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Biomedical subjects

Mark Fitzgerald

Publications and source records attributed to Mark Fitzgerald.

At least 19 recordsLinked to original sources
PubMed2006

Tackling the burden of injury in Australasia: developing a binational trauma registry.

Existing trauma registries in Australia and New Zealand play an important role in monitoring the management of injured patients. Over the past decade, such monitoring has been translated into changes in clinical processes and practices. Monitoring and changes have been ad hoc, as there are currently no Australasian benchmarks for "optimal" injury management. A binational trauma registry is urgently needed to benchmark injury management to improve outcomes for injured patients.

Australia↗
PubMed2006

The formation of the stable radicals .CH2CN, CH3.CHCN and .CH2CH2CN from the anions -CH2CN, CH3-CHCN and -CH2CH2CN in the gas phase. A joint experimental and theoretical study.

Franck-Condon one-electron oxidation of the stable anions -CH2CN, CH3-CHCN and -CH2CH2CN (in the collision cell of a reverse-sector mass spectrometer) produce the radicals .CH2CN, CH3.CHCN and .CH2CH2CN, which neither rearrange nor decompose during the microsecond duration of the neutralisation-reionisation experiment. Acetonitrile (CH3CN) and propionitrile (CH3CH2CN) are known interstellar molecules and radical abstraction of these could produce energised .CH2CN and CH3.CHCN, which might react with NH2. (a known interstellar radical) on interstellar dust or ice surfaces to form NH2CH2CN and NH2CH(CH3)CN, precursors of the amino acids glycine and alanine.

Acetonitriles↗
PubMed2006

Is the hypothiocyanite anion (OSCN)- the major product in the peroxidase catalyzed oxidation of the thiocyanate anion (SCN)-? A joint experimental and theoretical study.

The hypothiocyanate anion (OSCN)(-) is reported to be a major product of the lactoperoxidase/H(2)O(2)/(SCN)(-) system, and this anion is proposed to have significant antimicrobial properties. The collision induced (CID) negative ion mass spectrum of "(OSCN)(-)" has been reported: there is a pronounced parent anion at m/z 74, together with fragment anions at m/z 58 (SCN)(-) and 26 (CN)(-). These fragment anions are consistent with structure (OSCN)(-). However there is also a lesser peak at m/z 42 (OCN(-) or CNO(-)) in this spectrum which is either formed by rearrangement of (OSCN)(-) or from an isomer of this anion. The current theoretical investigation of (OSCN)(-) and related isomers, together with the study of possible rearrangements of these anions, indicates that ground-state singlet (OSCN)(-) is a stable species and that isomerization is unlikely. The three anions (OSCN)(-), (SCNO)(-), and (SNCO)(-) have been synthesized (in the ion source of a mass spectrometer) by unequivocal routes, and their structures have been confirmed by a consideration of their collision induced (negative ion) and charge reversal (positive ion) mass spectra. The CID mass spectrum of (SCNO)(-) shows formation of m/z 42 (CNO(-)), but the corresponding spectra of (OSCN)(-) or (SNCO)(-) lack peaks at m/z 42. Combined theoretical and experimental data support earlier evidence that the hypothiocyanite anion is a major oxidation product of the H(2)O(2)/(SCN)(-) system. However, the formation of m/z 42 in the reported CID spectrum of "(OSCN)(-)" does not originate from (OSCN)(-) but from another isomer, possibly (SCNO)(-).

Anti-Infective Agents↗
PubMed2006

Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile.

INTRODUCTION: The use of guidelines regarding the termination or withholding of cardiopulmonary resuscitation (CPR) in traumatic cardiac arrest patients remains controversial. This study aimed to describe the outcomes for victims of penetrating and blunt trauma who received prehospital CPR. METHODS: We conducted a retrospective review of a statewide major trauma registry using data from 2001 to 2004. Subjects suffered penetrating or blunt trauma, received CPR in the field by paramedics and were transported to hospital. Demographics, vital signs, injury severity, prehospital time, length of stay and mortality data were collected and analysed. RESULTS: Eighty-nine patients met inclusion criteria. Eighty percent of these were blunt trauma victims, with a mortality rate of 97%, while penetrating trauma patients had a mortality rate of 89%. The overall mortality rate was 95%. Sixty-six percent of patients had a length of stay of less than 1 day. Four patients survived to discharge, of which two were penetrating and two were blunt injuries. Hypoxia and electrical injury were probable associated causes of two cardiac arrests seen in survivors of blunt injury. CONCLUSIONS: While only a small number of penetrating and blunt trauma patients receiving CPR survived to discharge, this therapy is not always futile. Prehospital emergency personnel need to be aware of possible hypoxic and electrical causes for cardiac arrest appearing in combination with traumatic injuries.

Adult↗
PubMed2006

The one-electron oxidation of [HCCOCC]- to form neutral HCCOCC, and the subsequent rearrangement of HCCOCC to form HCCCCO. An experimental and computational study.

The singlet anion [HCCOCC]- may be made in the source of a VG ZAB 2HF mass spectrometer by the reaction between F- (from SF6) and H-C[triple chemical bond]C-O-C[triple chemical bond]C-TMS. Vertical (Franck-Condon) one-electron oxidation of [HCCOCC]- in the first collision cell produces doublet neutral HCCOCC. A combination of experiment and molecular modelling [at the CCSD(T)/aug-cc-pVDZ//B3LYP/6-31 + G(d) level of theory] provides data which are consistent with some HCCOCC neutrals being stable for the duration of the neutralisation reionisation experiment, while others rearrange to form the decomposing doublet neutral HCCCCO.

Journal Article↗
PubMed2006

Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patients.

Recording a patient's vital signs is a basic requirement that in part informs clinical decision-making. Practice suggests that recording a trauma patient's temperature is occasionally overlooked in the emergency department. A staff survey was undertaken to gain an appreciation of knowledge and understanding of the issues that surround accidental or exposure hypothermia in trauma patients. Results demonstrate that nurses and doctors are unsure of how to define hypothermia and are not conversant with simple ways to prevent heat loss or rewarm patients. Complications from hypothermia such as coagulopathy and metabolic acidosis were seldom identified. Issues that limit staff recording temperature include patient access and acuity, lack of knowledge and confidence and access to temperature-measuring devices. These results emphasize the need for regular education. Implications for clinical practice were considered; an algorithm to guide staff on ways to improve the monitoring and management of temperature in trauma patients was developed. Opportunities for ongoing and further research were identified.

Education, Continuing↗
PubMed2006

Challenges and opportunities for pharmacoepidemiology in drug-therapy decision making.

Pharmacoepidemiology is a relatively new and evolving science that attempts to quantify mainly adverse drug events and patterns of drug use in a large population. The strength of pharmacoepidemiology over randomized trials is the ability to quantify rare adverse events that may occur over long periods. Recently, discordance in the results of pharmacoepidemiologic studies has made it difficult for clinicians and policy makers to make informed drug-therapy decisions. This commentary addresses the strength of pharmacoepidemiology and the advances in the methodology of pharmacoepidemiologic studies over the years. We also discuss the potential problem of discordant results and urge pharmacoepidemiologists to develop good practice guidelines for the conduct of pharmacoepidemiologic studies.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Do angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers decrease the risk of hospitalization secondary to community-acquired pneumonia? A nested case-control study.

STUDY OBJECTIVE: As studies have shown that angiotensin-converting enzyme (ACE) inhibitors may lower the risk of developing pneumonia by increasing the cough reflex, we sought to explore the potential association between use of ACE inhibitors and the risk of hospitalization secondary to community-acquired pneumonia (CAP). To test this hypothesis further, we also looked at the risk for CAP in those taking angiotensin II receptor blockers (ARBs), as these drugs have a similar mechanism of action to that of ACE inhibitors but have minimal or no effect on the cough reflex. In addition, the putative protection against pneumonia may instead be related to general inhibition of the renin-angiotensin system. DESIGN: Nested case-control study. DATA SOURCE: Universal Quebec, Canada, administrative health databases. PATIENTS: From a cohort of 47,148 patients with coronary artery disease who had a revascularization procedure between 1996 and 2000, 1666 patients with CAP and 33,315 time-matched control subjects (20 controls for each case) were identified. MEASUREMENTS AND MAIN RESULTS: Conditional logistic regression analysis was used to estimate rate ratios, while controlling for potential confounders. No association was observed between patients receiving ACE inhibitors and hospitalization for CAP (rate ratio [RR] 0.98, 95% confidence interval [CI] 0.69-1.40). A similar lack of association was noted for those receiving ARBs (RR 1.02, 95% CI 0.70-1.49). CONCLUSION: In this case-control study, no association was found between use of ACE inhibitors or ARBs and risk of hospitalization secondary to CAP. Future studies are necessary to explore this association further.

Aged↗
PubMed2005

One-electron oxidation of [CCOCC]-* in the gas phase forms stable and decomposing forms of CCCCO.

The radical anion [CCOCC]-* may be made in the source of a VG ZAB 2HF mass spectrometer by the reaction between F-(from SF6) and (CH3)3SiC[triple bond]COC[triple bond]CSi(CH3)3. Vertical (Franck-Condon) one-electron oxidation of [CCOCC]-* in the first collision cell produces both singlet and triplet CCOCC. A combination of experiment and molecular modelling (at the CCSD(T)/aug-cc-pVDZ//B3LYP/6-31G* level of theory) gives data which are consistent with the CCOCC neutrals rearranging over small barriers to form singlet and triplet CCCCO in exothermic reactions. Both singlet and triplet CCCCO formed in this way have excess energy. Singlet CCCCO has sufficient excess energy to effect decomposition exclusively to CCC and CO. In contrast, some of the triplet CCCCO neutrals are stable, while others decompose to CCC and CO.

Journal Article↗
PubMed2005

Revision surgery for exertional anterior compartment syndrome of the lower leg: technique, findings, and results.

BACKGROUND: Recurrent symptoms or failure after fasciotomy for exertional anterior compartment syndrome is not uncommon. HYPOTHESIS: Symptoms from high compartment pressures can be secondary to involvement of the entire compartment or to localized constrictions from postsurgical fibrosis, as well as to entrapment of the superficial peroneal nerve. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eighteen patients who underwent revision surgery for exertional anterior compartment syndrome were available for follow-up. All were athletes who had either a failure or a recurrence of symptoms at a mean of 23.5 months (range, 8-54 months) after the index fasciotomy. Pressure measurements using a slit catheter at rest, at 1 minute postexercise, and at 5 minutes postexercise were performed in 2 places within the compartment: in the area of the previous incision and in the proximal muscle belly of the tibialis anterior. Surgical technique consisted of a 2-incision approach with partial fasciectomy, exploration and decompression of the superficial peroneal nerve, and excision of all fibrotic tissue. An objective examination and a comprehensive subjective questionnaire previously described were performed at a mean follow-up of 42 months (range, 22-67 months). RESULTS: Sixty percent of patients had abnormal pressures only in a localized area, whereas 40% had high pressures throughout the compartment. Eight of 18 (44%) patients had symptoms, signs, and surgical findings of entrapment of the superficial peroneal nerve. At follow-up, 72% of patients had a satisfactory outcome (5 excellent, 8 good), and 28% had an unsatisfactory outcome for intense running sports (4 fair, 1 poor), although 3 patients with the fair results reported improvement with low-level activity. All 8 patients with documented peroneal nerve entrapment had a satisfactory outcome. CONCLUSION: Symptoms from high pressures can be secondary to involvement of the entire compartment or localized to a certain area from postsurgical fibrosis. Pressure measurements should be performed in at least 2 separate areas.

Compartment Syndromes↗
PubMed2005

Neutral cumulene oxide CCCCO is accessible by one-electron oxidation of [CCCCO]-* in the gas phase.

Calculations at the CCSD(T)/aug-cc-pVDZ//B3LYP/6-31G* level of theory indicate that doublet [CCCCO]-* is a stable species which should undergo collision-induced Franck-Condon vertical oxidation under neutralisation-reionisation conditions (-NR+) to produce both triplet CCCCO (ground state) and singlet CCCCO. Some of the neutral CCCCO species formed (particularly the triplet) should be stable for the microsecond duration of the NR experiment, whereas others will be energised (particularly the singlet) and should decompose to C3 and CO. The [CCCCO]-* radical anion has been formed in the ion source of the mass spectrometer by the reaction CH3OCH2C[triple bond]C-CO-CH(CH3)2 + O-* --> [CCCCO]-* + CH3O* + H2O + (CH3)2CH*. The -NR+ spectrum of [CCCCO]-* shows a recovery signal at m/z 64 corresponding to ionised CCCCO, together with a pronounced peak at m/z 36 (CCC+*) produced by ionisation of CCC (formed by the reaction CCCCO --> CCC + CO). The experimental observations are in agreement with the predictions of the theoretical study.

Journal Article↗
PubMed2005

The formation of neutral CCCO2H and HCCCO2 molecules from anionic precursors in the gas phase: a joint experimental and theoretical study.

Calculations at the CCSD(T)/aug-cc-pVDZ//B3LYP/6-31G(d) level of theory indicate that the anions -CCCO2H and HCCCO2(-) are stable species in their singlet states. Upon collision-induced, vertical one-electron oxidation under neutralisation-reionisation (-NR+) conditions, they produce the neutral molecules CCCO2H and HCCCO2, respectively. Some of the CCCO2H neutrals should be stable for the duration of the neutralisation-reionisation experiment (10(-6) s), while others will dissociate to CCCO and OH (requires 125 kJ mol(-1)). In contrast, neutral HCCCO2 is expected to be much less stable, and dissociate to HCC and CO2 (37 kJ mol(-1)). Neither CCCO2H nor HCCCO2 is expected to interconvert, or to rearrange to other isomers. The anions -CCCO2H and HCCCO2(-) have been formed in the ion source of the mass spectrometer by the reactions between (CH3)3Si-C[triple bond]C-CO2H and F- and HC[triple bond]C-CO2Si(CH3)3 and F-, respectively. The -NR+ spectrum of -CCCO2H shows a recovery signal and also indicates that the lowest energy dissociation pathway of neutral CCCO2H corresponds to the loss of OH. The -NR+ spectrum of HCCCO2 displays little or no recovery signal, and the spectrum is dominated by the [CO2]+ ion. The experimental observations are in agreement with the predictions of the extensive theoretical studies.

Journal Article↗
PubMed2005

The evolution of an integrated State Trauma System in Victoria, Australia.

The incidence of major trauma and associated fatalities in the State of Victoria, Australia, have declined over 20 years following the successful implementation of strategies to modify environmental and behavioural factors that contribute to motor vehicle injuries. However, several system deficiencies in the management of major trauma patients had remained unresolved. To investigate these shortfalls the State Government of Victoria established a task force in 1997 to review trauma and emergency services. The task force adopted the principle of "the right patient to the right hospital in the shortest time" and in 2000 began to deploy an integrated State Trauma System. Implementation of such a system required the designation of specific hospitals of various levels to care for trauma patients; the concentration of trauma expertise at these centres; integration and coordination between the service providers; development of agreed triage and transfer protocols and improved education, training and research programs. A statewide major trauma database was established to enable system monitoring and facilitate further enhancements. The Victorian experience with the development of an integrated trauma system should aid in the development of similar systems nationally and internationally and is described in this paper.

Ambulances↗
PubMed2005

Cervical spine assessment in the unconscious trauma patient: a major trauma service's experience with passive flexion-extension radiography.

BACKGROUND: There is no consensus on the most appropriate method of cervical spine assessment in unconscious trauma patients. Passive flexion-extension imaging is one option for further investigating unconscious patients whose plain cervical radiographs are normal. This study examines the usefulness of this passive imaging in investigating for occult cervical injury. METHODS: All unconscious patients admitted to The Alfred Trauma Intensive Care Unit over 1 year (January 1-December 31, 1998), who could not be clinically assessed within 48 hours in regard to their cervical spine, were identified. Results of passive flexion-extension radiography were compared with final injury status and clinical outcome as determined by retrospective review of the imaging reports, radiographic films, and case notes. RESULTS: One hundred twenty-three patients with normal three-view plain radiographs proceeded to passive functional investigation. These were false-negative in four of the seven patients with cervical spine injuries at presentation. No patients suffered any adverse neurologic events from their delayed diagnoses or from the flexion-extension procedure. CONCLUSION: Passive flexion-extension imaging has inadequate sensitivity for detecting occult cervical spine injuries. Although no patients suffered adverse neurologic complications, the potential for devastating consequences from missed cervical injury has resulted in the removal of passive flexion-extension imaging from the screening protocol.

Adult↗
PubMed2005

Cardiac tamponade due to coronary artery erosion.

This report describes two patients with cardiac tamponade secondary to bleeding from a coronary artery, which had been eroded by a foreign body. In one patient the foreign body had been ingested and in the other patient, the cause was iatrogenic. This report highlights varied and unusual causes of cardiac tamponade.

Adult↗
PubMed2004

Complications of intercostal catheter insertion using EMST techniques for chest trauma.

BACKGROUND: The purpose of the present study was to determine the complication rates associated with intercostal catheter insertion (ICI) performed using Early Management of Severe Trauma (EMST) guidelines on trauma patients admitted through The Alfred Trauma Centre. METHODS: The Alfred Trauma Registry identified demographic and clinical data for patients who underwent ICI in the Alfred hospital following admission for trauma. The medical histories were subsequently reviewed for complications resulting from ICI. RESULTS: There were 211 ICI performed on 173 trauma patients at The Alfred Trauma Centre between July 2001 and June 2002. The mean injury severity score was 34. Mean age was 38 (range 15-82 years), with 77% of the patients being men. Chest injury was the result of blunt trauma in 90.2% and penetrating trauma in 9.8%. ICI occurred in the Trauma Centre (84%), operating theatre (6%), intensive care unit (9%) and in the general ward (1%). Eighty per cent of patients had a unilateral ICI. The indications for ICI were pneumothorax (45.7%), haemothorax (15.0%), haemopneumothorax (28.3%) and tension pneumothorax (7.5%). There were no insertional and 11 (5.2%) positional complications. The infection rate was 2.4% comprising two superficial and three deep (empyema thoraces) infections. No statistically significant association was found between infective complications and age, injury severity score (ISS), haemothorax, penetrating trauma, prehospital needle thoracostomy and time to ICI. There was no mortality arising from ICI complications. CONCLUSION: Intercostal catheter insertion for chest trauma performed in accordance with EMST guidelines has a low complication rate. Prehospital prophylactic chest decompression for ventilated patients with chest trauma, using a lateral rather than an anterior approach, may decrease the incidence of untreated tension pneumothorax.

Adolescent↗