Interpersonal violence and violent re-injury in the Northern Territory.

OBJECTIVES: To analyse incidence of prior emergency department presentations for interpersonal violence and demographics for a series of hospital admissions for interpersonal violence injuries. DESIGN: Retrospective analysis of trauma registry. SETTING: A tertiary hospital and primary referral centre for trauma in the Top End of the Northern Territory. PARTICIPANTS: Patients hospitalised from 2010 to 2015 for injuries due to interpersonal violence with an injury severity score > 9. MAIN OUTCOME MEASURES: Patient demographics, injury location, assault mechanism, alleged perpetrator, time/day of event, alcohol involvement, clinical outcome and prior emergency department presentations for interpersonal violence. RESULTS: A total of 248 admissions for patients with Injury Severity Score > 9 due to interpersonal violence were identified. Indigenous females over-represented non-Indigenous females (35.4% vs 5.0%, P < .001). The majority of victims had evidence of alcohol intake at presentation. Victims of single-punch head injuries were mostly male and non-Indigenous, whilst Indigenous persons experienced significantly more blunt and penetrating weapon injuries (66.7% and 68.1%). Forty-three per cent of patients had a preceding emergency department presentation for interpersonal violence; female gender, Indigenous ethnicity, evidence of alcohol intake, and urban location of injury were independent risk factors for prior interpersonal violence presentation. CONCLUSIONS: Interpersonal violence is a recurring disease for a just under half of those presenting to a Top End hospital with moderate to severe injuries. Indigenous ethnicity, female gender and evidence of alcohol intake are predictive of prior interpersonal violence presentations. Patient under-reporting and incomplete data may underestimate the true prevalence of interpersonal violence presentations in rural and remote locales.

Monoclonal gammopathy of undetermined significance as viewed by haematology healthcare professionals.

OBJECTIVES: To investigate the words and descriptions used by haematology healthcare professionals (HCPs) to describe monoclonal gammopathy of undetermined significance (MGUS) to their patients. METHODS: A cross-sectional survey of haematology HCPs attending an annual haematology conference was undertaken. Content analysis was applied to the returned qualitative responses. RESULTS: In total, 55 people, many of whom were doctors (n = 32; 58.2%), responded. The majority of respondents reported using simple terminology such as "abnormal protein" to describe MGUS to their patients. Some reported using analogies that the patient was more likely to be familiar with, such as comparing a paraprotein to the finding of a mole or lump. Education level, age and cognitive ability were cited as important factors in deciding how and whether information was relayed to patients. Many respondents supported frequent follow-up and the transfer of low-risk MGUS patients to primary care. However, several highlighted a lack of awareness and understanding of MGUS outside of haematology, particularly within primary care. Only 41.8% of respondents reported providing all of their patients with an information leaflet. CONCLUSIONS: With an ageing population, it is important to consider management strategies for MGUS patients. Our findings will assist those in making these arrangements.

Use of 3D printed models in medical education: A randomized control trial comparing 3D prints versus cadaveric materials for learning external cardiac anatomy.

Three-dimensional (3D) printing is an emerging technology capable of readily producing accurate anatomical models, however, evidence for the use of 3D prints in medical education remains limited. A study was performed to assess their effectiveness against cadaveric materials for learning external cardiac anatomy. A double blind randomized controlled trial was undertaken on undergraduate medical students without prior formal cardiac anatomy teaching. Following a pre-test examining baseline external cardiac anatomy knowledge, participants were randomly assigned to three groups who underwent self-directed learning sessions using either cadaveric materials, 3D prints, or a combination of cadaveric materials/3D prints (combined materials). Participants were then subjected to a post-test written by a third party. Fifty-two participants completed the trial; 18 using cadaveric materials, 16 using 3D models, and 18 using combined materials. Age and time since completion of high school were equally distributed between groups. Pre-test scores were not significantly different (P = 0.231), however, post-test scores were significantly higher for 3D prints group compared to the cadaveric materials or combined materials groups (mean of 60.83% vs. 44.81% and 44.62%, P = 0.010, adjusted P = 0.012). A significant improvement in test scores was detected for the 3D prints group (P = 0.003) but not for the other two groups. The finding of this pilot study suggests that use of 3D prints do not disadvantage students relative to cadaveric materials; maximally, results suggest that 3D may confer certain benefits to anatomy learning and supports their use and ongoing evaluation as supplements to cadaver-based curriculums. Anat Sci Educ 9: 213-221. © 2015 American Association of Anatomists.

Surgical Treatment of Genital Manifestations of Lymphatic Filariasis: A Systematic Review.

Genital manifestations of lymphatic filariasis (genital LF) are a significant cause of disfigurement and disability in the developing world. Surgery is the standard treatment; however, definitive publications are lacking and best practice remains unclear. An exhaustive search strategy using keyword and subject headings was applied to Medline, EMBASE, Web of Science, CINAHL, and Scopus. Additionally citation lists, Google and Google Scholar, archives of relevant journals and websites were searched systematically. Studies with data on one or more human patient(s) who underwent surgery for genital LF were included. Articles were screened and data extracted by the first author with data verification by the second author. Fifty-seven studies were included: 18 series of ablative surgery, four series of non-ablative surgery and 35 case reports. Poor study quality, heterogeneous case definitions, lack of severity grading and limited follow-up precluded meta-analysis. Two series of simple hydrocelectomies performed in resource-limited settings reported early complication rates of 3.0-3.5 % using eversion and 5-7 % using excision, with recurrence of 7 % and 3-5 %, respectively. Complications were minimal for single-surgeon series and greater (12-18 %) when scrotal reconstruction was performed. There is little useful evidence for lymphatic bypass procedures in genital LF. Under-recognition of atypical manifestation of genital LF leads to potentially unnecessary surgeries. Surgery for genital LF is safe in resource-limited settings; however, more well-designed studies with better follow-up are needed. Research priorities include validation of case definitions and severity grading systems, and solutions to improve post-operative follow-up in resource-limited settings.

Deep venous reflux definitions and associated clinical and physiological significance.

BACKGROUND: Deep venous reflux (DVR) is often a poorly defined clinical entity. The extent of DVR that must occur for it to be clinically and hemodynamically important is not clear and is usually confounded by the presence of superficial venous reflux. This study aims to investigate the effect of the extent of DVR on clinical and hemodynamic parameters while controlling for the presence of superficial reflux. METHODS: We performed a cross-sectional study, using a prospectively designed data set obtained from patients presenting to a vascular laboratory for lower limb venous assessment. Age, gender, duplex ultrasound assessment of the deep and superficial systems, CEAP clinical class, and venous filling index (VFI) measurements were obtained. A classification of axial DVR is described, based on the level of continuous reflux occurring in the vertical axis as detected by duplex ultrasound: axial 0 (no deep reflux), axial 1 (common femoral vein only), axial 2 (to any level of the femoral vein), axial 3 (to the level of the popliteal vein), and axial 4 (into the calf veins) A subset of segmental reflux is also defined. RESULTS: This study included 3122 limbs from 2349 subjects. Limbs with increasing axial level were more likely to have CEAP 4-6 (axial 0: 294 [37.2%]; axial 1: 520 [41.6%]; axial 2: 82 [41.2%]; axial 3: 92 [59.7%]; axial 4: 148 [64.9%], P value for trend <.0001). This relationship remained highly significant following adjustment for superficial reflux and demographic variables. Compared with limbs with no DVR, the adjusted odds ratio for having CEAP 4-6 was 2.10 (1.25-3.51; P < .0048) for limbs with axial level 3 and 3.07 (1.94-4.88, P < .0001) for limbs with axial level 4. Similarly after adjustment, predicted mL/s increases in VFI were significant (P < .0001) for level 1 (1.19 [1.08-1.31]), level 3 (1.53 [1.31-1.78]), and level 4 (1.74 [1.51-1.95]). Segmental reflux, when extensive, also contributed to the risk of more severe disease. CONCLUSIONS: Deep axial reflux to the level of the knee and calf is associated with more severe venous disease and greater VFI, independently of reflux in the superficial system. A system of classification of DVR is recommended.

Is there a correlation between bacterial vaginosis and preterm labour in women in the Otago region of New Zealand?

CONTEXT: While an association between bacterial vaginosis and preterm labour has been established, the relative contribution of this condition remains controversial. OBJECTIVE: To determine whether bacterial vaginosis is likely to be an important contributing factor in preterm births in Otago, New Zealand, a region with a historically high rate of such births. DESIGN AND SETTING: Women receiving antenatal care from Queen Mary Maternity Services were studied prospectively. Cases were women presenting with preterm labour or premature rupture of membranes. Controls had uncomplicated pregnancies and delivered at term. PATIENTS AND METHODS: Vaginal swabs from 44 cases and 72 controls were examined by amplification of bacterial 16S rRNA genes followed by denaturing gel gradient electrophoresis. Atopobium vaginae, a bacterial vaginosis-associated bacterium, was detected in a separate polymerase chain reaction. Nugent Gram stain scoring of vaginal swabs from 44 cases and 69 controls was also carried out. RESULTS: Denaturing gel gradient electrophoresis revealed three major types of band profiles corresponding to normal, intermediate and bacterial vaginosis microflorae. There were significantly more cases with bacterial vaginosis band profiles compared with controls (P = 0.024). More cases had intermediate or bacterial vaginosis Nugent scores compared with controls (P = 0.022). Conversely, controls were more likely to have normal scores than cases (P = 0.022). Atopobium vaginae was equally distributed between the cases and controls. CONCLUSIONS: Women in the Otago region undergoing preterm labour were approximately twice as likely to have a bacterial vaginosis type vaginal microflora as controls. In preterm labour, the incidence of bacterial vaginosis was comparable with that found elsewhere, suggesting that current guidelines for treatment and detection of this condition are appropriate.