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Royal North Shore Hospital (royal + north_shore_hospital)
Selected AbstractsThe Contribution of Foot Problems to Mobility Impairment and Falls in Community-Dwelling Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2001Hylton B. Menz B Pod (Hons) OBJECTIVES: To investigate the relationship between foot problems, balance, and functional ability in community-dwelling older people and to determine whether older people with a history of multiple falls exhibit greater foot impairment than those who have not fallen or who have fallen once only. DESIGN: A cross-sectional, retrospective study. SETTING: Falls and Balance Laboratory, Royal North Shore Hospital, Sydney, Australia. PARTICIPANTS: One hundred thirty-five community-dwelling men and women age 75 to 93 (mean age ± standard deviation, 79.8 ± 4.1). MEASURES: Foot problem score; postural sway; coordinated stability; stair ascent and descent; an alternate stepping test; timed 6-meter walk; and tests of vision, sensation, strength, and reaction time. RESULTS: Eighty-seven percent of the sample had at least one foot problem. Women had a significantly higher foot problem score than did men. The foot problem score was significantly associated with performance on the coordinated stability test, stair ascent and descent, alternate stepping test, and timed 6-meter walk. Multiple regression analyses revealed that the foot problem score was a significant independent predictor of performance in the coordinated stability test, stair ascent and descent, and the alternate stepping test. Subjects with a history of multiple falls had a significantly higher foot problem score than did those who had not fallen or who had fallen once only, but the prevalence of individual foot conditions or the presence of foot pain did not differ between these groups. CONCLUSIONS: Foot problems are common in older people and are associated with impaired balance and performance in functional tests. Furthermore, older people with a history of multiple falls have greater foot impairment than non- or once-only fallers. These findings provide further evidence that foot problems are a falls risk factor and suggest that the cumulative effect of multiple foot problems is more important in increasing falls risk than the presence or absence of individual foot conditions. [source] Age-Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center StudyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2008LAUREN D. VAZQUEZ M.S. Background: Common psychological adjustment difficulties have been identified for groups of implantable cardioverter defibrillator patients, such as those who are young (<50 years old), have been shocked, and are female. Specific aspects and concerns, such as fears of death or shock and body image concerns, that increase the chance of distress, have not been examined in different aged female implantable cardioverter defibrillator (ICD) recipients. The aim of the study was to investigate these areas of adjustment across three age groups of women from multiple centers. Methods: Eighty-eight female ICD patients were recruited at three medical centers: Shands Hospital at the University of Florida, Brigham and Women's Hospital in Boston, and Royal North Shore Hospital in Sydney, Australia. Women completed individual psychological assessment batteries, measuring the constructs of shock anxiety, death anxiety, and body image concerns. Medical record review was conducted for all patients regarding cardiac illnesses and ICD-specific data. Results: Multivariate and univariate analyses of variance revealed that younger women reported significantly higher rates of shock and death anxiety (Pillai's F = 3.053, P = 0.018, ,2p= 0.067) and significantly greater body image concerns (Pillai's F = 4.198, P = 0.018, ,2p= 0.090) than middle- and older-aged women. Conclusions: Women under the age of 50 appear to be at greater risk for the development of psychosocial distress associated with shock anxiety, death anxiety, and body image. Clinical-based strategies and interventions targeting these types of adjustment difficulties in younger women may allow for improved psychosocial and quality of life outcomes. [source] Paediatric trauma at an adult trauma centreANZ JOURNAL OF SURGERY, Issue 10 2005Andrew J. A. Holland Background: Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC). Methods: A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred. Results: A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks,15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1,75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury. Conclusions: The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC. [source] The value of laparoscopic skills coursesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009George CONDOUS Objectives: To evaluate the effectiveness of ,hands-on' laparoscopic skills course. Methods: A prospective observational study conducted between May 2005 and June 2006. All gynaecologists who attended ,hands-on' laparoscopic skills course held over a five-day period were assessed initially and at the end of the intensive course. Subjective assessment involved each attendee self-scoring their own knowledge in laparoscopy in different fields; this was done using visual analog scoring (VAS). Objective assessment was done through multiple choice questions (MCQs) and motor skill tasks. The difference between the performances of each of the candidates at pre- and post-course periods was evaluated using the Wilcoxon signed rank test. P -values < 0.05 represented statistical significance. Setting: Centre for Advanced Reproductive Endosurgery (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia. Results:, Twenty-four consecutive gynaecologists have been enrolled in the study , 14 were specialists and ten were obstetrics and gynaecology trainees. Mean age was 44.4 years (range 35,58 years). Pre- and post-course subjective assessment measuring VAS improved significantly for all variables. Objective measurements of pre- and post-course mean MCQ results also improved significantly from 71% to 84.5%, respectively (P -value < 0.0001). There was dramatic improvement in the performing of motor skills in the dry laboratory. Conclusions: Laparoscopic skills workshops can improve both knowledge base and motor skills. Such courses result in a short-term measurable improvement. Future studies should focus on assessing the impact of such ,hands-on' courses to see if these skills are transferred to the operating room. [source] | ||||||||||