The Current State of Neurosurgery in Somaliland.

Background: Surgical conditions account for as much as one third of the global burden of disease, yet 5 billion people worldwide do not have access to timely, affordable surgical care. These disparities in access to timely surgical care are most pronounced in low- and middle-income countries, where the availability of specialty surgical services such as neurosurgery are severely limited or completely absent. The African autonomous region of Somaliland, in the Horn of Africa, is one such region.

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

Background: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes.

Metered-dose inhaler ipratropium bromide in moderate acute asthma in children: A single-blinded randomised controlled trial.

Aim: To determine if the addition of ipratropium bromide (IB) by metered-dose inhaler in moderate acute asthma in children affects hospital admission rates when compared with inhaled salbutamol and oral prednisolone alone.

Methods: A prospective, single-blinded, randomised, controlled, equivalence trial in a tertiary paediatric emergency department. Patients aged 2-15 years with acute, moderate asthma were randomised to two groups, one receiving salbutamol, prednisolone and IB, the other receiving only salbutamol and prednisolone.

Human rhinovirus species C infection in young children with acute wheeze is associated with increased acute respiratory hospital admissions.

Rationale: Human rhinovirus species C (HRV-C) is the most common cause of acute wheezing exacerbations in young children presenting to hospital, but its impact on subsequent respiratory illnesses has not been defined.

Objectives: To determine whether acute wheezing exacerbations due to HRV-C are associated with increased hospital attendances due to acute respiratory illnesses (ARIs).

Methods: Clinical information and nasal samples were collected prospectively from 197 children less than 5 years of age, presenting to hospital with an acute wheezing episode.

The National Emergency Access Target (NEAT): can quality go with timeliness?

Objective: To report the experience of implementing a 4-hour-rule program.

Design, Setting And Participants: A 3-2013 whole-of-hospital clinical service redesign program in a tertiary paediatric hospital in Western Australia, involving all patients presenting to the emergency department (ED) from 1 January 2009 to 31 December 2011.

Main Outcome Measures: Percentage of patients admitted, discharged or transferred from the ED within 4 hours of arrival at triage, and percentage of patients discharged from inpatient wards before 10 am.

Brigham to the Bush: carrying the inspiration of Dr. Joseph E. Murray for humanitarian surgical care to the world's "bottom billion".

Dr. Joseph Murray has inspired me, among many others, to develop medical and surgical care through thoughtful research and to see that the benefits achieved are applied to human needs in a greater global perspective. In active encouragement of his protégées, he has stimulated innovation not only in academic centers and in specialty fields such as transplantation and craniofacial reconstruction, but also in wide-scale benefit to all peoples in need, passing hope along through transformational learning and indigenizing health care skills.

How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial.

Objective: For children with croup controversy remains over dosage and time to onset of action of oral steroids. The Cochrane Collaboration and other reviews have suggested 0.6 mg/kg dexamethasone be used (despite some evidence that 0.

Emergency department overcrowding, mortality and the 4-hour rule in Western Australia.

Objective: To assess whether emergency department (ED) overcrowding was reduced after the introduction of the 4-hour rule in Western Australia and whether any changes in overcrowding were associated with significant changes in patient mortality rates.

Design, Setting And Patients: Quasi-experimental intervention study using dependent pretest and post-test samples. Hospital and patient data were obtained for three tertiary hospitals and three secondary hospitals in Perth, WA, for 2007-08 to 2010-11.

Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine.

Background: The 2010 influenza vaccination program for children aged 6 months to 4 years in Western Australia (WA) was suspended following reports of severe febrile reactions, including febrile convulsions, following vaccination with trivalent inactivated influenza vaccine (TIV).

Methods: To investigate the association between severe febrile reactions and TIV, three studies were conducted: (i) rates of febrile convulsions within 72 h of receiving TIV in 2010 were estimated by vaccine formulation and batch; (ii) numbers of children presenting to hospital emergency departments with febrile convulsions from 2008 to 2010 were compared; and (iii) a retrospective cohort study of 360 children was conducted to compare the reactogenicity of available TIV formulations.

Findings: In 2010, an estimated maximum of 18,816 doses of TIV were administered and 63 febrile convulsions were recorded, giving an estimated rate of 3.

Symptomatic viral infection is associated with impaired response to treatment in children with acute asthma.

Objective: To examine the influence of viral respiratory infection (VRI) on treatment response in acute asthma in children.

Study Design: A total of 218 children (mean age, 6.6 years) with acute asthma were recruited.

Trivalent influenza vaccine and febrile adverse events in Australia, 2010: clinical features and potential mechanisms.

Introduction: Increased numbers of children presenting with febrile adverse events following trivalent influenza vaccine (TIV) were noted in Australia in 2010. We describe the epidemiology and clinical features of the adverse events and explore the biological basis for the adverse events using an in vitro model.

Materials And Methods: Children presenting to a tertiary paediatric hospital in 2010 with adverse events within 72 h of TIV were retrospectively reviewed.

Association between human rhinovirus C and severity of acute asthma in children.

A new and potentially more pathogenic group of human rhinovirus (HRV), group C (HRVC), has recently been discovered. We hypothesised that HRVC would be present in children with acute asthma and cause more severe attacks than other viruses or HRV groups. Children with acute asthma (n = 128; age 2-16 yrs) were recruited on presentation to an emergency department.

27 years of croup: an update highlighting the effectiveness of 0.15 mg/kg of dexamethasone.

Objective: To update an earlier observational study (1980-1995) documenting dramatic improvements in the management of croup with the mandatory use of a single oral dose of dexamethasone and to ascertain whether a reduction from a dose of 0.6 to 0.15 mg/kg in 1995 maintained these improved outcomes over the next 11 years.

Leukotriene pathway polymorphisms are associated with altered cysteinyl leukotriene production in children with acute asthma.

Cysteinyl leukotrienes (cysLTs) are pro-inflammatory mediators with increasing evidence for a role in childhood acute asthma. This study examined the influence of polymorphisms in cysLT pathway genes on urinary leukotriene E(4) (uLTE(4)) levels and clinical status in acute asthmatic children. Children aged 2-16 years were recruited during an asthma attack (n=205).

Anti-bacterial IgE in the antibody responses of house dust mite allergic children convalescent from asthma exacerbation.

Background: Atopic sensitization to the house dust mite (HDM) is associated with altered antibody responses to the nasopharyngeal colonizing bacterium Haemophilus influenzae and children admitted to the emergency department for asthma exacerbation have reduced IgG responses to HDM allergens.

Objective: To investigate anti-bacterial and anti-allergen antibody responses during convalescence from asthma exacerbation and differences found in exacerbations associated with and without viral infection.

Results: IgE antibodies to the P6 bacterial antigen increased in 60% of sera during convalescence and for many children achieved titres as high as IgE titres to allergens.

Beta2-adrenoceptor polymorphisms predict response to beta2-agonists in children with acute asthma.

The aim of this study was to determine the influence of single nucleotide polymorphisms in the beta(2)-adrenoceptor gene, on the response to inhaled beta(2)-agonists in children with acute asthma. We hypothesised that children with polymorphisms that generate enhanced receptor downregulation in vitro, Gly16 and Gln27, would have a slower response to beta(2)-agonist therapy during acute asthma. One hundred and forty-eight children with acute asthma were recruited and genotyped for beta(2)Arg16Gly and beta(2)Gln27Glu.

Tertiary pediatric emergency department admission rates fall as waiting times increase.

Objectives: To examine whether children in the same triage category presenting to a tertiary paediatric emergency department are more likely to be admitted to hospital if their wait is longer.

Methods: Retrospectively during a 7-year period, we determined the admission rate of children with lower acuity triage scores and compared 3 groups; those seen in their recommended triage time (group A), those seen under twice their recommended time (group B), and those seen in over twice their recommended time (group C).

Results: Patients in groups B and C were less likely to be admitted for both triage categories 3 and 4 compared with group A (P < 0.

Positive impact of increased number of emergency consultants.

The increased presence of consultant staff should theoretically lead to better outcomes in emergency departments (EDs). A retrospective observational study was conducted in a tertiary paediatric emergency department (PED) over a 10-year period documenting trends in percentage of children admitted, complaints to the department and average waiting times. Consultant numbers increased from 2.

Prednisolone versus dexamethasone in croup: a randomised equivalence trial.

Background: Croup remains a common respiratory problem presenting to emergency departments. A single oral treatment of oral dexamethasone results in improved outcome. Prednisolone has similar pharmacokinetic properties and has a significant advantage in that it is commercially available in liquid preparations.