Progressive multifocal leukoencephalopathy with gastrointestinal disease in a pediatric kidney transplant recipient.

PML is a demyelinating disease of the central nervous system caused by infection with JCV. Several cases of PML in bone marrow and solid organ transplant recipients have been reported in recent years. JCV has been isolated from the gastrointestinal mucosa of immunocompromised patients, but there are no published reports of PML associated with symptomatic gastrointestinal involvement in kidney transplant recipients.

Data quality of the Australia and New Zealand Dialysis and Transplant Registry: a pilot audit.

Aim: Most clinical registries in Australia, including the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), do not audit submitted data. Inaccurate data can bias registry analysis. This study aimed to audit data submitted to ANZDATA from a single region.

Macroscopic haematuria--a urological approach.

Background: Haematuria is a common symptom with a multitude of differentials. It can often be a diagnostic dilemma.

Objective: This article looks at the role of the general practitioner in the investigation and initial management of macroscopic haematuria.

A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients--the HEALTHY-CATH trial.

Background: Tunnelled central venous dialysis catheter use is significantly limited by the occurrence of catheter-related infections. This randomised controlled trial assessed the efficacy of a 48 hour 70% ethanol lock vs heparin locks in prolonging the time to the first episode of catheter related blood stream infection (CRBSI).

Methods: Patients undergoing haemodialysis (HD) via a tunnelled catheter were randomised 1:1 to once per week ethanol locks (with two heparin locks between other dialysis sessions) vs thrice per week heparin locks.

Bringing top-end endoscopy to regional australia: hurdles and benefits.

This paper focuses on recent experience in setting up an endoscopy unit in a large regional hospital. The mix of endoscopy in three smaller hospitals, draining into the large hospital endoscopy unit, has enabled the authors to comment on practical and achievable steps towards creating best practice endoscopy in the regional setting. The challenges of using what is available from an infrastructural equipment and personnel setting are discussed.

The race for mainstream gastrointestinal endoscopy: frontrunners.

In recent years, gastrointestinal endoscopy has evolved and branched out from a primary naked-eye diagnostic technique to a multitude of sophisticated investigative and therapeutic procedures. While many of the new endoscopic techniques are currently too complex or expensive to make it to mainstream clinical practice, others are already bringing major progress to the management of digestive diseases. In this review we will discuss a selected group of the emerging techniques and technologies used to increase the diagnostic yield in the colon and small intestine, including Third Eye® Retroscopes®, colon capsule endoscopy, spiral enteroscopy and confocal laser endomicroscopy.

Coccidioidomycosis in returned Australian travellers.

Coccidioidomycosis is a fungal infection caused by Coccidioides species. The disease has wide clinical presentation and a distinct geographical distribution. We describe two cases of coccidioidomycosis in returned Australian travellers who presented to Nambour Hospital.

Creating a culture of safety by coaching clinicians to competence.

Contemporary discussions of nursing knowledge, skill, patient safety and the associated ongoing education are usually combined with the term competence. Ensuring patient safety is considered a fundamental tenet of clinical competence together with the ability to problem solve, think critically and anticipate variables which may impact on patient care outcomes. Nurses are ideally positioned to identify, analyse and act on deteriorating patients, near-misses and potential adverse events.

A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

Introduction: Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported.

Atypical fractures associated with bisphosphonate use post-renal transplantation.

Bone disease is a major cause of morbidity post renal transplantation. The authors present a case of adynamic bone disease and atypical fractures associated with the use of bisphosphonates following renal transplantation. The uncertain role of parathyroidectomy and bone mineral density scans is also reviewed.

A theoretically informed education program designed specifically for acute surgical nurses.

Aim: The aim of the research was to evaluate the effectiveness of implementing the Respiratory Skills Update (ReSKU) education program using integrated teaching and learning strategies, in the context of organisational utility, on improving surgical nurses' practice in the area of respiratory assessment.

Background: Technological advances and changes in healthcare delivery have necessitated that nurse educators adopt innovative teaching and learning strategies to better prepare acute care nurses for their increasingly complex roles. This 2007 study used a robust overarching theoretical framework to develop and evaluate an educational model using the ReSKU program as a basis for the content.

Dialysis in public and private hospitals in Queensland.

Background: Clinical outcomes for patients treated in public and private hospitals may be different.

Aim: The aim of the study was to compare the characteristics and outcomes of patients receiving dialysis at public and private hospitals in Queensland.

Methods: Incident adult dialysis patients in Queensland registered with the Australia and New Zealand Dialysis and Transplant Registry between 1999 and 2009 were classified by dialysis modality at either a public or private hospital.

Dual pathology of corticobasal degeneration and Parkinson's disease in a patient with clinical features of progressive supranuclear palsy.

Corticobasal degeneration and Parkinson's disease are pathologically distinct disorders with unique histological and biochemical features of a tauopathy and a-synucleinopathy respectively. We report the first case of co-occurrence of these pathologies in the same patient. Convergence of such distinctly separate neuropathology in the same brain highlights the need for extensive brain banking and further research in supporting the hypothesis that tauopathies and a-synucleinopathies might share common pathogenic mechanisms.

Acute dapsone overdose: the effects of continuous veno-venous haemofiltration on the elimination of dapsone.

A 15-year-old girl presented after intentional ingestion of dapsone (7.2 g) and small quantities of azathioprine, methotrexate and prednisolone. The resulting methaemoglobinaemia and lactic acidosis persisted despite treatment with methylene blue, multiple-dose activated charcoal and ascorbic acid.

Renal replacement therapy in rural and urban Australia.

Background: Australians living in rural regions have poorer health outcomes than city residents. This study compares rural and city patient access to and outcomes of renal replacement therapy (RRT) in Australia.

Methods: Non-indigenous Australians aged ≥16 years who commenced dialysis or underwent renal transplantation between 1996 and 2009 and were registered with the Australia and New Zealand Dialysis and Transplant Registry were included.

Premature labour precipitated by highly active antiretroviral therapy: an adverse reaction in a newly diagnosed HIV-positive patient.

A pregnant woman was diagnosed with HIV infection at 29 weeks' gestation. Antiretroviral therapy (ART) of lopinavir-ritonavir and zidovudine-lamivudine was initiated. Ten days later, a hypersensitivity reaction occurred, followed by preterm delivery of the infant 3 days later at 30 weeks' gestation.

Impact of non-traditional phosphate binders and cinacalcet on haemodialysis patient biochemistry, pill burden and cost.

Aim: The Australian Pharmaceutical Benefits Scheme (PBS) commenced cost subsidization for haemodialysis patients of sevelamer in December 2007, cinacalcet in July 2008 and lanthanum in May 2009. To determine the impact of PBS listing of these medications, we performed a single centre cross-sectional, longitudinal study.

Methods: Dialysis parameters and biochemistry were prospectively collected at 6 monthly intervals for all prevalent haemodialysis patients from October 2007 to April 2010.

Clinical utility of the four-quadrant model of facilitated learning: perspectives of experienced occupational therapists.

Background/aims: This study explored perspectives of experienced occupational therapists regarding teaching-learning approaches used during intervention. The aim was to ascertain the clinical utility of the Four-Quadrant Model of Facilitated Learning (4QM) (Greber, Ziviani, & Rodger, 2007a) by understanding how it might enhance clinical competency when applying teaching-learning modalities.

Methods:   Mixed methods were used to ascertain the perspectives of two groups of therapists with seven or more years experience in either adult (n=8) or paediatric (n=7) practice.

Management of pre-labour rupture of membranes at term - a survey of current practice in Australia.

Background: Women with pre-labour rupture of membranes at term (Term-PROM) commonly choose to have early induction of labour with the use of oxytocin. Although there is evidence of efficacy and safety of induction by the use of prostaglandin, it is used infrequently in Australia.

Aims: To identify current practice and views of obstetricians in Australia, on Term-PROM.

Phaeochromocytoma-associated critical peripheral ischaemia.

Limb Ischaemia is an exceptional complication of catecholamine toxicity caused by a phaeochromocytoma. We present a middle-aged female patient with severe subacute peripheral ishaemia, gangrene and eventual amputation of all four distal limbs due to a large non-metastatic left adrenal gland phaeochromocytoma and summarise the available literature concerning previously reported cases.

Atypical antipsychotic-induced diabetes mellitus: an update on epidemiology and postulated mechanisms.

Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome are rare, but potentially fatal complications of antipsychotic-associated hyperglycaemia. The mechanisms for this remain unclear, but are probably multifactorial. The suggested reasons include drug-induced weight gain and adiposity, development of the metabolic syndrome, antagonism of serotonin (5-hydroxytryptamine) receptors, drug-induced leptin resistance, dyslipidaemia mediated pancreatic beta-cell damage and hepatocyte transcription factor dysregulation.

Clinical outcomes of Queensland children with cystic fibrosis: a comparison between tertiary centre and outreach services.

Objective: To evaluate and compare the clinical outcomes of children with cystic fibrosis (CF) managed primarily at a tertiary cystic fibrosis centre (CFC) with those treated at regional centres by local health care professionals and the cystic fibrosis outreach service (CFOS).

Design, Setting And Patients: Retrospective study of 273 children with CF born between 19 October 1982 and 19 February 2002 and with clinical data available between 1 January 2000 and 31 December 2002. Patients were grouped into CFC (n = 131) or CFOS (n = 142), with CFOS then further categorised into three groups depending on the level of care they received.

The impact of surgical ward nurses practising respiratory assessment on positive patient outcomes.

Objective: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes.

Primary Argument: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially.

[Knee osteotomy versus unicompartmental knee replacement in the treatment of unicompartmental knee arthritis].

Unicompartmental arthritis of the knee is defined as a condition characterized by degenerative articular cartilage in the medial or lateral aspect of the tibiofemoral joint, which may be associated with meniscal disruption, ligamentous instability, and malalignment. The treatment of unicompartmental arthritis of the knee remains a challenge to the orthopaedic surgeon. When non-operative procedures and arthroscopic debridement fail the surgical treatment consist of one of three options: realignment osteotomy, unicompartmental knee replacement or total knee replacement.