induced anaphylaxis. Thus, detection and recognition of OAS are important. New insights into the molecular mechanisms underlying OAS have elucidated earlier epidemiological observations that sensitivity to certain foods is related to reactivity to certain aeroallergens. This article reviews the clinical presentation, pathogenesis, and treatment of OAS.
Food Hypersensitivity↗