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At least 19 recordsLinked to original sources

PubMed2005

Multilaboratory testing of thrombophilia: current and past practice in Australasia as assessed through the Royal College of Pathologists of Australasia Quality Assurance Program for Hematology.

We have conducted a series of multilaboratory surveys during the last 6 years to evaluate testing proficiency in the detection of congenital and acquired thrombophilia. For lupus anticoagulant (LA) testing, participant laboratories used a panel of tests, including activated partial thromboplastin time (aPTT; 100% of laboratories), kaolin clotting time (26 to 70%), and Russell's viper venom time (RVVT; 75 to 100%). Coefficients of variation (CVs) for assays ranged from 5 to 40%. RVVT assays appeared to be most sensitive and specific for detection of LA (fewer false-negatives or -positives), although laboratories performed best when they used a panel of tests. For congenital thrombophilia, tests evaluated comprised protein C (PC), protein S (PS), antithrombin (AT), and activated protein C resistance (APCR). Most participant laboratories performed PC using chromogenic (approximately 75%), or clot based (approximately 15%) assays, with few (< 10%) performing antigenic assessments. PS was most often assessed (approximately 60%) by immunological or antigenic assays, usually of free PS, or by functional or clot-based assays (approximately 40%). AT is usually assessed by functional chromogenic assays (approximately 95%). APCR was assessed using aPTT (approximately 50%) or RVVT (approximately 50%) clot-based assays, with the aPTT APCR typically performed using factor V-deficient plasma predilution, but the RVVT APCR typically performed without. Laboratories using the RVVT APCR generally performed better in detection of factor V Leiden-associated APCR, with the aPTT method group yielding higher false-negative and/or false-positive findings (approximately 5% of occasions). Some clot-based PC and PS assays appeared to be influenced by APCR status, and yielded lower apparent PC and PS levels with positive APC resistance. The overall error rate for PC, PS, and AT was approximately 2 to 8% (i.e., false-normal interpretations for deficient plasma or false-abnormal interpretations for normal plasma). The CVs for these assays ranged from 5 to 40%, with highest CVs typically obtained with PS assays.

Activated Protein C Resistance↗

PubMed1998

The management of anterior abdominal stab wounds in Australasia.

BACKGROUND: The low incidence of stab wounds in Australasia has led to a more operative approach for the management of anterior abdominal stab wounds. A survey of Australasian surgeons interested in trauma was undertaken to analyse current practice. METHODS: Ninety-seven early management of severe trauma surgical instructors (known as ATLS in Australasia) were surveyed using a four-part, single-page questionnaire. RESULTS: Sixty-five instructors completed the survey. Thirty-nine instructors stated that they would admit patients with stab wounds even if the wound appeared superficial or 'skin only'. For 14 surgeons the decision to perform a laparotomy was dependent on fascial penetration and for 17 the decision depended upon peritoneal penetration. Six felt that all but the most superficial wounds should have a laparotomy. Laparoscopy, diagnostic peritoneal lavage and other investigations were also thought to be helpful. Thirteen surgeons felt that the presence of peritonism or tenderness were the most important determinants. There was no hospital protocol for 44 respondents and there was a wide variation in individual approach to this problem. However, all agreed that peritonism and haemodynamic instability were indications for immediate laparotomy. CONCLUSIONS: There is still a low threshold for laparotomy in Australasia and this approach is not without risks. However, the alternative of using serial observation should be regarded as an active form of management and protocols must be established to ensure regular repeat examinations by experienced personnel. The low incidence of abdominal stab wounds in Australasia makes this approach difficult. A safe approach for the Australasian situation is described.

Abdominal Injuries↗

PubMed2006

Energetics of emergence in the cicadas, Cyclochila australasiae and Abricta curvicosta (Homoptera: Cicadidae).

The final moult in cicadas marks a major transition in lifestyle and is a behaviour that makes the cicada vulnerable to predation. Consequently, emergence times are short and, we predict, therefore the rate of energy consumption would be high. Hence, we measured the energetic cost of emergence in Cyclochila australasiae (green grocer) and Abricta curvicosta (floury baker) cicadas during the final moult from nymph to adult cicada. Maximum energy expended whilst emerging was compared between the sexes and species. Even though C. australasiae take longer to emerge than A. curvicosta, the mass-specific cost of emergence is not different between the two species (C. australasiae: 11.34+/-2.55 J g(-1); A. curvicosta: 12.91+/-1.90 J g(-1)). The mass-specific metabolic rates of fully emerged adults of both species are approximately twice those of the nymphs and the maximum metabolic rate during emergence is about 1.5 times higher than the resting metabolic rate of emerged adults. Emergence times, as indicated by rates of oxygen consumption, are longer than expected and probably reflect limitations in the oxygen capacity of the cicadas during moulting.

Animals↗

PubMed2003

A strategic plan for disaster medicine in Australasia.

Disaster epidemiology reveals epidemic increases in incidence of disasters. Rare disasters with catastrophic consequences also threaten modern populations. This paper profiles natural disasters, transportation incidents, emerging infectious diseases, complex disasters and terrorism for their historical and future potential impact on Australasia. Emergency physicians are in a position to assume leadership roles within the disaster management community in Australasia. The Australasian College for Emergency Medicine is in a position to lead medical specialty advances in disaster medicine in Australasia. To optimize its impact in disaster medicine, the specialty and its College have opportunities for advances in key areas of College administration, intra and interinstitutional representation, disaster preparedness and planning, disaster relief operations, education and training programs, applied clinical research, and faculty development.

Australia↗

PubMed1991

History of veterinary public health in Australasia.

The geographic isolation of Australasia has played a significant role in preventing the introduction of exotic diseases or in limiting the spread of many diseases which entered after settlement. Some infections such as psoroptic mange, tuberculosis and brucellosis became widely dispersed and some were ultimately to require novel methods to curtail them, e.g. greater use of rail and road transportation to convey stock, improved methods to locate and muster livestock in bush terrain (helicopters), improved diagnostic tests and the introduction of effective methods for tracing diseases found at abattoirs to the farms of origin. From the 1860s to the 1880s, there were such high mortalities from anthrax in Australia that a business syndicate associated with the Pasteur Institute established a laboratory in Sydney to produce anthrax vaccine from 1890 to 1898. The two-dose vaccine developed by Pasteur was unable to compete with a single dose spore vaccine later pioneered locally by Gunn and McGarvie-Smith. The most important achievements in veterinary public health in Australasia have been the successful eradication of brucellosis, the virtual eradication of hydatid disease in New Zealand and Tasmania, the substantial progress made in the eradication of tuberculosis from all but small regions of Australasia, and the development of a commercial vaccine to prevent Q fever in humans.

Animals↗

PubMed1989

International neurosurgery: neurosurgical training and practice in India, Korea, Japan, and Australasia.

During the 1985 annual meeting of the Congress of Neurological Surgeons in Honolulu, neurosurgical training and practice in India, Korea, Japan, and Australasia were discussed at the International Committee symposium. This article summarizes the information presented. India has about 300 neurosurgeons for a population of 650 million, while Japan has about 4,000 neurosurgeons and trainees for a population of 120 million. Korea has 424 neurosurgeons for a population of 41.5 million, and Australasia has 92 neurosurgeons and 19 trainees for 17.5 million people. Various other demographic, institutional, organizational, and economic aspects of neurological health care and delivery, education, and quality control are described. While financing and availability of adequate neurosurgical care remains a major problem in India, it appears that reducing the number of neurosurgical trainees remains, as it is in North America, a major issue in Japan and, to a lesser extent, in Korea. This problem, as well as certification of the quality of training, is being managed effectively in Australasia.

Asia↗

PubMed2004

Susceptibility of human influenza viruses from Australasia and South East Asia to the neuraminidase inhibitors zanamivir and oseltamivir.

Human influenza viruses isolated from Australasia (Australia and New Zealand) and South East Asia were analysed to determine their sensitivity to the NA inhibitor drugs, zanamivir and oseltamivir. A total of 532 strains isolated between 1998 and 2002 were tested using a fluorescence-based assay to measure the relative inhibition of NA activity over a range of drug concentrations. Based on median IC50 values, influenza A viruses (with neuraminidase subtypes N1 and N2) were more sensitive to both the NA inhibitors than were influenza B strains. Influenza A viruses with a N1 subtype and influenza B strains both demonstrated a greater sensitivity to zanamivir than to oseltamivir carboxylate, whereas influenza A strains with a N2 subtype were more susceptible to oseltamivir carboxylate. For each of the neuraminidase types, IC50 values for viruses from Australasia and South East Asia were found to be comparable. Based on the data prior to and following the licensing of the drugs into the respective regions, the use of the NA inhibitors did not appear to have a significant impact on the susceptibility of the viruses tested to zanamivir or oseltamivir carboxylate.

Acetamides↗

PubMed2005

Prospective audit of treatment of paediatric febrile neutropenia in Australasia.

OBJECTIVES: Febrile neutropenia post-chemotherapy continues to impose a burden of morbidity and mortality on patients and families affected by childhood cancer, whereas these unplanned hospital admissions increase the financial cost of treating paediatric malignancies. There are currently no published national guidelines. This study comprises the first audit of current therapeutic practice in Australasia. METHODS: Information was sought prospectively from the 12 paediatric oncology tertiary referral centres in Australia and New Zealand regarding treatment of febrile neutropenia episodes commencing between 11 March and 10 May 2002. RESULTS: Data were returned on 127 episodes by nine centres. The median length of stay was 6 days and 18 different antibiotic regimens were implemented as first-line therapy. The median neutrophil count at the beginning and end of the febrile neutropenic episode was 0.0 x 10(9)/L (range 0.0 to 2.3 x 10(9)/L) and 0.7 x 10(9)/L (range 0.0 to 25.4 x 10(9)/L), respectively. Thirty per cent of episodes had positive blood cultures. Of these, 81% occurred in patients with tunnelled central venous catheters. The initial antimicrobial combination was changed in 61% of episodes. Outpatient antibiotics were used in 21% episodes after initial intravenous antimicrobial therapy. CONCLUSIONS: The current practice in Australasia is consistent with international guidelines, although changes are made more frequently to first-line therapy than in previous published studies. The central venous catheters are associated with a much higher risk of bacteraemia and consideration should be given to increased use of implanted port systems.

Adolescent↗

PubMed2001

Training for the role of triage in Australasia.

OBJECTIVE: To characterize the prerequisite experience and training undertaken by nurses for the role of triage in emergency departments in Australasia. METHODS: Postal survey of charge nurses/unit nurse managers of all Australasian emergency departments accredited for specialist emergency physician training by the Australasian College for Emergency Medicine. RESULTS: The response rate was 89%. The most common duration of prerequisite experience was 12-18 months. Most programmes use a combination of educational activities, with self-directed learning packages, lectures and mentored experience being the most common. Three hospitals reported no preparation for triage. CONCLUSION: In Australasia, there is wide variability in required training and experience before triage duties are performed. Strategies to set suggested minimum standards in these areas and to make training activities more accessible are recommended.

Australia↗

PubMed2002

Cyclosporin monitoring in Australasia: survey of laboratory practices in 2000.

Therapeutic drug monitoring of cyclosporin has been established as part of the routine clinical management of patients following organ transplantation for some 20 years. The current practices of laboratories in Australia and New Zealand have been surveyed for the year 2000 to update previous similar surveys in the light of considerable changes in CsA formulation (now exclusively Neoral throughout Australasia), assay methods, and blood sampling strategies. The results, representing 93% of CsA laboratories in Australasia (n = 44), found that there was still a plethora of approaches adopted within each organ type for monitoring the established trough (C0) CsA concentration. There was a considerable uptake of 2-hour post-dose sampling (C2) monitoring practices, as demonstrated by assay requests to the responding laboratories, particularly in renal and liver transplantation (46% of centers). Most of these laboratories were also assaying C0 and/or to a much lesser extent, so-called limited sampling strategy AUC (lssAUC) samples at this time. The mFPIA (on TDx and AxSYM analyzers) were still strongly represented (54%) (relatively consistent with international data from the UKQAS proficiency testing scheme at this time) despite on-going concerns expressed in the literature about these methods. However, the Cedia assays had made considerable impact so soon after their introduction with 22% of the laboratories using Cedia or Cedia Plus (Microgenics or Roche Diagnostics; Sydney, Australia) methods. There were a wide variety of dilution protocols adopted in many centers for measuring samples above calibration ranges (such as C2 samples), and hence there was scope for improvement to fully validated techniques. Few centers (16%) made any attempt at interpretation of their results, many seeing their role as purely "measuring" (i.e., an analytical role), not "monitoring" (i.e., including assay and result interpretation). Despite many detailed attempts at providing international or national guidelines for CsA monitoring, etc., there is still considerable scope for improving the quality of the laboratory services offered in this complex as well as expensive area. Several respondents volunteered their support for further Australasian CsA monitoring consensus guidelines.

Australia↗

PubMed2004

Ten-year study on the effect of intrapartum antibiotic prophylaxis on early onset group B streptococcal and Escherichia coli neonatal sepsis in Australasia.

BACKGROUND: Intrapartum antibiotics have reduced the incidence of neonatal early onset (EO) group B streptococcal (GBS) disease. Some surveillance data suggest that this success may be at the cost of increasing rates of non-GBS infection, especially in premature neonates. OBJECTIVE: To examine rates of EOGBS infection and EO Escherichia coli neonatal sepsis in Australasia. METHODOLOGY: Analysis of trends in EO (<48 h age) GBS and E. coli sepsis from longitudinal prospective surveillance data collected from representative tertiary obstetric hospitals in each state of Australia and selected centers in New Zealand during a 10-year period from 1992 through 2001. Statistical analysis used Poisson regression. RESULTS: 206 GBS and 96 E. coli cases occurred in 298,319 live births during the study period. The EOGBS sepsis rate fell from a peak of 1.43/1000 live births in 1993 to 0.25/1000 in 2001 (P < 0.001). The overall EO E. coli sepsis rate was 0.32/1000. In babies with birth weight <1500 g, it was 6.20/1000. There was an overall trend to decreasing EO E. coli sepsis (P = 0.07), and there was no significant change in E. coli sepsis in babies <1500 g (P = 0.60). Sixty-nine percent of E. coli cases occurred in the <1500 g cohort; the case fatality rate in this group was 50%. The overall case fatality rate from E. coli sepsis was 36%, and this rate remained stable during the study period (P = 0.47). CONCLUSIONS: The increasing use of intrapartum antibiotics produced a steady decline in EOGBS disease in Australasia. There was also a trend to decreasing EO E. coli sepsis in all babies, and the rate in very low birth weight infants remained stable.

Antibiotic Prophylaxis↗

PubMed1995

Urological training in Australasia: perceptions of recent fellows and current trainees.

In this study we sought to determine the opinions of recent Fellows and current trainees on the state of urological training in Australasia. Self administered questionnaires were mailed to all urologists in Australia and New Zealand who had obtained their FRACS from 1988 to the present, as well as all current advanced urological trainees. Eight-seven per cent of Fellows and ninety-four per cent of trainees completed and returned the questionnaire. Most Fellows and trainees felt that their training adequately equipped them for subsequent independent practice. At the completion of training and FRACS examination the majority of respondents felt competent in dealing with most urological conditions. However, many did not feel confident with paediatric and specialized or complex adult urology, particularly oncology and reconstruction. Post-Fellowship training, however, appears valuable in overcoming these deficiencies. Several limitations were also noted as a consequence of the fact that training is based entirely in the public hospital system. This created particular difficulties with respect to outpatient or 'office' urology as well as exposure to some non-acute conditions such as urinary incontinence and infertility. The current research requirements of training do not appear to provide trainees with an adequate knowledge of scientific method, with many respondents not feeling equipped to critically appraise urological literature. High levels of competence are also not attained for other important professional skills, particularly communication with other medical practitioners. Despite its importance for learning, feedback on progress is not adequately provided and this was seen as a major problem with current urological training in Australasia. The majority of respondents felt that mentors required specific training to facilitate feedback to trainees.

Adult↗

PubMed1999

Transduction of mechanical energy into sound energy in the cicada cyclochila australasiae

The anatomy of the paired tymbal muscles of Cyclochila australasiae was described. Force-distance relationships of the sound-producing in-out cycle of tymbal movement were measured. The largest forces were measured when the push occurred at the apodeme pit on the tymbal plate at angles similar to the angles of internal pull of the tymbal muscle. Initially, inward movement was opposed by the elasticity of the tymbal, which stored energy. At a mean force of 0. 38 N after a mean inward strain of 368 microm, the tymbal ribs buckled, the mean energy release being 45.1 microJ. The energy release occurred over 2-10 ms in three or four sound-producing steps as successive tymbal ribs buckled inwards. After the ribs had buckled, the force decreased to a mean value of 0.17 N. The force returned to zero during the outward movement, during which the tymbal ribs buckled outwards. The mean energy dissipated in the outward movement was 32.8 microJ. During contraction, the tymbal muscle produced mean values for the peak active force of 0.31 N over 295 microm, which gave mean values for the area of the work loops of 47.0 microJ. The calling song of C. australasiae had a mean pulse rate of 234 Hz (117 Hz for each side of the insect). The peak power to mean power ratio for the songs was 8.51:1 (+9.30 dB). Measurements of the sound field around tethered insects and of the peak power to mean power ratio of the songs gave values for the mean power of the song of 3.15-7 mW; these correspond to an energy per song pulse of 13.5-30 microJ. Previously reported mean values are 3. 15 mW for protest song and 5.1 mW for calling song. The efficiency of transduction of mechanical energy into sound energy is between 18 and 46 %.

Journal Article↗

PubMed1985

External quality assurance in hematology. The programme of the Royal College of Pathologists of Australasia.

The Royal College of Pathologists of Australasia introduced a comprehensive national external quality assurance programme (QAP) in hematology in 1979. This now provides regular monthly trials of full blood counting, supplemented by 3-monthly sets of samples for a large variety of other tests for "state of the art" studies, together with case slides for diagnosis for 294 participants. In addition educational supplements are provided, based on one or other aspect of each major quarterly trial. The frequency and variety of tests and analysis of participants' results conform to suggested standards for similar national schemes elsewhere in the world. There is evidence that the programme has helped raise the standards of hematopathology in Australasia and has identified areas which require improvement. It is envisaged that the scheme will satisfy the requirements of state legislation designed to accredit pathology laboratories. Future development should include a refinement of objective methods of scoring performance, especially in areas such as morphology where participants' results cannot readily be expressed numerically.

Asia↗

PubMed2006

The epidemiology of sepsis--is Australasia different?

Sepsis is a common reason for intensive care unit admission and a leading cause of mortality. Recent prospective randomised controlled trials have shown improved outcomes for patients with severe sepsis. Implementation of these findings into clinical practice has varied. Reasons appear complex but may include regional differences in the epidemiology of sepsis. To improve clinicians' understanding of sepsis, multiple epidemiological studies have been performed in the past 15 years. Differences in study populations and methodology make comparison difficult. After allowing for these differences, it is likely that the percentage of patients with severe sepsis in ICUs is less in Australasia than in many other developed nations. However, the population incidence, mortality, site and causative agent of infection are probably similar. This suggests that treatments and strategies whose efficacy has been demonstrated in other jurisdictions will also be effective in Australasia.

Australia↗

PubMed1987

Performance of quantitative urine analysis in Australasia critically assessed.

The standard of quantitative urine analysis in Australasia has been assessed over a three-year period (1984-1986) through a national interlaboratory quality-assurance program, conducted jointly by the Royal College of Pathologists of Australasia and the Australian Association of Clinical Biochemists. We investigated the precision and accuracy of individual methods and measurement systems routinely used in 14 urine assays. Assays of sodium, potassium, creatinine, glucose, and chloride were performed satisfactorily. Further improvement is required in assays of urinary osmolality, phosphate, and 5-hydroxyindoleacetic acid. Determinations of oxalate, urea, calcium, and 4-hydroxy-3-methoxymandelic acid are improving, but assays of protein and urate in urine present major problems for Australasian laboratories. In this program the sulfosalicylic acid turbidimetric method for urinary protein has consistently displayed poor precision plus a significant positive bias and should be abandoned. In contrast, the trichloroacetic acid-Ponceau S manual method has continued to perform well.

Australia↗

PubMed2004

Where are all the burn surgeons? A survey of plastic surgical trainees in Australasia.

There is a world shortage of burn surgeons. A questionnaire survey of all plastic surgical trainees in Australasia was conducted at a recent training event. 10/48 trainees would consider burns as a major subspecialty interest. A good experience of burn care whilst training seems to be important in influencing trainees consider it as a career choice. The perception of a career as a burn surgeon is poor, and requires some urgent attention.

Attitude of Health Personnel↗

PubMed2005

Management of infants with chronic lung disease of prematurity in Australasia.

Chronic lung disease is common in extremely preterm infants born in Australasia. In 2002, 53% of surviving infants born before 28 weeks' gestation remained either oxygen-dependent or on other respiratory support at 36 weeks' postmenstrual age. In the first weeks of life oxygenation should be kept generally "lower", although what is the most appropriate level remains uncertain. During the mid-phase of the neonatal course, functional oxygen saturation levels around 90-95% probably confer the best benefit/risk balance. The most appropriate target saturation range for infants on home oxygen also remains uncertain. Definitive data to guide clinical practice is lacking regarding the use of postnatal corticosteroids, bronchodilators, and diuretics for either the treatment or prevention of chronic lung disease. Home oxygen programmes are effective in avoiding prolonged hospitalisation for infants with chronic lung disease, but require the coordination of a large, multidisciplinary team.

Adrenal Cortex Hormones↗