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Rory Wolfe

Publications and source records attributed to Rory Wolfe.

35 records · Page 2Linked to original sources
PubMed2005

Sonographically guided biopsy of focal lesions: a comparison of freehand and probe-guided techniques using a phantom.

OBJECTIVE: A phantom model of lesions in the human liver with simulated ribs was used to test an ultrasound probe-guided sonographic biopsy technique. The aim of the experiment was to compare biopsy time and sample quality between freehand and probe-guided methods of sonographic biopsy. MATERIALS AND METHODS: Ten operators with a range of clinical biopsy experience were tested. Each operator was given two phantoms containing four targets. Each target was biopsied with both biopsy methods. Data collected included procedure time and sample quality in the biopsy specimen. Analyses were stratified by level of operator experience. RESULTS: Median biopsy time was 23 sec with the ultrasound probe guide and 32 sec freehand. Differences between probe-guided and freehand pairs of measurements approximately followed a normal distribution. The mean time difference between probe-guided and freehand times to complete biopsy was -20 sec (95% confidence interval, -35 to -5 sec; p = 0.01). Analysis of sample quality across all operators showed no difference. CONCLUSION: The ultrasound probe-guided technique of sonographic biopsy could be used in a complex phantom model, and there was a statistically significant time benefit with the use of probe guides compared with the freehand biopsy technique. This benefit was greatest for inexperienced operators. There was no difference in sample quality between the probe-guided and freehand techniques.

Analysis of Variance↗
PubMed2004

Predicting death in young offenders: a retrospective cohort study.

OBJECTIVE: To examine predictors of death in young offenders who have received a custodial sentence using data routinely collected by juvenile justice services. DESIGN: A retrospective cohort of 2849 (2625 male) 11-20-year-olds receiving their first custodial sentence between 1 January 1988 and 31 December 1999 was identified. MAIN OUTCOME MEASURES: Deaths, date and primary cause of death ascertained from study commencement to 1 March 2003 by data-matching with the National Death Index; measures comprising year of and age at admission, sex, offence profile, any drug offence, multiple admissions and ethnic and Indigenous status, obtained from departmental records. RESULTS: The overall mortality rate was 7.2 deaths per 1000 person-years of observation. Younger admission age (hazard ratio [HR], 1.4; 95% CI, 1.0-1.9), repeat admissions (HR, 1.8; 95% CI, 1.1-2.9) and drug offences (HR, 1.5; 95% CI, 1.0-2.1) predicted early death. The role of ethnicity/Aboriginality could only be assessed in cohort entrants from 1996 to 1999. The Asian subcohort showed higher risk of death from drug-related causes (HR, 2.5; 95% CI, 1.1-5.5), more drug offences (relative risk ratio [RRR], 13; 95% CI, 8.5-20.0) and older admission age (oldest group v youngest: RRR, 9.3; 95% CI, 1.3-68.0) than non-Indigenous Australians. Although higher mortality was not identified in Indigenous Australians, this group was more likely to be admitted younger (oldest v youngest: RRR, 0.31; 95% CI, 0.15-0.63) and experience repeat admissions (RRR, 1.6; 95% CI, 1.0-2.4). CONCLUSIONS: Young offenders have a much higher death rate than other young Victorians. Early detention, multiple detentions and drug-related offences are indicators of high mortality risk. For these offenders, targeted healthcare while in custody and further mental healthcare and social support after release appear essential if we are to reduce the mortality rate in this group.

Adolescent↗
PubMed2004

The static examination of children and young adults with cerebral palsy in the gait analysis laboratory: technique and observer agreement.

The assessment of ambulant children with spastic cerebral palsy frequently includes an evaluation in the motion analysis laboratory, consisting of a standardized physical examination and instrumented gait analysis. We therefore designed a repeatability study to evaluate observer agreement of five joint range of motion parameters, in 20 patients with cerebral palsy aged 5-25 years. These five parameters are some of the most important measurements made during the static examination in the gait laboratory. Intra-observer agreement was high (concordance correlation coefficient range, 0.67 -0.96), and using Bland and Altman analysis it was clinically acceptable with 95% limits of agreement of all parameters close to within +/- 10degrees. The level of inter-observer agreement was less satisfactory, particularly in hip flexion deformity.

Adolescent↗
PubMed2004

TRISS: does it get better than this?

The Trauma and Injury Severity Scoring (TRISS) system was developed in the 1980s to improve the prediction of patient outcomes following trauma through the use of physiological and anatomical criteria. The TRISS is used for a number of purposes, including quantifying the severity of injury of a patient population, calculating the probability of survival of patients for identification of cases for peer review, and comparing the death or survival rates of different populations/hospitals. Despite the advancements in trauma care, improved statistical techniques, and the identification of numerous limitations of TRISS, it continues to be the most commonly used tool for judging hospital performance and monitoring trauma death rates. This article critically evaluates the development, structure, and practical use of TRISS to determine its value in the current trauma environment. Limitations of TRISS are discussed and suggestions are made for the future development of trauma prediction tools.

Benchmarking↗
PubMed2003

Mortality in young offenders: retrospective cohort study.

OBJECTIVES: To estimate overall and cause specific standardised mortality ratios in young offenders. DESIGN: Comparison of mortality data in cohort of young offenders. SETTINGS: State of Victoria, Australia. SUBJECTS: Cohort of young offenders aged 10-20 years with a first custodial sentence from 1 January 1988 to 31 December 1999. MAIN OUTCOME MEASURES: Deaths ascertained by matching with the national death index, a database containing records of all deaths in Australia since 1980. Death rates in the reference Victorian population used to calculate standardised mortality ratios. RESULTS: The offender cohort comprised 2621 men and 228 women with 11 333 person years of observation. The median age of first detention was 17.9 years for men and 18.4 years for women. Median follow up was 3.3 years for men and 1.4 years for women. Overall standardised mortality ratio adjusted for age (expressed as a ratio) was 9.4 (95% confidence interval 7.4 to 11.9) for men and 41.3 (20.2 to 84.7) for women. Cause specific standardised mortality ratios for men were 25.7 (17.9 to 36.9) for drug related causes, 9.2 (5.8 to 15) for suicide, and 5.7 (3.6 to 9.2) for non-intentional injury. A quarter of drug related deaths in men aged 15-19 years were in offenders. CONCLUSIONS: Social policies for young offenders should address both the prevalent drug and mental health problems as well the high levels of social disadvantage.

Adolescent↗
PubMed2003

Transitions in an imperfectly observed binary variable: depressive symptomatology in adolescents.

We describe a methodology for analysing transitions over time in a binary outcome variable that is subject to misclassification (that is, measurement error). Logistic regression models for transition events in the true underlying state are combined with estimates of probabilities of misclassification of the underlying state. The model is based on the Markovian assumption that the probabilities of transition in the underlying state at a given time depend only on the underlying state at the previous time. Hence we estimate odds-ratio effects for transitions that are adjusted for the effect of misclassification. Comparing these adjusted estimates with estimates that are obtained without taking misclassification into account indicates that the latter can be biased either toward or away from the null. For the estimates to exist, certain restrictions on the observed data and misclassification probabilities need to be met. If these restrictions are not satisfied then the conclusion from the analysis is that all observed transition events can be explained solely by the error in outcome assessment, in which case it is likely that an aspect of the model is incorrect. The motivation for this work comes from an analysis of transitions in depression status for a cohort of Australian teenagers participating in a longitudinal study of adolescent health.

Adolescent↗
PubMed2003

Acquisition of methicillin-resistant Staphylococcus aureus in a large intensive care unit.

OBJECTIVES: To determine the prevalence of MRSA colonization on admission to the ICU and the incidence of MRSA colonization in the ICU. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: Patients admitted to the ICU in 2000-2001. METHODS: Patients were screened for MRSA with nose, throat, groin, and axilla swabs on admission and discharge. MRSA acquisition was defined as a negative admission screen and a positive discharge screen. Risk factors analyzed included previous wards/current unit, gender, age, and length of stay prior to and in the ICU. Univariate and multivariate analyses were performed using logistic regression. RESULTS: Of screened patients, 6.8% were MRSA colonized on admission to the ICU. Some patients (11.4%) became newly colonized during their stay in the ICU. Factors that remained significant in the multivariate analysis of MRSA colonization on admission were previous admission to various wards and length of stay prior to ICU admission of more than 3 days. In the multivariate analysis of MRSA acquisition in the ICU, being a trauma patient and length of stay in the ICU greater than 2 days remained significant Thirty-six percent of patients had both admission and discharge swabs taken. This percentage increased in the presence of a supervisory nurse. CONCLUSION: Significant acquisition of MRSA occurs in the ICU of our hospital, with trauma patients at increased risk. Patients who had been on the cardiothoracic ward prior to the ICU had a lower risk of MRSA colonization on admission. Presence of a supervisory nurse improved compliance with screening

Adolescent↗
PubMed2003

Food and nutrient intakes and asthma risk in young adults.

BACKGROUND: Some aspects of diet are relatively newly recognized potential risk factors for asthma, but the evidence to date is conflicting. OBJECTIVE: The goal was to determine whether the food and nutrient intakes of adults with asthma differ from those of adults without asthma. DESIGN: This was a community-based, cross-sectional study of 1601 young adults ( +/- SD age: 34.6 +/- 7.1 y) who were initially recruited by random selection from the federal electoral rolls in Melbourne in 1999. Subjects completed a detailed respiratory questionnaire, a validated semiquantitative food-frequency questionnaire, skin-prick testing, and lung function tests, including a methacholine challenge test for bronchial hyperreactivity (BHR). A total of 25 nutrients and 47 food groups were analyzed by using multiple logistic regression with alternate definitions of asthma and atopy as the outcomes. RESULTS: Whole milk appeared to protect against current asthma (odds ratio: 0.66; 95% CI: 0.46, 0.97), doctor-diagnosed asthma (0.73; 0.54, 0.99), BHR (0.68; 0.48, 0.92), and atopy (0.71; 0.54, 0.94). Conversely, soy beverage was associated with an increased risk of current asthma (2.05; 1.19, 3.53), doctor-diagnosed asthma (1.69; 1.04, 2.77), and BHR (1.65; 1.00, 2.71). Apples and pears appeared to protect against current asthma (0.83; 0.71, 0.98), asthma (0.88; 0.78, 1.00), and BHR (0.88; 0.77, 1.00). CONCLUSIONS: The consumption of dairy products, soy beverages, and apples and pears, but not of nutrients per se, was associated with a range of asthma definitions. Dietary modification after diagnosis is one possible explanation for this finding. Intervention studies using whole foods are required to ascertain whether such modifications of food intake could be beneficial in the prevention or amelioration of asthma.

Adult↗
PubMed2003

Risk factors for new detection of vancomycin-resistant enterococci in acute-care hospitals that employ strict infection control procedures.

Accurate assessment of the risk factors for colonization with vancomycin-resistant enterococci (VRE) among high-risk patients is often confounded by nosocomial VRE transmission. We undertook a 15-month prospective cohort study of adults admitted to high-risk units (hematology, renal, transplant, and intensive care) in three teaching hospitals that used identical strict infection control and isolation procedures for VRE to minimize nosocomial spread. Rectal swab specimens for culture were regularly obtained, and the results were compared with patient demographic factors and antibiotic exposure data. Compliance with screening was defined as "optimal" (100% compliance) or "acceptable" (minor protocol violations were allowed, but a negative rectal swab specimen culture was required within 1 week of becoming colonized with VRE). Colonization with VRE was detected in 1.56% (66 of 4,215) of admissions (0.45% at admission and 0.83% after admission; the acquisition time was uncertain for 0.28%), representing 1.91% of patients. No patients developed infection with VRE. The subsequent rate of new acquisition of VRE was 1.4/1,000 patient days. Renal units had the highest rate (3.23/1,000 patient days; 95% confidence interval [CI], 1.54 to 6.77/1,000 patient days). vanB Enterococcus faecium was the most common species (71%), but other species included vanB Enterococcus faecalis (21%), vanA E. faecium (6%), and vanA E. faecalis (2%). The majority of isolates were nonclonal by pulsed-field gel electrophoresis analysis. Multivariate analysis of risk factors in patients with an acceptable screening suggested that being managed by a renal unit (hazard ratio [HR] compared to the results for patients managed in an intensive care unit, 4.6; 95% CI, 1.2 to 17.0 [P = 0.02]) and recent administration of either ticarcillin-clavulanic acid (HR, 3.6; 95% CI, 1.1 to 11.6 [P = 0.03]) or carbapenems (HR, 2.8; 95% CI, 1.0, 8.0 [P = 0.05]), but not vancomycin or broad-spectrum cephalosporins, were associated with acquisition of VRE. The relatively low rates of colonization with VRE, the polyclonal nature of most isolates, and the possible association with the use of broad-spectrum antibiotics are consistent with either the endogenous emergence of VRE or the amplification of previously undetectable colonization with VRE among high-risk patients managed under conditions in which the risk of nosocomial acquisition was minimized.

Adult↗
PubMed2003

A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee.

OBJECTIVE: To assess the ability of a topical preparation of glucosamine sulfate and chondroitin sulfate to reduce pain related to osteoarthritis (OA) of the knee. METHODS: Sixty-three patients were randomized to receive either a topical glucosamine and chondroitin preparation or placebo to be used as required over an 8 week period. Efficacy was assessed using a visual analog scale (VAS) for pain as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the SF-36 questionnaire. RESULTS: VAS scores indicated a greater mean reduction in pain for the glucosamine/chondroitin preparation group (mean change -3.4 cm, SD 2.6 cm) compared to the placebo group (mean change -1.6 cm, SD 2.7 cm) after 8 weeks. After 4 weeks the difference between active and placebo groups in their mean reduction from baseline was 1.2 (95% CI 0.1 to 2.4, p = 0.03) and after 8 weeks was 1.8 (95% CI for difference between groups, 0.6 to 2.9 cm; p = 0.002). CONCLUSION: Topical application of glucosamine and chondroitin sulfate is effective in relieving the pain from OA of the knee and improvement is evident within 4 weeks.

Administration, Topical↗
PubMed2002

Complaints from emergency department patients largely result from treatment and communication problems.

OBJECTIVE: Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. METHODS: We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). RESULTS: In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. CONCLUSIONS: Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.

Adolescent↗
PubMed2002

Are methods used to estimate weight in children accurate?

OBJECTIVE: The exact weight of a child undergoing resuscitation is usually not known. Several methods to estimate a child's weight have been proposed. We evaluated six of these methods to determine their accuracy and clinical usefulness across a range of weights and ages. METHOD: Children attending a tertiary paediatric emergency department on 30 non-consecutive days were weighed, a length or height was obtained and an estimation of body habitus (slim, average or heavy) made by a single investigator, Karen Black (KB). All children less than 145 cm were also measured using the Broselow tape. Six methods of weight estimation were employed and the calculated weight compared to the true weight. The weight estimation methods evaluated were the advanced paediatric life support (APLS) method, Broselow tape, devised weight estimation method (DWEM), Oakley table, Traub-Johnson and the Traub-Kichen methods. RESULTS: Four hundred and ninety-five children were included in the study. Children were evenly distributed among the weight groups of less than 10 kg, 10-25 kg, 25-40 kg and over 40 kg. The methods with the best overall performance were the devised weight estimation method and Broselow tape although the latter has a length limitation of 145 cm. The other methods performed well in the middle two weight groups but poorly outside these groups. CONCLUSIONS: The most accurate methods of weight estimation in children are the Broselow tape and the devised weight estimation method. We recommend the use of either of these methods in emergency situations where direct weighing is not possible.

Body Weight↗
PubMed2002

Graft loss following renal transplantation in Australia: is there a centre effect?

BACKGROUND: Assessment of centre variation in renal transplantation outcome provides an opportunity to examine differences in quality of care between centres. However, differences in outcome may represent differences in patient factors between centres and be biased by sampling variability and inadequate data ascertainment. METHODS: Differences in 12-month graft survival in 1986 primary renal transplant adult recipients from 16 centres in Australia between 1993 and 1998 were examined. Fifteen recipient and donor factors known prior to transplantation were examined to determine factors independently predictive of graft survival. Differences between centres in these factors were examined. Unadjusted and multivariable adjusted outcomes for each centre were compared to the average for all centres. Multivariable hierarchical modelling was employed to account for potential bias due to sampling variability. RESULTS: Factors predictive of reduced 12-month graft survival on multivariable analysis that were significantly different between centres were time on dialysis prior to transplantation, donor age, organ source, and number of human lymphocyte antigen mismatches. Unadjusted 12-month graft survival for all centres was 91.7% and ranged from 83.1 to 96.4%. Although two centres performed significantly lower than average, this poorer outcome was accounted for in one of these two centres after adjusting for factors shown to be independently predictive of outcome. However, multivariable hierarchical modelling failed to identify any centre as performing significantly different to average, with 12-month graft survival ranging from 89.2 to 92.2%. Outcome in patients excluded from the study due to inadequate data ascertainment was significantly worse than patients who were included. CONCLUSIONS: There was no evidence of centre variation after accounting for variation in risk factors predictive of poor outcome between centres, as well as potential bias due to sampling variability. Exclusion of patients due to inadequate data remains an important source of bias in estimating accurate outcomes. Appropriate analytical strategies and consideration of sources of bias are important for the valid identification of centres with poorer outcomes.

Adolescent↗
PubMedDate not supplied

Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women.

OBJECTIVE: Circulating testosterone in women declines during the late reproductive years such that otherwise healthy women in their 40s have approximately half the testosterone level as women in their 20s. Despite this, research showing the benefits of androgen replacement has been limited to the postmenopausal years. In view of the known premenopausal physiological decline in testosterone, we have evaluated the efficacy of transdermal testosterone therapy on mood, well-being, and sexual function in eugonadal, premenopausal women presenting with low libido. DESIGN: Premenopausal women with low libido participated in a randomized, placebo-controlled, crossover, efficacy study of testosterone cream (10 mg/day) with two double-blind, 12-week, treatment periods separated by a single-blind, 4-week, washout period. RESULTS: Thirty-four women completed the study per protocol, with 31 women (mean age 39.7 +/- 4.2 years; serum testosterone 1.07 + 0.50 nmol/L) providing complete data. Testosterone therapy resulted in statistically significant improvements in the composite scores of the Psychological General Well-Being Index [+12.9 (95% CI, +4.6 to +21.2), P = 0.003] and the Sabbatsberg Sexual Self-Rating Scale [+15.7 (95% CI, +6.5 to +25.0), P = 0.001] compared with placebo. A mean decrease in the Beck Depression Inventory score approached significance [-2.8 (95% CI, -5.7 to +0.1), P = 0.06]. Mean total testosterone levels during treatment were at the high end of the normal range, and estradiol was unchanged. No adverse effects were reported. CONCLUSIONS: Testosterone therapy improves well-being, mood, and sexual function in premenopausal women with low libido and low testosterone. As a substantial number of women experience diminished sexual interest and well-being during their late reproductive years, further research is warranted to evaluate the benefits and safety of longer-term intervention.

Administration, Cutaneous↗
PubMedDate not supplied

Cerebral palsy in Victoria: motor types, topography and gross motor function.

OBJECTIVES: To study the relationships between motor type, topographical distribution and gross motor function in a large, population-based cohort of children with cerebral palsy (CP), from the State of Victoria, and compare this cohort to similar cohorts from other countries. METHODS: An inception cohort was generated from the Victorian Cerebral Palsy Register (VCPR) for the birth years 1990-1992. Demographic information, motor types and topographical distribution were obtained from the register and supplemented by grading gross motor function according to the Gross Motor Function Classification System (GMFCS). RESULTS: Complete data were obtained on 323 (86%) of 374 children in the cohort. Gross motor function varied from GMFCS level I (35%) to GMFCS level V (18%) and was similar in distribution to a contemporaneous Swedish cohort. There was a fairly even distribution across the topographical distributions of hemiplegia (35%), diplegia (28%) and quadriplegia (37%) with a large majority of young people having the spastic motor type (86%). CONCLUSIONS: The VCPR is ideal for population-based studies of gross motor function in children with CP. Gross motor function is similar in populations of children with CP in developed countries but the comparison of motor types and topographical distribution is difficult because of lack of consensus with classification systems. Use of the GMFCS provides a valid and reproducible method for clinicians to describe gross motor function in children with CP using a universal language.

Ataxia↗
PubMedDate not supplied

Hip displacement in spastic cerebral palsy: repeatability of radiologic measurement.

Radiologic measures of migration percentage (MP) and acetabular index (AI) taken from plain radiographs of the pelvis are the most commonly used tools for determining hip displacement and management options in children with cerebral palsy and spastic hip disease. This study determined interrater and intrarater reliability of MP and AI on pelvic radiographs chosen to represent a wide range of age (11 months to 8 years 5 months), MP (0%-56%), and AI (9 degrees -33 degrees ). The study demonstrated that an experienced rater would be expected to measure MP on a single radiograph to within +/-5.8% of the true value and a change in MP between two radiographs taken at different times to within +/-8.3% of the true value. Similarly for AI, the measurement error for a typical rater would be within +/-2.6 degrees on a single reading and +/-3.7 degrees if recording change between two occasions. The authors believe that the results indicating true change are acceptable in clinical practice, provided treatment decisions are based on a series of radiographs taken at 6-month intervals, methods and training are standardized, and consistent raters are used.

Acetabulum↗