Epidemiology of Traumatic Spinal Cord Injury in Ireland, 2010-2015.

BACKGROUND: The International Spinal Cord Society and World Health Organisation recommend the collection of epidemiological data on traumatic spinal cord injury (TSCI). A 1-year prospective study is ongoing in Ireland. While the results of this study are awaited, it was concluded from a feasibility exercise that a complete retrospective dataset, 2010-2015, could be obtained and would be useful for service planning. METHODS: All patients with TSCI discharged from the national SCI acute and rehabilitation centres were included. Data was collected on gender, age, aetiology, level of injury, American Spinal Injuries Association impairment scale, length of rehabilitation admission and discharge destination. Population denominators were national census figures 2006 and 2011, rolled forward. RESULTS: The incidence of TSCI remained constant throughout the study period, 11.5-13.3 per million per year. The mean age of injury onset was 48.9 (SD 19.8) years. Males accounted for 71.5%. The most common injury level/AIS was incomplete tetraplegia, accounting for 43.2% of all TSCI. Leading aetiology was falls, accounting for 53.3% of injuries. Patients with incomplete tetraplegia were older than those with all other injuries (p < 0.001). CONCLUSIONS: The epidemiological trends identified are similar to those prevalent elsewhere in the developed world. More incomplete tetraplegia among an older patient population necessitates a review of how acute care and rehabilitation services are delivered.

Mechanical Dissociation of Tissues for Single Cell Analysis Using a Motorized Device.

Being able to isolate and prepare single cells for the analysis of tissue samples has rapidly become crucial for new biomedical discoveries and research. Manual protocols for single-cell isolations are highly time-consuming and prone to user variability. Automated mechanical protocols are able to reduce processing time and sample variability but aren't easily accessible or cost-effective in lower-resourced research settings. The device described here was designed for semi-automated tissue dissociation using commercially available materials as a low-cost alternative for academic laboratories. Instructions to fabricate, assemble, and operate the device design have been provided. The dissociation protocol reliably produces single-cell suspensions with comparable cell yields and sample viability to manual preparations across multiple mouse tissues. The protocol provides the ability to process up to 12 tissue samples simultaneously per device, making studies requiring large sample sizes more manageable. The accompanying software also allows for customization of the device protocol to accommodate varying tissues and experimental constraints.

Fatigue--a general diagnostic approach.

BACKGROUND: Fatigue or excessive tiredness of body or mind is a common presenting problem in general practice. OBJECTIVE: This article provides a diagnostic model for the diagnosis of fatique in general practice. DISCUSSION: Fatigue is not a diagnosis but rather a symptom. Fatigue is interchangeable with terms such as tiredness, weariness, loss of energy, listlessness and exhaustion. It can be a difficult and frustrating symptom for the general practitioner to evaluate.

Fits, faints and funny turns. A general diagnostic approach.

BACKGROUND: The patient presenting with a fit, faint or 'funny turn' can present a diagnostic dilemma for the general practitioner. OBJECTIVE: This article aims to provide an overview of the diagnostic approach to these 'episodes'. DISCUSSION: The key to diagnosis is to elicit a clear history focussing on the lead-up to the episode, a description of what took place and the events that took place after the episode. The patient's feelings, symptoms, circumstances and provocative factors give vital information.

Needle length required for intramuscular vaccination of infants and toddlers. An ultrasonographic study.

BACKGROUND: To be maximally effective and to induce less adverse reactions, injection with many vaccine antigens must penetrate muscle rather than subcutaneous tissue. AIM: To determine the length of needle needed to penetrate muscle at the anterolateral thigh vaccination site in children aged two, four, six and 18 months. METHOD: Ultrasound measurements were made of the subcutaneous and muscle layer thickness of children aged two, four, six and 18 months at the junction of the upper and middle thirds of the anterolateral thigh with the probe applied parallel to the long axis of the leg and at 45 degrees to the vertical and at 90 degrees to the skin's plane. RESULTS: Subcutaneous tissue (SCT) and muscle layer (ML) thickness were measured in 57 children (2 months, n = 14; 4 months, n = 13; 6 months, n = 18; 18 months, n = 12) with mean SCT thickness of: 8.6 +/- 3.0 mm at 2 months; 9.4 +/- 2.0 mm at 4 months; 10.2 +/- 2.1 mm at 6 months; and 8.1 +/- 1.7 mm at 18 months. Muscle layer thickness in these children was: 10.5 +/- 2.4 mm at 2 months; 12.2 +/- 2.0 mm at 4 months; 14.8 +/- 2.0 mm at 6 months, and 16.5 +/- 4.6 mm at 18 months. CONCLUSION: The optimal needle length to routinely penetrate muscle of the anterolateral thigh in children aged two, four, six and 18 months depends on the technique employed. A 16 mm long needle is suitable with the WHO technique (injecting at 90 degrees to skin's surface) and 25 mm long needle with the NH&MRC and American techniques (injecting at 45 degrees to skin's surface).

Paradigms of family medicine: bridging traditions with new concepts; meeting the challenge of being the good doctor from 2011.

This is the paper for the Wes Fabb Oration for the WONCA Asia Pacific Regional Conference 2011. This paper will review the case for the important role of the family physician/general practitioner in worldwide health care as determined by the WHO. The importance of continuing care is highlighted. The features of a good doctor will be defined and the process of meeting this challenge for excellence of care is presented.

Optimal technique for intramuscular injection of infants and toddlers: a randomised trial.

OBJECTIVE: To compare the rates of adverse reactions and parental approval ratings for three different techniques for anterolateral thigh vaccination in children aged 2, 4, 6 and 18 months. DESIGN: Randomised, observer-blind trial. PARTICIPANTS: 375 children who received pertussis-containing vaccines in a regional New South Wales town between 29 May 2001 and 30 June 2002. INTERVENTIONS: Children were randomised to receive intramuscular injection with acellular pertussis-containing and Haemophilus influenzae type b vaccines with one of three recognised injection techniques (Australian, World Health Organization or United States). MAIN OUTCOME MEASURES: Local adverse reactions (bruising and redness/swelling), systemic adverse reactions (irritability, perceived fever, persistent crying/screaming, drowsiness, vomiting/poor feeding) and parental acceptance were assessed 24 hours after injection. RESULTS: 361 children (96%) were evaluated 24 hours after vaccination. The WHO technique resulted in significantly fewer children, than with the other two techniques, with the systemic adverse reaction variable "irritability" (P = 0.0039). There was a significant difference between the technique groups overall for the local adverse reaction "bruising" with acellular pertussis-containing vaccines (P = 0.0418), due to a lower reaction rate in the WHO group compared with the US group (P = 0.0356). CONCLUSION: The WHO technique appears to be the optimal technique for anterolateral thigh injection in children--it ensures that the injection is intramuscular, results in fewer adverse reactions, and is the easiest technique to perform as it does not require angling of the needle to the long axis of the femur.

Diabetes mellitus: the general practitioner's perspective.

Diabetes mellitus is a disease of modern society. It has been estimated that there are 700,000 people in Australia with diabetes, 50 per cent of whom are not aware of it. Type 2 diabetes in particular is on the increase and is sinister. The concern is the serious complications, especially those of the ocular fundi leading to deterioration of vision, of kidney function, neurological function and the heart. The general practitioner, assisted by share care, must aim to maintain optimal glycaemic control and control of blood pressure and serum lipids. Optimal management to prevent complications involves a team approach. The optometrist has an important role in competent screening of the ocular fundi of all patients having an eye examination.