Now showing 1 - 10 of 14
  • Publication
    Journal Article
    Dental extraction in a child with chronic idiopathic thrombocytopenia purpura: are preoperative platelet transfusions necessary?
    (2013-10)
    Tay, Stanley
    ;
    ;
    Thresholds for platelet counts in patients at risk for bleeding are often used before surgery. We present a case report of a 13-year-old female with chronic idiopathic thrombocytopenia purpura for dental extraction with a platelet count of 4 × 10 L. Usually, therapies including platelet infusions, IV immunoglobulin, or corticosteroids would be used to increase platelet numbers. In this patient, rather than using any of these prophylactic therapies preoperatively, we used a "watchful waiting" strategy with a multidisciplinary team, the use of tranexamic acid and the aforementioned therapies available only as "rescue" agents.
      1036
  • Publication
    Journal Article
    Joining the world response to the Nepal disaster
    (2015-06-01)
    At this early stage there were estimated to be up to 200 patients with spinal cord injury and up to 1000 with complex orthopaedic injuries."
      434
  • Publication
    Journal Article
    Do combined upper airway cultures identify lower airway infections in children with chronic cough?
    (2019-04-21)
    Hare, Kim M
    ;
    Chang, Anne B
    ;
    Smith-Vaughan, Heidi C
    ;
    Bauert, Paul A
    ;
    ;
    Beissbarth, Jemima
    ;
    Grimwood, Keith
    Obtaining lower airway specimens is important for guiding therapy in chronic lung infection but is difficult in young children unable to expectorate. While culture-based studies have assessed the diagnostic accuracy of nasopharyngeal or oropharyngeal specimens for identifying lower airway infection, none have used both together. We compared respiratory bacterial pathogens cultured from nasopharyngeal and oropharyngeal swabs with bronchoalveolar lavage (BAL) cultures as the "gold standard" to better inform the diagnosis of lower airway infection in children with chronic wet cough. Nasopharyngeal and oropharyngeal swabs and BAL fluid specimens were collected concurrently from consecutive children undergoing flexible bronchoscopy for chronic cough and cultured for bacterial pathogens. In cultures from 309 children (median age, 2.3 years) with chronic endobronchial suppuration, all main pathogens detected (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) were more prevalent in nasopharyngeal than oropharyngeal swabs (37%, 34%, and 23% vs 21%, 6.2%, and 3.2%, respectively). Positive and negative predictive values for lower airway infection by any of these three pathogens were 63% (95% confidence interval [95% CI] 55, 70) and 85% (95% CI, 78, 91) for nasopharyngeal swabs, 65% (95% CI, 54, 75), and 66% (95% CI, 59, 72) for oropharyngeal swabs, and 61% (95% CI, 54,68), and 88% (95% CI, 81, 93) for both swabs, respectively. Neither nasopharyngeal nor oropharyngeal swabs, alone or in combination, reliably predicted lower airway infection in children with chronic wet cough. Although upper airway specimens may be useful for bacterial carriage studies and monitoring antimicrobial resistance, their clinical utility in pediatric chronic lung disorders of endobronchial suppuration is limited.
      1156
  • Publication
    Journal Article
    Barriers to effective perioperative communication in indigenous Australians: an audit of progress since 1996.
    (2004-08)
    Cheng, W Y C
    ;
    Blum, P
    ;
    This prospective study was designed to elucidate barriers limiting effective perioperative communication between indigenous Australians and anaesthetists, and to identify strategies for improving communication. A questionnaire was used to collect data on 1040 consecutive patients undergoing anaesthesia at Royal Darwin Hospital between February and March 2003. 27.1% of these patients described themselves as Aboriginal. Aboriginal patients were more likely to undergo emergency surgery and were more likely to be classified as ASA 3, 4 or 5 than non-indigenous patients. Communication difficulties were identified in 28.7% of all Aboriginal patients, which was 31 times higher than those in non-Aboriginal patients. The most common reason identified for this was difficulty in speaking English. Only 17.7% of Aboriginal patients presenting to the operating theatre spoke English as their first language. Unfortunately, the anaesthetic team utilized the Aboriginal interpreter service in only a minority of cases. Communication difficulty in indigenous Australians is pervasive and often goes unrecognized. The results suggest that heath care providers may need staff training in cross-cultural communication and that protocols need to be developed within the health care system so that interpreters are called upon automatically early in the admission process.
      1240
  • Publication
    Journal Article
    The Bali bombing: the Royal Darwin Hospital response.
    (2003-10-06) ; ;
    Fisher DA
    ;
    ;
    Read DJ
    ;
    Notaras L
    After the Bali bombing on 12 October 2002, injured Australians were evacuated to Darwin. The first patients arrived at the Royal Darwin Hospital (RDH) 26 hours after the blasts. RDH assessed and resuscitated 61 patients (including 20 intensive care patients, with 15 requiring ventilation, 19 surgery and more than 20 escharotomies). RDH evacuated 48 patients to burns centres around Australia within 36 hours of the first patient arrivals at the hospital and 62 hours after the bomb blasts. The response was successful, but improvements are needed in coordination between the different groups involved in such operations.
      1205
  • Publication
    Journal Article
    Telemedicine in the Northern Territory: an assessment of patient perceptions in the preoperative anaesthetic clinic.
    (2015-06)
    Roberts, Simon
    ;
    ;
    Hicks, Chelsea
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    London, James
    ;
    Tay, Stanley
    We investigated patient perceptions of a virtual preoperative anaesthesia evaluation clinic linking Royal Darwin Hospital to Katherine Hospital. Descriptive study, cross-sectional survey. Regional and rural areas of Northern Territory, Australia. Sample includes 27 respondents, five Indigenous, 18 non-Indigenous and four unknown. Introduction of a preoperative anaesthesia evaluation clinic. We designed a 10-item, 5-point Likert scale questionnaire assessing patient perceptions in four domains: (i) technical quality; (ii) perceived efficacy; (iii) affective patient experience; and (iv) patient preference. Qualitative responses are also reported. Twenty-seven out of 35 patients (77%) completed the questionnaire. Ninety-eight per cent were in positive agreement on technical quality with a mean score of 1.35 (SD: 0.53); Ninety-five per cent on perceived efficacy, 1.35 (SD: 0.65); Eighty-four per cent in negative agreement on affective patient experience (negative perception item), 4.19 (SD: 1.07); Eighty-one per cent in negative agreement on patient preference (negative perception item), 4.23 (SD: 1.14). There were no significant differences in the answers between Indigenous (five patients) and non-Indigenous patients (18 patients). Our study confirms the acceptability of telemedicine in the remote assessment of preoperative patients in the Northern Territory, with positive perceptions in all four domains.
      1944
  • Publication
    Journal Article
    Remembering a day of terror and triumph: 10 years on from the Bali bombing
    (2012-09-01)
    October 13, 2002 dawned as another balmy, tropical Sunday in Darwin. The inaugural Northern Territory Anaesthesia Continuing Medical Education (CME) meeting was under way and we'd recovered from dinner the previous night.
      401
  • Publication
    Journal Article
    Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia's Northern Territory.
    (2017-11-15) ;
    Lowell A
    ;
    Murphy J
    ;
    Dias T
    ;
    Butler D
    ;
    ; ; ;
    Bauert B
    ;
    Salter C
    ;
    Tune K
    ;
    Cass A
    In Australia's Northern Territory, most Aboriginal people primarily speak an Aboriginal language. Poor communication between healthcare providers and Aboriginal people results in adverse outcomes including death. This study aimed to identify remediable barriers to utilisation of Aboriginal Interpreter services at the Northern Territory's tertiary hospital, which currently manages over 25,000 Aboriginal inpatients annually. This is a multi-method study using key stakeholder discussions, medical file audit, bookings data from the Aboriginal Interpreter Service 2000-2015 and an online cross-sectional staff survey. The Donabedian framework was used to categorise findings into structure, process and outcome. Six key stakeholder meetings each with approximately 15 participants were conducted. A key structural barrier identified was lack of onsite interpreters. Interpreter bookings data revealed that only 7603 requests were made during the 15-year period, with completion of requests decreasing from 337/362 (93.1%) in 2003-4 to 649/831 (78.1%) in 2014-15 (p < 0.001). Non-completion was more common for minority languages (p < 0.001). Medical files of 103 Aboriginal inpatients were audited. Language was documented for 13/103 (12.6%). Up to 60/103 (58.3%) spoke an Aboriginal language primarily. Of 422 staff who participated in the survey, 18.0% had not received 'cultural competency' training; of those who did, 58/222 (26.2%) indicated it was insufficient. The Aboriginal Interpreter Service effectiveness was reported to be good by 209/368 (56.8%), but only 101/367 (27.5%) found it timely. Key process barriers identified by staff included booking complexities, time constraints, inadequate delivery of tools and training, and greater convenience of unofficial interpreters. We identified multiple structural and process barriers resulting in the outcomes of poor language documentation and low rates of interpreter bookings. Findings are now informing interventions to improve communication.
      1326
  • Publication
    Journal Article
    Comparison of First Nations and non-First Nations children's profiles with bronchiectasis over two five-year periods from the Northern Territory, Australia.
    (2021-05-05)
    McCallum, Gabrielle B
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    Oguoma, Victor M
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    Versteegh, Lesley A
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    Wilson, Cate A
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    Bauert, Paul
    ;
    ;
    Chang, Anne B
    BACKGROUND: Although the burden of bronchiectasis is globally recognised, there is limited paediatric data particularly on trends over the years. There is also no published data on whether vitamin D deficiency/insufficiency and human T-cell lymphotropic virus type 1 (HTLV-1) infection, both found to relate with severe bronchiectasis in First Nations adults, is also important in children with bronchiectasis. RESEARCH QUESTION: Among children with bronchiectasis, has (a) the clinical and bronchoalveolar lavage (BAL) profiles changed between two 5-year periods (period-1=2007-11, period-2=2012-16); and (b) is vitamin D deficiency/insufficiency and/or HTLV-1 infection associated with radiological severity of bronchiectasis? STUDY DESIGN AND METHODS: We analysed the data from children with bronchiectasis prospectively enrolled at Royal Darwin Hospital, Australia at their first diagnosis i.e. no child was in both time-periods. Data collected include demographics, BAL, bloods and computed tomography chest scan evaluated using the Bhalla and modified Bhalla scores. RESULTS: The median age of the 299 children was 2.2 years (interquartile range 1.5-3.7), 168 (56%) males and most were First Nations (92%). Overall, bronchiectasis was high over time, particularly among First Nations children. In the later period, numbers of non-First Nations more than tripled, but did not reach statistical significance. In period-2 compared to period-1, fewer First Nations children had chronic cough (period-1=61%, period-2=47%, p=0.03), were younger, less likely to have received azithromycin (period-1=42%, period-2=21%, p<0.001) and their BAL had lower Haemophilus influenzae and Moraxella catarrhalis infection. HTLV-1 was not detected and vitamin D deficiency/insufficiency did not correlate with severity of bronchiectasis. INTERPRETATION: Bronchiectasis remains high particularly among First Nations children. Important changes that arguably reflect improvements were present, but overall, profiles remained similar. Although Vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 was non-existent and is unlikely to play any role in First Nations children with bronchiectasis.
      938
  • Publication
    Journal Article
    Clonidine for pain-related distress in Aboriginal children on a penicillin regimen to prevent recurrence of rheumatic fever.
    (2020-11)
    Mitchell, Alice
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    Kelly, John
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    Cook, Jeff
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    Atkinson, Natalie
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    ;
    Remenyi, Bo
    ;
    Wade, Vicki
    ;
    CONTEXT: Indigenous children and adolescents in Australia and globally bear the burden of acute rheumatic fever (ARF). It has been virtually eliminated in well-resourced, developed settings. ARF is an autoimmune response to infection with group A Streptococcus. The mainstay of management is long-acting intramuscular penicillin injections to prevent recurrence of ARF and development of rheumatic heart disease (RHD), comprising valvular pathology and attendant complications. In Australia, penicillin injections are currently prescribed every 28 days for 5-10 years after diagnosis of ARF, depending on cardiac involvement. Adherence to this regimen reduces ARF recurrences and RHD progression. 'Days at risk' of ARF recurrence are calculated as the number of days after day 28 that an injection is not received. Adherence to the injection schedule has been reported as difficult in most global locations due to the painful nature of the injections, the long timeframes of the prescription, young age of patients, access problems and costs in some locations. The newly updated Australian guideline on the prevention, diagnosis and management of ARF and RHD has a chapter dedicated to secondary prophylaxis. This chapter takes into account cultural considerations and advises on ways to minimise pain and distress of injections in children such as pain gate strategies, distraction techniques and concurrent injection of local anaesthetic. ISSUES: Some children continue to find the injection regimen traumatising despite strategies to reduce pain and fear. Clinicians providing the injections to children also find the injecting episodes distressing if pain is not effectively minimised. An Aboriginal Community Controlled Health Service in a remote setting in northern Australia addressed the issue of severe trauma of injection episodes experienced by an Aboriginal boy aged 7 years. Usual strategies were not effective, so advice was sought from an expert anaesthetist at a tertiary hospital. As a result, oral clonidine 3 µg/kg was trialled 45 minutes prior to the penicillin injection. Procedural coaching and monitoring protocols specific to administration of clonidine in children under their care were created by the health service. The initial dose of clonidine was delivered with the child as an inpatient. LESSONS LEARNED: Clonidine was successful in reducing pain related distress and facilitating adherence to the penicillin regimen. Subsequent doses were delivered and monitored in a remote setting by nurses. After 18 months, the boy no longer required clonidine due to his increased coping capacity. A second child was recognised with similar trauma and has been taking clonidine for pre-procedural sedation for 6 months with good effect and no adverse effects. An additional child was similarly prescribed clonidine without success. Failure in that instance was attributed to lack of procedural coaching and receiving the initial dose of clonidine in an emergency department in hurried circumstances. Individualised child-focused and culturally appropriate care in remote settings is feasible: in this instance team planning for use of clonidine and procedural coaching when other measures have failed. However, for children with RHD, or other comorbidities, advice from the child's treating cardiologist is required prior to prescribing clonidine due to possible adverse consequences. These include hypotension and atrioventricular block, which could lead to haemodynamic compromise in the setting of moderate to severe RHD.
      1045