Gary Browne - Academia.edu (original) (raw)

Papers by Gary Browne

British Journal of Sports Medicine, 2006

The Medical journal of Australia, Jan 21, 2008

Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in Januar... more Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in January 2007. Four received basic life support (BLS) within 5 minutes of immersion and survived with good functional neurological outcomes. The other four were not discovered for >or= 5 minutes and all died. This cluster serves as a reminder that timely effective bystander BLS is crucial to survival and good clinical outcomes in near-drowning episodes.

The Canadian journal of urology, 1999

In 1998, we conducted the first national survey of urology residents to evaluate Canadian trainin... more In 1998, we conducted the first national survey of urology residents to evaluate Canadian training programs and other aspects related to the future practice of urology. The survey, a 7-page questionnaire, examined the educational learning needs of the trainees. Of 70 residents surveyed, 41 responded (response rate 60%). Topic areas in which the respondents felt comfortable included uro-oncology, and surgery of the prostate, kidney, and bladder. They were less comfortable with management of incontinence and infertility. In-training evaluation was thought to be an important activity that was well done by the training programs. A large majority (81%) expressed interest in elective rotations which they indicated should last 3 to 4 months. They suggested that research rotations be available, but not mandatory. There was strong support for the concept of a national examination preparation course. Almost half of the respondents indicated that American board examinations in urology were imp...

The Canadian journal of urology, 1999

In 1998, we conducted the first national survey of urology residents to evaluate Canadian trainin... more In 1998, we conducted the first national survey of urology residents to evaluate Canadian training programs and other aspects related to the future practice of urology. The survey, a 7-page questionnaire, examined the educational learning needs of the trainees. Of 70 residents surveyed, 41 responded (response rate 60%). Topic areas in which the respondents felt comfortable included uro-oncology, and surgery of the prostate, kidney, and bladder. They were less comfortable with management of incontinence and infertility. In-training evaluation was thought to be an important activity that was well done by the training programs. A large majority (81%) expressed interest in elective rotations which they indicated should last 3 to 4 months. They suggested that research rotations be available, but not mandatory. There was strong support for the concept of a national examination preparation course. Almost half of the respondents indicated that American board examinations in urology were imp...

The Medical journal of Australia, Jan 7, 2008

A 2-year-old boy and a 10-year-old girl presented to the emergency department with a decreased le... more A 2-year-old boy and a 10-year-old girl presented to the emergency department with a decreased level of consciousness. The girl had had persistent vomiting and a seizure. Urine metabolic screening tests were positive for gamma-hydroxybutyrate (GHB). Samples from toy beads ingested by both children contained 1,4-butanediol, which is metabolised to GHB in humans. Regulatory authorities were notified, leading to an international recall of the toy beads.

The Great Lakes Review, 1984

Journal of Quality In Clinical Practice, 2001

The aim of this study was to provide an evaluation of the overall effectiveness of using a number... more The aim of this study was to provide an evaluation of the overall effectiveness of using a number of clinical pathways in treating common acute paediatric conditions in an emergency department. This was a before and after study conducted on the effectiveness of three clinical pathways (gastroenteritis, asthma, and croup) in the emergency department of the Children's Hospital at Westmead, conducted over two separate yearly periods January to December 1996 and January to December 1999 representing before and after the introduction of clinical pathways in the emergency department. The main outcomes of the effectiveness of the pathways, namely admission to an in-patient bed, length of hospital stay and re-presentation after discharge from the ED were compared. Other outcomes of interest such as parental satisfaction and patient waiting times were also presented. Any deviation from a key clinical pathway process was reported. A total of 2854 children were managed by a clinical pathway compared to 2680 children managed before clinical pathways were introduced. The admission rate was reduced by threefold (9.1% compared to 23.6%) with a twofold reduction in length of hospital stay (32.7 h compared to 17.5 h). In 3.6% of children using a clinical pathway an unscheduled medical visit or re-presentation to the emergency department occurred after discharge, compared to 4.9% before the use of clinical pathways. No adverse events were reported in these children. In 76 cases deviation from a clinical pathway process was reported. High parental satisfaction was reported for clinical pathways throughout the study. Clinical pathways in this emergency department allowed rapid stabilisation of children, reducing admission rate, with a shortened length of hospital stay and few patients re-presenting after discharge and were well accepted by parents.

Journal of the European Academy of Dermatology and Venereology, 1994

The Histochemical Journal, 1994

Pediatric Emergency Care, 2010

To increase the evidence base by characterizing various features of pediatric sports-related abdo... more To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and managed effectively.

The Journal of American History, 1981

The Journal of American History, 1977

Emergency Medicine Australasia, 2001

Pediatric Emergency Care, 2012

The objective of this study was to describe the characteristics and outcome of pediatric patients... more The objective of this study was to describe the characteristics and outcome of pediatric patients presenting to an emergency department (ED) following out-of-hospital primary cardiac arrest (OHPCA), to determine if long-term survival is influenced by specific resuscitation interventions. This was a prospective observational study of cases of OHPCA during sport or exertion in young patients presenting to an ED over a 5-year period. Cases were identified from a resuscitation database, which documented patient demographics, nature of event, emergency treatment, response times, and clinical progress. These data were analyzed to determine outcomes. Nine children were identified who presented following OHPCA during the study period. The mean age was 10.7 (±4.2) years. All were subsequently diagnosed with an underlying primary cardiac disorder. Six patients (66.6%) survived to make a full recovery. All patients who survived had received early chest compressions (within 5 minutes) and early defibrillation (within 10 minutes). The initial cardiac arrest rhythm in all survivors had been an electrically cardiovertable rhythm. Five (83%) of the 6 survivors did not receive epinephrine during resuscitation. The importance of early chest compressions and defibrillation in collapsed young athletes is highlighted in this report. These interventions can result in full long-term neurological recovery. Use of epinephrine in these patients may be dangerous. We suggest that special consideration should be given to this subgroup of patients in the development of future resuscitation guidelines.

Biochemical Pharmacology, 1999

Non-steroidal anti-inflammatory drugs (NSAIDs) cause a range of adverse effects, some of which ha... more Non-steroidal anti-inflammatory drugs (NSAIDs) cause a range of adverse effects, some of which have been associated with perturbances of lipid metabolic pathways. Previous data demonstrating stereoselective formation of the CoA thioester of R-ibuprofen in particular were suggestive of possible stereoselective effects on lipid metabolism. Our aim was to characterise the relative stereoselectivity of the effects of ibuprofen, flurbiprofen, and ketorolac (0.01-1.0 mM) on both the beta-oxidation of palmitate and oxidative phosphorylation in rat hepatic mitochondria as a means of dissecting prostaglandin related from non-prostaglandin-related events. Beta-oxidation was inhibited stereoselectively by R-ibuprofen (P = 0.015), non-stereoselectively by R- and S-flurbiprofen (P = 0.002 and P = 0.004, respectively), and was essentially unaffected by either enantiomer of ketorolac. At 0.25 mM, inhibition by R-ibuprofen and both flurbiprofen enantiomers was partially reversed by increasing CoA concentrations (0-200 microM). Mitochondrial respiration was moderately inhibited by both enantiomers of ibuprofen and flurbiprofen (P < 0.01), but only by high concentrations (> or = 1 mM) of the enantiomers of ketorolac (P < 0.01). Uncoupling of oxidative phosphorylation measured as stimulation of State 4 respiration contributed to these effects. The data support interactions involving both stereoselective CoA-dependent and non-CoA-dependent mechanisms. The plasma drug concentrations required to achieve these effects are not likely to be attained in the majority of patients, although these concentrations are achievable in the gastrointestinal tract and may contribute to the well-known spectrum of adverse effects in this organ. Some patients do experience systemic adverse events which may be mediated by these mechanisms.

Pediatric Emergency Care, 2002

The American Historical Review, 1986

1. A city in the republic, 2. The chronicles of party, 3. Fellow citizens, 4. The second American... more 1. A city in the republic, 2. The chronicles of party, 3. Fellow citizens, 4. The second American party system, 5. Status and solidarities, 6. The voice of industry, 7. A house of power in town, 8. The democracy.

Medicine & Science in Sports & Exercise, 2008

British Journal of Sports Medicine, 2006

The Medical journal of Australia, Jan 21, 2008

Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in Januar... more Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in January 2007. Four received basic life support (BLS) within 5 minutes of immersion and survived with good functional neurological outcomes. The other four were not discovered for >or= 5 minutes and all died. This cluster serves as a reminder that timely effective bystander BLS is crucial to survival and good clinical outcomes in near-drowning episodes.

The Canadian journal of urology, 1999

In 1998, we conducted the first national survey of urology residents to evaluate Canadian trainin... more In 1998, we conducted the first national survey of urology residents to evaluate Canadian training programs and other aspects related to the future practice of urology. The survey, a 7-page questionnaire, examined the educational learning needs of the trainees. Of 70 residents surveyed, 41 responded (response rate 60%). Topic areas in which the respondents felt comfortable included uro-oncology, and surgery of the prostate, kidney, and bladder. They were less comfortable with management of incontinence and infertility. In-training evaluation was thought to be an important activity that was well done by the training programs. A large majority (81%) expressed interest in elective rotations which they indicated should last 3 to 4 months. They suggested that research rotations be available, but not mandatory. There was strong support for the concept of a national examination preparation course. Almost half of the respondents indicated that American board examinations in urology were imp...

The Canadian journal of urology, 1999

In 1998, we conducted the first national survey of urology residents to evaluate Canadian trainin... more In 1998, we conducted the first national survey of urology residents to evaluate Canadian training programs and other aspects related to the future practice of urology. The survey, a 7-page questionnaire, examined the educational learning needs of the trainees. Of 70 residents surveyed, 41 responded (response rate 60%). Topic areas in which the respondents felt comfortable included uro-oncology, and surgery of the prostate, kidney, and bladder. They were less comfortable with management of incontinence and infertility. In-training evaluation was thought to be an important activity that was well done by the training programs. A large majority (81%) expressed interest in elective rotations which they indicated should last 3 to 4 months. They suggested that research rotations be available, but not mandatory. There was strong support for the concept of a national examination preparation course. Almost half of the respondents indicated that American board examinations in urology were imp...

The Medical journal of Australia, Jan 7, 2008

A 2-year-old boy and a 10-year-old girl presented to the emergency department with a decreased le... more A 2-year-old boy and a 10-year-old girl presented to the emergency department with a decreased level of consciousness. The girl had had persistent vomiting and a seizure. Urine metabolic screening tests were positive for gamma-hydroxybutyrate (GHB). Samples from toy beads ingested by both children contained 1,4-butanediol, which is metabolised to GHB in humans. Regulatory authorities were notified, leading to an international recall of the toy beads.

The Great Lakes Review, 1984

Journal of Quality In Clinical Practice, 2001

The aim of this study was to provide an evaluation of the overall effectiveness of using a number... more The aim of this study was to provide an evaluation of the overall effectiveness of using a number of clinical pathways in treating common acute paediatric conditions in an emergency department. This was a before and after study conducted on the effectiveness of three clinical pathways (gastroenteritis, asthma, and croup) in the emergency department of the Children's Hospital at Westmead, conducted over two separate yearly periods January to December 1996 and January to December 1999 representing before and after the introduction of clinical pathways in the emergency department. The main outcomes of the effectiveness of the pathways, namely admission to an in-patient bed, length of hospital stay and re-presentation after discharge from the ED were compared. Other outcomes of interest such as parental satisfaction and patient waiting times were also presented. Any deviation from a key clinical pathway process was reported. A total of 2854 children were managed by a clinical pathway compared to 2680 children managed before clinical pathways were introduced. The admission rate was reduced by threefold (9.1% compared to 23.6%) with a twofold reduction in length of hospital stay (32.7 h compared to 17.5 h). In 3.6% of children using a clinical pathway an unscheduled medical visit or re-presentation to the emergency department occurred after discharge, compared to 4.9% before the use of clinical pathways. No adverse events were reported in these children. In 76 cases deviation from a clinical pathway process was reported. High parental satisfaction was reported for clinical pathways throughout the study. Clinical pathways in this emergency department allowed rapid stabilisation of children, reducing admission rate, with a shortened length of hospital stay and few patients re-presenting after discharge and were well accepted by parents.

Journal of the European Academy of Dermatology and Venereology, 1994

The Histochemical Journal, 1994

Pediatric Emergency Care, 2010

To increase the evidence base by characterizing various features of pediatric sports-related abdo... more To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and managed effectively.

The Journal of American History, 1981

The Journal of American History, 1977

Emergency Medicine Australasia, 2001

Pediatric Emergency Care, 2012

The objective of this study was to describe the characteristics and outcome of pediatric patients... more The objective of this study was to describe the characteristics and outcome of pediatric patients presenting to an emergency department (ED) following out-of-hospital primary cardiac arrest (OHPCA), to determine if long-term survival is influenced by specific resuscitation interventions. This was a prospective observational study of cases of OHPCA during sport or exertion in young patients presenting to an ED over a 5-year period. Cases were identified from a resuscitation database, which documented patient demographics, nature of event, emergency treatment, response times, and clinical progress. These data were analyzed to determine outcomes. Nine children were identified who presented following OHPCA during the study period. The mean age was 10.7 (±4.2) years. All were subsequently diagnosed with an underlying primary cardiac disorder. Six patients (66.6%) survived to make a full recovery. All patients who survived had received early chest compressions (within 5 minutes) and early defibrillation (within 10 minutes). The initial cardiac arrest rhythm in all survivors had been an electrically cardiovertable rhythm. Five (83%) of the 6 survivors did not receive epinephrine during resuscitation. The importance of early chest compressions and defibrillation in collapsed young athletes is highlighted in this report. These interventions can result in full long-term neurological recovery. Use of epinephrine in these patients may be dangerous. We suggest that special consideration should be given to this subgroup of patients in the development of future resuscitation guidelines.

Biochemical Pharmacology, 1999

Non-steroidal anti-inflammatory drugs (NSAIDs) cause a range of adverse effects, some of which ha... more Non-steroidal anti-inflammatory drugs (NSAIDs) cause a range of adverse effects, some of which have been associated with perturbances of lipid metabolic pathways. Previous data demonstrating stereoselective formation of the CoA thioester of R-ibuprofen in particular were suggestive of possible stereoselective effects on lipid metabolism. Our aim was to characterise the relative stereoselectivity of the effects of ibuprofen, flurbiprofen, and ketorolac (0.01-1.0 mM) on both the beta-oxidation of palmitate and oxidative phosphorylation in rat hepatic mitochondria as a means of dissecting prostaglandin related from non-prostaglandin-related events. Beta-oxidation was inhibited stereoselectively by R-ibuprofen (P = 0.015), non-stereoselectively by R- and S-flurbiprofen (P = 0.002 and P = 0.004, respectively), and was essentially unaffected by either enantiomer of ketorolac. At 0.25 mM, inhibition by R-ibuprofen and both flurbiprofen enantiomers was partially reversed by increasing CoA concentrations (0-200 microM). Mitochondrial respiration was moderately inhibited by both enantiomers of ibuprofen and flurbiprofen (P < 0.01), but only by high concentrations (> or = 1 mM) of the enantiomers of ketorolac (P < 0.01). Uncoupling of oxidative phosphorylation measured as stimulation of State 4 respiration contributed to these effects. The data support interactions involving both stereoselective CoA-dependent and non-CoA-dependent mechanisms. The plasma drug concentrations required to achieve these effects are not likely to be attained in the majority of patients, although these concentrations are achievable in the gastrointestinal tract and may contribute to the well-known spectrum of adverse effects in this organ. Some patients do experience systemic adverse events which may be mediated by these mechanisms.

Pediatric Emergency Care, 2002

The American Historical Review, 1986

1. A city in the republic, 2. The chronicles of party, 3. Fellow citizens, 4. The second American... more 1. A city in the republic, 2. The chronicles of party, 3. Fellow citizens, 4. The second American party system, 5. Status and solidarities, 6. The voice of industry, 7. A house of power in town, 8. The democracy.

Medicine & Science in Sports & Exercise, 2008