HOSPEX in the antipodes.

The Australian Army recently adopted the British concept of hospital exercise (HOSPEX) as a means of evaluating the capabilities of its deployable NATO Role 2E hospital, the 2nd General Health Battalion. The Australian approach to HOSPEX differs from the original UK model. This article describes the reasons why the Australian Army needed to adopt the HOSPEX concept, how it was adapted to suit local circumstances and how the concept may evolve to meet the needs of the wider Australian Defence Force and our allies.

A bifunctional role for group IIA secreted phospholipase A2 in human rheumatoid fibroblast-like synoviocyte arachidonic acid metabolism.

Human group IIA-secreted phospholipase A(2) (sPLA(2)-IIA) is an important regulator of cytokine-mediated inflammatory responses in both in vitro and in vivo models of rheumatoid arthritis (RA). However, treatment of RA patients with sPLA(2)-IIA inhibitors shows only transient benefit. Using an activity-impaired sPLA(2)-IIA mutant protein (H48Q), we show that up-regulation of TNF-dependent PGE(2) production and cyclooxygenase-2 (COX-2) induction by exogenous sPLA(2)-IIA in RA fibroblast-like synoviocytes (FLSs) is independent of its enzyme function.

Open reduction and internal fixation for concomitant talar neck, talar body, and medial malleolar fractures: a case report.

Fractures of the talus are rare and generally associated with severe trauma. The mechanism of injury is usually forced dorsiflexion or a fall from a height. Severe talar fractures pose a challenge for surgeons as they are often associated with complications such as avascular necrosis, collapse, malunion, secondary osteoarthritis and pain.

Selection of patients for inpatient rehabilitation or direct home discharge following total joint replacement surgery: a comparison of health status and out-of-pocket expenditure of patients undergoing hip and knee arthroplasty for osteoarthritis.

Objectives: To analyse the differences in patient health outcomes and out-of-pocket costs following hip and knee joint replacement for osteoarthritis between patients who went home immediately after the acute care hospital stay and those who were admitted to inpatient rehabilitation care before going home.

Methods: One hundred and eighteen patients undergoing total hip or knee replacement in Sydney, Australia completed cost diaries, SF-36 and WOMAC Index, pre-operatively and for one year post-operatively.

Results: The health status of all groups improved significantly from before surgery to 12 months post-surgery.

Operation Sumatra Assist: surgery for survivors of the tsunami disaster in Indonesia.

The tsunami of 26 December 2004 was one of the deadliest natural disasters recorded, with the Indonesian province of Aceh being the most devastated region. As part of the Australian Government's response to the disaster, the Australian Defence Force deployed personnel from the Sydney-based 1st Health Support Battalion to Banda Aceh, the capital of the province. This unit joined with medical personnel from the New Zealand Defence Force to form the ANZAC field hospital.

A single-centre prospective study of clinical and haemostatic risk factors for venous thromboembolism following lower limb arthroplasty.

Previous studies report conflicting results concerning the potential significance of thrombophilic genotypes in postarthroplasty venous thromboembolism (VTE). This study assessed thrombophilic genotypes, haemostatic and clinical variables as independent risk factors for VTE postarthroplasty. A total number of 569 patients undergoing elective lower limb arthroplasty at a single centre were prospectively studied.

Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA.

Aims: This study aims to address medical and non-medical direct costs and health outcomes of bilateral and unilateral total knee replacement from the patients' perspective during the first year post-surgery.

Methods: Osteoarthritis patients undergoing primary unilateral total knee or bilateral total knee replacement (TKR) surgery at three Sydney hospitals were eligible. Patients completed questionnaires pre-operatively to record expenses during the previous three months and health status immediately prior to surgery.

Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients.

Background: The treatment of open fractures of the tibial shaft is often complicated by delayed union and nonunion. The objective of this study was to evaluate the safety and efficacy of the use of recombinant human bone morphogenetic protein-2 (rhBMP-2; dibotermin alfa) to accelerate healing of open tibial shaft fractures and to reduce the need for secondary intervention.

Methods: In a prospective, randomized, controlled, single-blind study, 450 patients with an open tibial fracture were randomized to receive either the standard of care (intramedullary nail fixation and routine soft-tissue management [the control group]), the standard of care and an implant containing 0.

Living with rheumatoid arthritis: expenditures, health status, and social impact on patients.

Objective: To determine costs related to living with rheumatoid arthritis (RA), and to identify the association between health status-as measured by the Health Status Questionnaire short form-36 (SF-36) and the disease specific index Health Assessment Questionnaire (HAQ)-and the social impact of RA.

Methods: A prospective cohort study was carried out on 81 patients with RA who completed four consecutive three month cost diaries. The SF-36, HAQ, and social impact at baseline and one year follow up were also assessed.

Cost of joint replacement surgery for osteoarthritis: the patients' perspective.

Objective: To address costs of total joint replacement surgery from the patients' perspective by determining patient out-of-pocket costs during the first year following joint replacement, and to explore whether health status presurgery or in the immediate 3 months postsurgery were determinants of costs. In light of the different outcomes experienced by patients with total knee replacement (TKR) and total hip replacement (THR), any differences in costs between the 2 groups were also explored.

Methods: Patients with osteoarthritis (OA) scheduled for primary unilateral TKR or THR surgery at 3 Sydney hospitals were approached.

Independent influences of central fat and skeletal muscle lipids on insulin sensitivity.

Objective: Insulin resistance is closely associated with two disparate aspects of lipid storage: the intracellular lipid content of skeletal muscle and the magnitude of central adipose beds. Our aim was to determine their relative contribution to impaired insulin action.

Research Methods And Procedures: Eighteen older (56 to 75 years of age) men were studied before elective knee surgery.

A molecular view of coping behavior in older adults.

Objectives: The purpose of this study was to assess age, gender, ethnicity, and education differences in specific ("molecular") coping behaviors for three older adult age groups.

Methods: Thirty-five specific coping reactions were assessed on the item level for 74 sexagenarians, 70 octogenarians, and 116 centenarians of the Georgia Centenarian Study.

Results: A multivariate analysis of covariance revealed significant age group, gender, and education differences for 14 coping reactions.

A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery.

Objective: The aims of this study were to assess changes in physical function and quality of life with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the instrument of the Medical Outcomes Study SF-36 Health Survey (MOS SF-36), respectively, in patients undergoing hip anf knee joint replacement surgery and to compare the responsiveness of these two outcome measures 1 year after surgery.

Design: One hundred and ninety-four patients with osteoarthritis (OA knee 108, OA hip 86) admitted to four hospitals in Sydney were followed over a period of 1 year at 3 monthly intervals.

Results: WOMAC measures improved significantly after 1 year for OA hip and OA knee: there was reduction in pain of 71% and 53%, reduction of stiffness of 55% and 43% and improvement in physical function of 68% and 43%, respectively.

Determinants of willingness to pay for hip and knee joint replacement surgery for osteoarthritis.

Objectives: To determine whether patients with osteoarthritis (OA) would be willing to pay for joint replacement and whether patient characteristics or health outcomes, including pain, physical function and health-related quality of life, were related to willingness to pay (WTP).

Methods: Patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) for OA completed a disease-specific questionnaire (Western Ontario and McMaster: WOMAC index), a generic measure of health status (Medical Outcome Study Short Form-36: SF-36) and an Evaluation Questionnaire to measure WTP and satisfaction with the replacement.

Results: Responses were obtained from 109 (77%) THR patients and 129 (72%) TKR patients.

Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms.

Objective: To compare the health-related quality of life of people with osteoarthritis before and after primary total hip and knee replacement surgery with that of the general Australian population.

Design: A prospective cohort study.

Setting: Three Sydney hospitals, public and private.

Religiosity and adaptation in the oldest-old.

Previous research has yielded mixed results with respect to the relationship between religiosity and adaptation in older adults. Most studies show that religiosity is stable over the life span, but that religiosity may or may not be related to such factors as physical and mental health, life satisfaction, and coping. This study adds to earlier investigations by including centenarians among the sample.

Stress fractures: clinical features and investigation.

In the period 1972 to 1989, 92 sports men and women were treated for stress fracture. Symptoms included localized bony pain aggravated by activity. Physical examination demonstrated point tenderness and pain on loading the bone.

Osteochondritis dissecans of the femoral condyles.

Because the results of treatment of osteochondritis dissecans of the femoral condyles are still not consistently satisfactory, we reviewed the cases of eighty-three patients (ninety-five knees) with osteochondritis dissecans who were followed for two to thirty-one years to identify factors that may influence treatment and long-term prognosis. Of the eighty-three patients, sixteen had only non-surgical treatment, sixty-five had only surgical treatment, and two had non-surgical treatment of one knee and surgical treatment of the other. Of the twenty-two knees (eighteen patients) that were treated non-surgically, fifteen were treated before and seven were treated after distal femoral epiphyseal closure.

Lack of effect of thymectomy on spontaneous recovery from tolerance to levan.

Adult CBA mice were made tolerant with 1 mg levan and tested subsequently for sponteneous recovery by plaque-forming cell assay in response to immunizing challenge. Weakening of tolerance was first detectable only after 100 days, while return to full normal responsiveness required 400 days. Thymectomy 2 weeks prior to tolerization neither retarded nor diminished the recovery process.

Influence of molecular structure of the tolerogenicity of bacterial dextrans. III. Dissociation between tolerance and immunity to the alpha1--6- and alpha1--3-linked epitopes of dextran B1355.

Dextran B1355 induces a direct PFC response detectable with dextran B512-sensitized red cells which is directed towards an alpha1--6-linked glucose epitope. This response is distinguishable from the alpha1--3-linked specificity assayed by homologous sensitization in that: (a) it is totally suppressed in donors previously rendered tolerant of B512; (b) the PFC are sensitive to inhibition by B512 and isomaltohexaose. The alpha1--6 epitope of B1355 is less immunogenic in BALB/c mice than that with alpha1--3 linkage, inducing a lower amplitude of response and requiring a 100-fold greater minimal dose, while conversely, it is the more effective tolerogen.