Andrew J A Holland | The University of Sydney (original) (raw)

Papers by Andrew J A Holland

Research paper thumbnail of Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

Injury Epidemiology

Background Aboriginal and Torres Strait Islander children have higher incidence, severity and hos... more Background Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. Methods Burns Registry of Australia and New Zealand admissions of children

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Balanitis xerotica obliterans: an update for clinicians

European Journal of Pediatrics

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Publishing trends in Journal of Paediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery over the past three decades

Pediatric Surgery International

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool

Injury

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Biobrane™ versus acticoat™ for the treatment of mid-dermal pediatric burns: a prospective randomized controlled pilot study

International journal of burns and trauma, 2018

The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane... more The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane™ (UDL Laboratories, Inc., Sugar Land, TX) may expedite epithelization, reducing the requirement for skin grafting. Our standard management for burns of this depth is Acticoat™ (Smith and Nephew, St. Petersburg, Fl, USA). No publications are known to compare Biobrane™ to Acticoat™ for treatment of mid-dermal burns. A prospective, randomised controlled pilot study was conducted, comparing Biobrane™ to Acticoat™ for mid-dermal burns affecting ≥ 1% Total Body Surface Area (TBSA) in children. Mid-dermal burns were confirmed using Laser Doppler Imaging within 48 hours of injury. Participants were randomized to Biobrane™ with an Acticoat™ overlay or Acticoat™ alone. 10 participants were in each group. Median age and TBSA were similar; 2.0 (Biobrane™) and 1.5 years (Acticoat™), 8% (Biobrane™) and 8.5% TBSA (Acticoat™). Use of Biobrane™ had higher infection rates (6 children versus 1) (P = 0.057...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children

The Medical journal of Australia, Jan 9, 2018

To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in chil... more To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children. Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013. Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital. Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mo...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The impact of general anesthesia on child development and school performance: a population-based study

Paediatric anaesthesia, Jun 27, 2018

There has been considerable interest in the possible adverse neurocognitive effects of exposure t... more There has been considerable interest in the possible adverse neurocognitive effects of exposure to general anesthesia and surgery in early childhood. The aim of this data linkage study was to investigate developmental and school performance outcomes of children undergoing procedures requiring general anesthesia in early childhood. We included children born in New South Wales, Australia of 37+ weeks' gestation without major congenital anomalies or neurodevelopmental disability with either a school entry developmental assessment in 2009, 2012, or Grade-3 school test results in 2008-2014. We compared children exposed to general anesthesia aged <48 months to those without any hospitalization. Children with only 1 hospitalization with general anesthesia and no other hospitalization were assessed separately. Outcomes included being classified developmentally high risk at school entry and scoring below national minimum standard in school numeracy and reading tests. Of 211 978 childr...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The effect of ambient lighting on Laser Doppler Imaging of a standardized cutaneous injury model

International journal of burns and trauma, 2017

The aim of this study was to investigate the potential confounding effects of four different type... more The aim of this study was to investigate the potential confounding effects of four different types of ambient lighting on the results of Laser Doppler Imaging (LDI) of a standardized cutaneous injury model. After applying a mechanical stimulus to the anterior forearm of a healthy volunteer and inducing a wheal and arteriolar flare (the Triple response), we used a Laser Doppler Line Scanner (LDLS) to image the forearm under four different types of ambient lighting: light-emitting-diode (LED), compact fluorescent lighting (CFL), halogen, daylight, and darkness as a control. A spectrometer was used to measure the intensity of light energy at 785 nm, the wavelength used by the scanner for measurement under each type of ambient lighting. Neither the LED nor CFL bulbs emitted detectable light energy at a wavelength of 785 nm. The color-based representation of arbitrary perfusion unit (APU) values of the Triple response measured by the scanner was similar between darkness, LED, and CFL lig...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Advances in paediatric urology

The Lancet

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Recurrent and metastatic congenital mesoblastic nephroma: where does the evidence stand?

Pediatric Surgery International

Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unex... more Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unexpected aggressive clinical behaviors prompted a sub-classification based on histology. Recent molecular genetic evidence has identified the aggressive cellular variant to be the renal manifestation of congenital infantile fibrosarcoma. We submit a reappraisal and analysis of the available literature on recurrent and metastatic CMN. An electronic search of PubMed, MEDLINE, EMBASE, and Scopus yielded 38 children with local recurrence and/or metastases. Of the 38 children with local recurrence and/or metastasis, 59% were girls. Median time to recurrence was 6 months (range 1-12 months). The commonest sites of metastases were the lung (39%) and liver (29%). Fifty percent of these children died of disease. The outcome of additional chemotherapy (p = 0.5) did not differ from that of surgery alone. The choice of chemotherapy did not influence the outcome (p = 0.6). Recurrence and metastasis in cellular CMN are much more common than described earlier and carry a high mortality. Children with cellular and mixed CMN require close clinical and radiological follow-up for a minimum of 12 months after primary surgery. Surgery is the mainstay of the treatment of recurrent and metastatic lesions. Neoadjuvant chemotherapy is recommended only if the lesion is inoperable. Targeted therapy may be an option in treatment of refractory cases.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of A comparison of the management of blunt splenic injury in children and young people—A New South Wales, population-based, retrospective study

Injury

The importance and safety of non-operative management (NOM) of Blunt Splenic Injury (BSI) has bee... more The importance and safety of non-operative management (NOM) of Blunt Splenic Injury (BSI) has been established in children and adults over recent decades. However, studies have shown higher operation rates in adults. There is international evidence that when children are managed in adult centres, operation rates are higher while adolescents in paediatric centres, are operated on in line with paediatric guidelines. This difference between children and young adults, and the factors responsible, have not been examined in New South Wales (NSW). To use NSW hospital and mortality data to compare the characteristics of BSI in patients aged 0-16 to those aged 17-25, and determine factors related to operative management (OM) and splenic salvage in each group. Patients age 0-25 between July 2000 and December 2011, with a diagnosis of BSI, were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages and Bureau of Statistics. Operation rate was compared between the two groups. Univariable analysis was used to determine factors associated with OM. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of OM according to age group, adjusting for potential confounders. 1986 cases were identified, with 422 (21.2%) managed operatively - 101/907 children (11.1%) and321/1079 (29.7%)young adults(p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Of these, 59 (58%) children underwent splenectomy compared with 233 (73%) young adults (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). OM increased significantly after the age of 12 (p=0.03), and the percentage almost tripled in the teenage years, coinciding with a higher proportion admitted to adult centres. OM doubled again in young adults(p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), all of whom were managed away from paediatric centres. On multivariable analysis, factors significantly associated with operation included age over 16 (OR 2.82, 95%CI 2.10-3.81), splenic injury severity, associated thoracic, liver, pancreatic and hollow viscus injury, and blood transfusion. While Paediatric Surgeons have wholeheartedly adopted non-operative management, away from paediatric centres, it is possible children and young people in NSW are undergoing operation unnecessarily. Further evaluation of the surgeon attitudes and institutional factors involved in the management of injured children and young people within the broad NSW trauma system is required.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Differences in survival outcome for severely injured paediatric trauma by type of trauma centre

Journal of paediatrics and child health, Jan 24, 2017

Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured c... more Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia. A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre. There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS > 12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Development of the major trauma case review tool

Scandinavian journal of trauma, resuscitation and emergency medicine, Jan 28, 2017

As many as half of all patients with major traumatic injuries do not receive the recommended care... more As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater ag...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Management of paediatric splenic injury in the New South Wales trauma system

Injury, 2016

Since the 1980&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Since the 1980&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s, paediatric surgeons have increasingly managed blunt splenic injury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere. To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related to the odds of operation. Secondarily, to investigate whether the likelihood of operation varied by year. Children age 0-16 admitted to a NSW hospital between July 2000 and December 2011 with a diagnosis of BSI were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages, and Bureau of Statistics. The operation rate was calculated and compared between different hospital types. Univariable analysis was used to determine patient and hospital factors associated with operative management. The difference in the odds of operation between the oldest data (July 2000-December 2005) and most recent (January 2006-December 2011) was also examined. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of operative management according to hospital category and era, adjusting for potential confounders. 955 cases were identified, with 101(10.6%) managed operatively. On multivariable analysis, factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), massive splenic disruption (OR 3.10, 95% CI 1.61-6.19, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), hollow viscus injury (OR 11.03, 95% CI 3.46-34.28, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and transfusion (OR 7.70, 95% CI 4.54-13.16, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Management outside a paediatric trauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), rural trauma centre (OR 3.72 95% CI 1.83-7.83, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) or metropolitan local hospital (OR 5.23, 95% CI 1.22-18.93 p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Comparing the 2 eras, the overall operation rate fell, although not significantly, from 12.9% to 8.7% (OR 1.3, 95% CI 0.89-243 p=0.13) CONCLUSION: While Paediatric Surgeons have wholeheartedly adopted non-operative management, away from paediatric centres, children in NSW are still being operated on for BSI unnecessarily. While the factors at play may be complex, further evaluation of the management and movement of injured children within the broad NSW trauma system is required.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Laser Doppler Imaging of paediatric burns: Burn wound outcome can be predicted independent of clinical examination

Burns, 2006

This study sought to assess the validity of independent, blinded reporting of Laser Doppler Imagi... more This study sought to assess the validity of independent, blinded reporting of Laser Doppler Imaging (LDI) prediction of burn wound outcome in children. Two experienced paediatric burn consultants were invited to report on LDI scans performed routinely within 3 days of burn. They were provided with the LDI flux image, a low-resolution colour digital photograph of the burnt area and a basic history. Report predictions were correlated with outcome. Reports were compiled on 50 scans performed on 31 patients at a mean of 54h post burn. Of the 100 reports generated, mean correlation with outcome was 97%. If the LDI predicted a deep burn, it was always correct. Non-correlations were due to a number of factors including inadequate scanning of the affected area, excessive movement and residual wound debris. Accurate prediction of burn wound outcome could be made via the standard information generated by LDI and appeared more reliable than clinical prediction. The correlation improved with increasing experience with LDI.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of J. Hamill and S.W. Beasley, Training in paediatric trauma: the problem of safer societies, Aust N Z J Surg 76 (2006 (July)), pp. 596–599

J Pediat Surg, 2007

Bookmarks Related papers MentionsView impact

Research paper thumbnail of A novel device to create consistent deep dermal burns in a porcine model

International journal of burns and trauma, 2016

We conducted this study to evaluate a novel device to create a consistent and reproducible deep p... more We conducted this study to evaluate a novel device to create a consistent and reproducible deep partial thickness burn in a porcine model. A thermostatically controlled, heated aluminium disc device was fashioned by the Biomedical Department of our institution. Contact burns were made on the flank of two Great White pigs by applying the device heated to 92°C at intervals of 5, 10, 15 and 20 seconds to four separate test areas area of skin. Biopsies for histological analysis of burn depth were taken on day 0 at 10 minutes post burn and on day 8. Biopsies taken at day 0 revealed superficial to mid-dermal burns, with minimal dermal edema and necrosis. Those from day 8 showed mid to deep dermal edema and necrosis in all four test areas following a 20 second contact duration burn. The new contact burn device was able to create a consistent deep dermal burn after 20 seconds of contact. We anticipate that this new device could be used to investigate the development of hypertrophic scarring...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Developmental outcomes following major surgery: What does the literature say?

Journal of Paediatrics and Child Health, Oct 1, 2010

Bookmarks Related papers MentionsView impact

Research paper thumbnail of F.K. Clarke and J.G. Cassey, Paraumbilical block for umbilical herniorrhaphy , Aust N Z J Surg 77 (2007 (August)), pp. 659–661

J Pediat Surg, 2008

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Spontaneous haemorrhage in a cavernoma associated with a suprasellar meningioma: An unusual post-operative complication

Brit J Neurosurg, 1994

Cavernoma and suprasellar meningioma are rarely associated. We describe a patient, whose recovery... more Cavernoma and suprasellar meningioma are rarely associated. We describe a patient, whose recovery after removal of the meningioma was complicated by haemorrhage from the cavernoma. This occurrence has not been previously reported.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

Injury Epidemiology

Background Aboriginal and Torres Strait Islander children have higher incidence, severity and hos... more Background Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. Methods Burns Registry of Australia and New Zealand admissions of children

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Balanitis xerotica obliterans: an update for clinicians

European Journal of Pediatrics

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Publishing trends in Journal of Paediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery over the past three decades

Pediatric Surgery International

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool

Injury

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Biobrane™ versus acticoat™ for the treatment of mid-dermal pediatric burns: a prospective randomized controlled pilot study

International journal of burns and trauma, 2018

The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane... more The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane™ (UDL Laboratories, Inc., Sugar Land, TX) may expedite epithelization, reducing the requirement for skin grafting. Our standard management for burns of this depth is Acticoat™ (Smith and Nephew, St. Petersburg, Fl, USA). No publications are known to compare Biobrane™ to Acticoat™ for treatment of mid-dermal burns. A prospective, randomised controlled pilot study was conducted, comparing Biobrane™ to Acticoat™ for mid-dermal burns affecting ≥ 1% Total Body Surface Area (TBSA) in children. Mid-dermal burns were confirmed using Laser Doppler Imaging within 48 hours of injury. Participants were randomized to Biobrane™ with an Acticoat™ overlay or Acticoat™ alone. 10 participants were in each group. Median age and TBSA were similar; 2.0 (Biobrane™) and 1.5 years (Acticoat™), 8% (Biobrane™) and 8.5% TBSA (Acticoat™). Use of Biobrane™ had higher infection rates (6 children versus 1) (P = 0.057...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children

The Medical journal of Australia, Jan 9, 2018

To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in chil... more To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children. Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013. Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital. Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mo...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The impact of general anesthesia on child development and school performance: a population-based study

Paediatric anaesthesia, Jun 27, 2018

There has been considerable interest in the possible adverse neurocognitive effects of exposure t... more There has been considerable interest in the possible adverse neurocognitive effects of exposure to general anesthesia and surgery in early childhood. The aim of this data linkage study was to investigate developmental and school performance outcomes of children undergoing procedures requiring general anesthesia in early childhood. We included children born in New South Wales, Australia of 37+ weeks' gestation without major congenital anomalies or neurodevelopmental disability with either a school entry developmental assessment in 2009, 2012, or Grade-3 school test results in 2008-2014. We compared children exposed to general anesthesia aged <48 months to those without any hospitalization. Children with only 1 hospitalization with general anesthesia and no other hospitalization were assessed separately. Outcomes included being classified developmentally high risk at school entry and scoring below national minimum standard in school numeracy and reading tests. Of 211 978 childr...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The effect of ambient lighting on Laser Doppler Imaging of a standardized cutaneous injury model

International journal of burns and trauma, 2017

The aim of this study was to investigate the potential confounding effects of four different type... more The aim of this study was to investigate the potential confounding effects of four different types of ambient lighting on the results of Laser Doppler Imaging (LDI) of a standardized cutaneous injury model. After applying a mechanical stimulus to the anterior forearm of a healthy volunteer and inducing a wheal and arteriolar flare (the Triple response), we used a Laser Doppler Line Scanner (LDLS) to image the forearm under four different types of ambient lighting: light-emitting-diode (LED), compact fluorescent lighting (CFL), halogen, daylight, and darkness as a control. A spectrometer was used to measure the intensity of light energy at 785 nm, the wavelength used by the scanner for measurement under each type of ambient lighting. Neither the LED nor CFL bulbs emitted detectable light energy at a wavelength of 785 nm. The color-based representation of arbitrary perfusion unit (APU) values of the Triple response measured by the scanner was similar between darkness, LED, and CFL lig...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Advances in paediatric urology

The Lancet

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Recurrent and metastatic congenital mesoblastic nephroma: where does the evidence stand?

Pediatric Surgery International

Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unex... more Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unexpected aggressive clinical behaviors prompted a sub-classification based on histology. Recent molecular genetic evidence has identified the aggressive cellular variant to be the renal manifestation of congenital infantile fibrosarcoma. We submit a reappraisal and analysis of the available literature on recurrent and metastatic CMN. An electronic search of PubMed, MEDLINE, EMBASE, and Scopus yielded 38 children with local recurrence and/or metastases. Of the 38 children with local recurrence and/or metastasis, 59% were girls. Median time to recurrence was 6 months (range 1-12 months). The commonest sites of metastases were the lung (39%) and liver (29%). Fifty percent of these children died of disease. The outcome of additional chemotherapy (p = 0.5) did not differ from that of surgery alone. The choice of chemotherapy did not influence the outcome (p = 0.6). Recurrence and metastasis in cellular CMN are much more common than described earlier and carry a high mortality. Children with cellular and mixed CMN require close clinical and radiological follow-up for a minimum of 12 months after primary surgery. Surgery is the mainstay of the treatment of recurrent and metastatic lesions. Neoadjuvant chemotherapy is recommended only if the lesion is inoperable. Targeted therapy may be an option in treatment of refractory cases.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of A comparison of the management of blunt splenic injury in children and young people—A New South Wales, population-based, retrospective study

Injury

The importance and safety of non-operative management (NOM) of Blunt Splenic Injury (BSI) has bee... more The importance and safety of non-operative management (NOM) of Blunt Splenic Injury (BSI) has been established in children and adults over recent decades. However, studies have shown higher operation rates in adults. There is international evidence that when children are managed in adult centres, operation rates are higher while adolescents in paediatric centres, are operated on in line with paediatric guidelines. This difference between children and young adults, and the factors responsible, have not been examined in New South Wales (NSW). To use NSW hospital and mortality data to compare the characteristics of BSI in patients aged 0-16 to those aged 17-25, and determine factors related to operative management (OM) and splenic salvage in each group. Patients age 0-25 between July 2000 and December 2011, with a diagnosis of BSI, were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages and Bureau of Statistics. Operation rate was compared between the two groups. Univariable analysis was used to determine factors associated with OM. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of OM according to age group, adjusting for potential confounders. 1986 cases were identified, with 422 (21.2%) managed operatively - 101/907 children (11.1%) and321/1079 (29.7%)young adults(p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Of these, 59 (58%) children underwent splenectomy compared with 233 (73%) young adults (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). OM increased significantly after the age of 12 (p=0.03), and the percentage almost tripled in the teenage years, coinciding with a higher proportion admitted to adult centres. OM doubled again in young adults(p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), all of whom were managed away from paediatric centres. On multivariable analysis, factors significantly associated with operation included age over 16 (OR 2.82, 95%CI 2.10-3.81), splenic injury severity, associated thoracic, liver, pancreatic and hollow viscus injury, and blood transfusion. While Paediatric Surgeons have wholeheartedly adopted non-operative management, away from paediatric centres, it is possible children and young people in NSW are undergoing operation unnecessarily. Further evaluation of the surgeon attitudes and institutional factors involved in the management of injured children and young people within the broad NSW trauma system is required.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Differences in survival outcome for severely injured paediatric trauma by type of trauma centre

Journal of paediatrics and child health, Jan 24, 2017

Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured c... more Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia. A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014. Logistic regression was used to examine the association of in-hospital mortality and type of trauma centre. There were 1230 children who were severely injured (i.e. Injury Severity Score; ISS > 12) and 81.0% received definitive care at a PTC. Two-thirds were male, 37.8% were aged 11-15 years and falls represented 32.0% of the injuries. Almost half (48.9%) the injured children had an ISS between 16 and 24, 31.9% between 25 and 39 and 3.8% an ISS between 40...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Development of the major trauma case review tool

Scandinavian journal of trauma, resuscitation and emergency medicine, Jan 28, 2017

As many as half of all patients with major traumatic injuries do not receive the recommended care... more As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater ag...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Management of paediatric splenic injury in the New South Wales trauma system

Injury, 2016

Since the 1980&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Since the 1980&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s, paediatric surgeons have increasingly managed blunt splenic injury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere. To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related to the odds of operation. Secondarily, to investigate whether the likelihood of operation varied by year. Children age 0-16 admitted to a NSW hospital between July 2000 and December 2011 with a diagnosis of BSI were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages, and Bureau of Statistics. The operation rate was calculated and compared between different hospital types. Univariable analysis was used to determine patient and hospital factors associated with operative management. The difference in the odds of operation between the oldest data (July 2000-December 2005) and most recent (January 2006-December 2011) was also examined. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of operative management according to hospital category and era, adjusting for potential confounders. 955 cases were identified, with 101(10.6%) managed operatively. On multivariable analysis, factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), massive splenic disruption (OR 3.10, 95% CI 1.61-6.19, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), hollow viscus injury (OR 11.03, 95% CI 3.46-34.28, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and transfusion (OR 7.70, 95% CI 4.54-13.16, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Management outside a paediatric trauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), rural trauma centre (OR 3.72 95% CI 1.83-7.83, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) or metropolitan local hospital (OR 5.23, 95% CI 1.22-18.93 p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Comparing the 2 eras, the overall operation rate fell, although not significantly, from 12.9% to 8.7% (OR 1.3, 95% CI 0.89-243 p=0.13) CONCLUSION: While Paediatric Surgeons have wholeheartedly adopted non-operative management, away from paediatric centres, children in NSW are still being operated on for BSI unnecessarily. While the factors at play may be complex, further evaluation of the management and movement of injured children within the broad NSW trauma system is required.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Laser Doppler Imaging of paediatric burns: Burn wound outcome can be predicted independent of clinical examination

Burns, 2006

This study sought to assess the validity of independent, blinded reporting of Laser Doppler Imagi... more This study sought to assess the validity of independent, blinded reporting of Laser Doppler Imaging (LDI) prediction of burn wound outcome in children. Two experienced paediatric burn consultants were invited to report on LDI scans performed routinely within 3 days of burn. They were provided with the LDI flux image, a low-resolution colour digital photograph of the burnt area and a basic history. Report predictions were correlated with outcome. Reports were compiled on 50 scans performed on 31 patients at a mean of 54h post burn. Of the 100 reports generated, mean correlation with outcome was 97%. If the LDI predicted a deep burn, it was always correct. Non-correlations were due to a number of factors including inadequate scanning of the affected area, excessive movement and residual wound debris. Accurate prediction of burn wound outcome could be made via the standard information generated by LDI and appeared more reliable than clinical prediction. The correlation improved with increasing experience with LDI.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of J. Hamill and S.W. Beasley, Training in paediatric trauma: the problem of safer societies, Aust N Z J Surg 76 (2006 (July)), pp. 596–599

J Pediat Surg, 2007

Bookmarks Related papers MentionsView impact

Research paper thumbnail of A novel device to create consistent deep dermal burns in a porcine model

International journal of burns and trauma, 2016

We conducted this study to evaluate a novel device to create a consistent and reproducible deep p... more We conducted this study to evaluate a novel device to create a consistent and reproducible deep partial thickness burn in a porcine model. A thermostatically controlled, heated aluminium disc device was fashioned by the Biomedical Department of our institution. Contact burns were made on the flank of two Great White pigs by applying the device heated to 92°C at intervals of 5, 10, 15 and 20 seconds to four separate test areas area of skin. Biopsies for histological analysis of burn depth were taken on day 0 at 10 minutes post burn and on day 8. Biopsies taken at day 0 revealed superficial to mid-dermal burns, with minimal dermal edema and necrosis. Those from day 8 showed mid to deep dermal edema and necrosis in all four test areas following a 20 second contact duration burn. The new contact burn device was able to create a consistent deep dermal burn after 20 seconds of contact. We anticipate that this new device could be used to investigate the development of hypertrophic scarring...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Developmental outcomes following major surgery: What does the literature say?

Journal of Paediatrics and Child Health, Oct 1, 2010

Bookmarks Related papers MentionsView impact

Research paper thumbnail of F.K. Clarke and J.G. Cassey, Paraumbilical block for umbilical herniorrhaphy , Aust N Z J Surg 77 (2007 (August)), pp. 659–661

J Pediat Surg, 2008

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Spontaneous haemorrhage in a cavernoma associated with a suprasellar meningioma: An unusual post-operative complication

Brit J Neurosurg, 1994

Cavernoma and suprasellar meningioma are rarely associated. We describe a patient, whose recovery... more Cavernoma and suprasellar meningioma are rarely associated. We describe a patient, whose recovery after removal of the meningioma was complicated by haemorrhage from the cavernoma. This occurrence has not been previously reported.

Bookmarks Related papers MentionsView impact