Robert Padbury - Academia.edu (original) (raw)
Papers by Robert Padbury
Anz Journal of Surgery, Mar 1, 1991
Bleeding from a peptic ulcer is associated with significant morbidity and mortality, particularly... more Bleeding from a peptic ulcer is associated with significant morbidity and mortality, particularly in the elderly. The results of a management policy of early endoscopy and close monitoring of patients were prospectively evaluated to assess whether major stigmata of recent haemorrhage (SRH) helped to identify patients who were likely to rebleed. Early endoscopy allowed the diagnosis of the most likely site of haemorrhage in 94% of the 190 patients. The nature and site of SRH (visible vessel, fresh clot, red or black spot) was recorded. Ninetythree of 167 patients in whom the presence or absence of SRH were recorded, had major S R H (visible vessel, fresh clot) and 5 I % of these patients rebled while only 10 of 74 (14%) patients without major S R H rebled. Overall, 80% of those with further haemorrhage had major SRH. Operation was performed on 28% of patients and the main indication for operation was further haemorrhage. Major morbidity in the surgical patients was strongly correlated with vascular instability at the time of further haemorrhage. Significant morbidity occurred in 16 of 28 patients (57%) with vascular instability, compared with only I of 18 patients (6%) without vascular instability (P <O.OOI). The overall low mortality of 5.3"h was attributed to an approach of joint medical and surgical management with early operation for further haemorrhage. Although major SRH identified a group of patients most likely to suffer further haemomhage, the positive predictive value of major SRH was only 5 I YO.
Liver transplantation and surgery, May 1, 1998
S trategies to minimize the long-term side effects of immunosuppression in liver transplant recip... more S trategies to minimize the long-term side effects of immunosuppression in liver transplant recipients have included the uniform reduction of all agents in double-or triple-therapy regimens, selective discontinuation of individual agents of such regimens, and the complete withdrawal of all long-term immunosuppression. The most effective clinical protocol to eliminate the serious cardiovascular, infectious, and neoplastic complications while preventing immunologic graft damage is not yet apparent.
BMC Health Services Research, Jun 18, 2021
Background: A key characteristic of healthcare systems that deliver high quality and cost perform... more Background: A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these. Methods: Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted. Results: We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a prerequisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge. Conclusions: Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.
Peptides, 1996
The neuropeptide galanin (GAL) is found in neurons in the biliary tract of several species. We ma... more The neuropeptide galanin (GAL) is found in neurons in the biliary tract of several species. We mapped the distribution of GAL-like immunoreactive nerve (GAL-LI) fibers in the sphincter of Oddi of the Australian brush-tailed possum by immunohistochemistry. The pharmacological effects of GAL in vitro and in vivo were studied by measuring sphincter of Oddi muscle strip contractility and transsphincteric flow, respectively. Muscle layers, and ganglionated and perivascular plexuses, contained GAL-L1 nerve fibers. Exogenous GAL caused a concentration-dependent (10-9-10m6 M) increase in the spontaneous longitudinal but not circular muscle contractions. At 1O-6 M GAL, contractile: activity was elevated two-to fourfold. This response was tetrodotoxin insensitive but competitively inhibited by galantide (10-8-10-7 M). In viva, intra-arterial bolus injections of GAL (100-1000 nglkg), decreased transsphincteric flow, with a maximum reduction to 80.2 ? 6.8% of control. In conclusion, GAL appears to selectively stimulate longitudinally oriented sphincter of Oddi smooth muscle via a direct mechanism, which results in a modest reduction in transsphincteric flow.
Journal of Hepato-biliary-pancreatic Surgery, 1993
Hpb Surgery, 1993
The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Tricho... more The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to form a common channel within the terminal intraduodenal segment. Nerve cell bodies of the gallbladder were found in an interconnecting network of ganglia that were located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most ganglia were located in two plexuses, the first between the layers of the external sphincter muscle, which was continuous with the external muscle of the duodenum, and the second was associated with the internal sphincter muscle. Nerve fibres were numerous in the sphincter muscle, and were also found in the subepithelial and periglandular plexuses of both the pancreatic and common bile ducts.
Annals of Surgery, Nov 1, 1993
The aim of this study was to prospectively assess the results of laparoscopic cholecystectomy in ... more The aim of this study was to prospectively assess the results of laparoscopic cholecystectomy in patients with acute inflammation of the gallbladder. Summary Background Data. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder disease. Its role in the surgical treatment of acute cholecystitis has not been defined, although a number of recent reports suggest that there should be few contraindications to an initial laparoscopic approach. Methods. All patients presenting with symptomatic cholelithiasis from October 1990 until June 1992 were evaluated at laparoscopy with intention of proceeding to a laparoscopic cholecystectomy. The gross appearance of the gallbladder was categorized as acute inflammation, chronic inflammation, or no inflammation. Ninety-eight (23.4%) of 418 patients had acute inflammation of the gallbladder: 55 were edematous, 10 were gangrenous, 15 had a mucocele, and 18 had an empyema. Results.
Anz Journal of Surgery, Dec 1, 1999
Although the feasibility of laparoscopic cholecystectomy performed as day surgery has been establ... more Although the feasibility of laparoscopic cholecystectomy performed as day surgery has been established, cost and recovery time have not previously been evaluated in a prospective comparative fashion. Patients were randomized to day stay only or overnight stay, and a nurse assessed the former postoperatively at home. All patients were reviewed weekly or as required if problems occurred. Costing comparisons were made between the two groups using Trendstar software. A total of 131 patients were evaluated after randomization (60 day-stay only patients and 71 overnight-stay patients). A total of 18.3% of the day-stay patients required in-hospital admission for nausea, vomiting, or pain, or after conversion to open operation; 18.3% of the overnight group required an extended length of stay for similar reasons. After discharge, two day-stay and three overnight-stay patients required readmission, only one had a significant complication. The mean times to return to normal activity averaged 1.8 weeks (SE: 0.1 weeks) and 1.9 weeks (SE: 0.1 weeks) for day-stay and overnight-stay groups, respectively (P = 0.63), and costs of 2732(SE:2732 (SE: 2732(SE:76) compared to 2835(SE2835 (SE 2835(SE110), respectively (P = 0.94). In the present randomized controlled study, day-stay management did not compromise postoperative patient outcome. In the setting of a major teaching hospital there was no cost advantage when compared to overnight-stay management.
Journal of The American College of Surgeons, Nov 1, 2021
Journal of Gastrointestinal Surgery, Nov 4, 2008
Journal of Gastrointestinal Surgery, Apr 1, 2005
compared to normothermic conditions. Decreasing body temperature further to 31ЊC had no additiona... more compared to normothermic conditions. Decreasing body temperature further to 31ЊC had no additional protective effect. Such moderate hyperthermia is applicable in the clinical setting and is frequently seen in cardiac, neurosurgical, and ophthalmologic procedures. Maintaining normothermia appears to be detrimental in procedures that may result in hepatic ischemia/reperfusion.
Journal of Hepatology, Apr 1, 2009
Transplant International, 1992
Steroid therapy was withdrawn in 85% of 152 orthotopic liver transplant recipients with grafts su... more Steroid therapy was withdrawn in 85% of 152 orthotopic liver transplant recipients with grafts surviving for more than 3 months, and 87% of these remained steroid-free. Steroid therapy was restarted in 8% for reasons other than rejection. The most common was conversion of immunosuppression because of cyclosporine nephrotoxicity. The incidence of rejection after steroid withdrawal was low: 3.8% for chronic rejection (CR) and 4.5% for acute rejection. Only 3 grafts (1.9%) were lost because of CR. No risk factors have been identified for the development of CRafter steroid withdrawal, but a protective role for azathioprine has been suggested.
The Medical Journal of Australia, May 1, 2012
Anz Journal of Surgery, Mar 1, 1991
Bleeding from a peptic ulcer is associated with significant morbidity and mortality, particularly... more Bleeding from a peptic ulcer is associated with significant morbidity and mortality, particularly in the elderly. The results of a management policy of early endoscopy and close monitoring of patients were prospectively evaluated to assess whether major stigmata of recent haemorrhage (SRH) helped to identify patients who were likely to rebleed. Early endoscopy allowed the diagnosis of the most likely site of haemorrhage in 94% of the 190 patients. The nature and site of SRH (visible vessel, fresh clot, red or black spot) was recorded. Ninetythree of 167 patients in whom the presence or absence of SRH were recorded, had major S R H (visible vessel, fresh clot) and 5 I % of these patients rebled while only 10 of 74 (14%) patients without major S R H rebled. Overall, 80% of those with further haemorrhage had major SRH. Operation was performed on 28% of patients and the main indication for operation was further haemorrhage. Major morbidity in the surgical patients was strongly correlated with vascular instability at the time of further haemorrhage. Significant morbidity occurred in 16 of 28 patients (57%) with vascular instability, compared with only I of 18 patients (6%) without vascular instability (P <O.OOI). The overall low mortality of 5.3"h was attributed to an approach of joint medical and surgical management with early operation for further haemorrhage. Although major SRH identified a group of patients most likely to suffer further haemomhage, the positive predictive value of major SRH was only 5 I YO.
Liver transplantation and surgery, May 1, 1998
S trategies to minimize the long-term side effects of immunosuppression in liver transplant recip... more S trategies to minimize the long-term side effects of immunosuppression in liver transplant recipients have included the uniform reduction of all agents in double-or triple-therapy regimens, selective discontinuation of individual agents of such regimens, and the complete withdrawal of all long-term immunosuppression. The most effective clinical protocol to eliminate the serious cardiovascular, infectious, and neoplastic complications while preventing immunologic graft damage is not yet apparent.
BMC Health Services Research, Jun 18, 2021
Background: A key characteristic of healthcare systems that deliver high quality and cost perform... more Background: A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these. Methods: Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted. Results: We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a prerequisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge. Conclusions: Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.
Peptides, 1996
The neuropeptide galanin (GAL) is found in neurons in the biliary tract of several species. We ma... more The neuropeptide galanin (GAL) is found in neurons in the biliary tract of several species. We mapped the distribution of GAL-like immunoreactive nerve (GAL-LI) fibers in the sphincter of Oddi of the Australian brush-tailed possum by immunohistochemistry. The pharmacological effects of GAL in vitro and in vivo were studied by measuring sphincter of Oddi muscle strip contractility and transsphincteric flow, respectively. Muscle layers, and ganglionated and perivascular plexuses, contained GAL-L1 nerve fibers. Exogenous GAL caused a concentration-dependent (10-9-10m6 M) increase in the spontaneous longitudinal but not circular muscle contractions. At 1O-6 M GAL, contractile: activity was elevated two-to fourfold. This response was tetrodotoxin insensitive but competitively inhibited by galantide (10-8-10-7 M). In viva, intra-arterial bolus injections of GAL (100-1000 nglkg), decreased transsphincteric flow, with a maximum reduction to 80.2 ? 6.8% of control. In conclusion, GAL appears to selectively stimulate longitudinally oriented sphincter of Oddi smooth muscle via a direct mechanism, which results in a modest reduction in transsphincteric flow.
Journal of Hepato-biliary-pancreatic Surgery, 1993
Hpb Surgery, 1993
The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Tricho... more The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to form a common channel within the terminal intraduodenal segment. Nerve cell bodies of the gallbladder were found in an interconnecting network of ganglia that were located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most ganglia were located in two plexuses, the first between the layers of the external sphincter muscle, which was continuous with the external muscle of the duodenum, and the second was associated with the internal sphincter muscle. Nerve fibres were numerous in the sphincter muscle, and were also found in the subepithelial and periglandular plexuses of both the pancreatic and common bile ducts.
Annals of Surgery, Nov 1, 1993
The aim of this study was to prospectively assess the results of laparoscopic cholecystectomy in ... more The aim of this study was to prospectively assess the results of laparoscopic cholecystectomy in patients with acute inflammation of the gallbladder. Summary Background Data. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder disease. Its role in the surgical treatment of acute cholecystitis has not been defined, although a number of recent reports suggest that there should be few contraindications to an initial laparoscopic approach. Methods. All patients presenting with symptomatic cholelithiasis from October 1990 until June 1992 were evaluated at laparoscopy with intention of proceeding to a laparoscopic cholecystectomy. The gross appearance of the gallbladder was categorized as acute inflammation, chronic inflammation, or no inflammation. Ninety-eight (23.4%) of 418 patients had acute inflammation of the gallbladder: 55 were edematous, 10 were gangrenous, 15 had a mucocele, and 18 had an empyema. Results.
Anz Journal of Surgery, Dec 1, 1999
Although the feasibility of laparoscopic cholecystectomy performed as day surgery has been establ... more Although the feasibility of laparoscopic cholecystectomy performed as day surgery has been established, cost and recovery time have not previously been evaluated in a prospective comparative fashion. Patients were randomized to day stay only or overnight stay, and a nurse assessed the former postoperatively at home. All patients were reviewed weekly or as required if problems occurred. Costing comparisons were made between the two groups using Trendstar software. A total of 131 patients were evaluated after randomization (60 day-stay only patients and 71 overnight-stay patients). A total of 18.3% of the day-stay patients required in-hospital admission for nausea, vomiting, or pain, or after conversion to open operation; 18.3% of the overnight group required an extended length of stay for similar reasons. After discharge, two day-stay and three overnight-stay patients required readmission, only one had a significant complication. The mean times to return to normal activity averaged 1.8 weeks (SE: 0.1 weeks) and 1.9 weeks (SE: 0.1 weeks) for day-stay and overnight-stay groups, respectively (P = 0.63), and costs of 2732(SE:2732 (SE: 2732(SE:76) compared to 2835(SE2835 (SE 2835(SE110), respectively (P = 0.94). In the present randomized controlled study, day-stay management did not compromise postoperative patient outcome. In the setting of a major teaching hospital there was no cost advantage when compared to overnight-stay management.
Journal of The American College of Surgeons, Nov 1, 2021
Journal of Gastrointestinal Surgery, Nov 4, 2008
Journal of Gastrointestinal Surgery, Apr 1, 2005
compared to normothermic conditions. Decreasing body temperature further to 31ЊC had no additiona... more compared to normothermic conditions. Decreasing body temperature further to 31ЊC had no additional protective effect. Such moderate hyperthermia is applicable in the clinical setting and is frequently seen in cardiac, neurosurgical, and ophthalmologic procedures. Maintaining normothermia appears to be detrimental in procedures that may result in hepatic ischemia/reperfusion.
Journal of Hepatology, Apr 1, 2009
Transplant International, 1992
Steroid therapy was withdrawn in 85% of 152 orthotopic liver transplant recipients with grafts su... more Steroid therapy was withdrawn in 85% of 152 orthotopic liver transplant recipients with grafts surviving for more than 3 months, and 87% of these remained steroid-free. Steroid therapy was restarted in 8% for reasons other than rejection. The most common was conversion of immunosuppression because of cyclosporine nephrotoxicity. The incidence of rejection after steroid withdrawal was low: 3.8% for chronic rejection (CR) and 4.5% for acute rejection. Only 3 grafts (1.9%) were lost because of CR. No risk factors have been identified for the development of CRafter steroid withdrawal, but a protective role for azathioprine has been suggested.
The Medical Journal of Australia, May 1, 2012