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1.  P02-004 - AIDs in a registry of children in North America 
Pediatric Rheumatology Online Journal  2013;11(Suppl 1):A111.
PMCID: PMC3952578
3.  Nurses' attitudes to a medical emergency team service in a teaching hospital 
Quality & Safety in Health Care  2006;15(6):427-432.
Cultural barriers including allegiance to traditional models of ward care and fear of criticism may restrict use of a medical emergency team (MET) service, particularly by nursing staff. A 1‐year preparation and education programme was undertaken before implementing the MET at the Austin Hospital, Melbourne, Australia. During the 4 years after introduction of the MET, the programme has continued to inform staff of the benefits of the MET and to overcome barriers restricting its use.
To assess whether nurses value the MET service and to determine whether barriers to calling the MET exist in a 400‐bed teaching hospital.
Immediately before hand‐over of ward nursing, we conducted a modified personal interview, using a 17‐item Likert agreement scale questionnaire.
We created a sample of 351 ward nurses and obtained a 100% response rate. This represents 50.9% of the 689 ward nurses employed at the hospital. Most nurses felt that the MET prevented cardiac arrests (91%) and helped manage unwell patients (97%). Few nurses suggested that they restricted MET calls because they feared criticism of their patient care (2%) or criticism that the patient was not sufficiently unwell to need a MET call (10%). 19% of the respondents indicated that MET calls are required because medical management by the doctors has been inadequate; many ascribed this to junior doctors and a lack of knowledge and experience. Despite hospital MET protocol, 72% of nurses suggested that they would call the covering doctor before the MET for a sick ward patient. However, 81% indicated that they would activate the MET if they were unable to contact the covering doctor. In line with hospital MET protocol, 56% suggested that they would make a MET call for a patient they were worried about even if the patient's vital signs were normal. Further, 62% indicated that they would call the MET for a patient who fulfilled MET physiological criteria but did not look unwell.
Nurses in the Austin Hospital value the MET service and appreciate its potential benefits. The major barrier to calling the MET appears to be allegiance to the traditional approach of initially calling parent medical unit doctors, rather than fear of criticism for calling the MET service. A further barrier seems to be underestimation of the clinical significance of the physiological perturbations associated with the presence of MET call criteria.
PMCID: PMC2464889  PMID: 17142592
5.  Eosinophilia and symptomatic pulmonary amyloidosis 
Postgraduate Medical Journal  2004;80(950):738-739.
The case of a man with progressive breathlessness and pulmonary infiltration caused by AL amyloidosis associated with multiple myeloma is presented. There was a marked peripheral eosinophilia, which has not previously been described with amyloidosis.
PMCID: PMC1743162  PMID: 15579619
6.  Beneficial effects of statins on the kidney 
Journal of Clinical Pathology  2004;57(7):673-674.
PMCID: PMC1770345  PMID: 15252929
cholesterol; creatinine clearance; renal function; statins
8.  Bilateral popliteal aneurysms complicating adult polycystic kidney disease in a patient with a marfanoid habitus 
Postgraduate Medical Journal  2003;79(934):474-475.
In 1994 he had noticed a painful swelling behind his left knee. Computed tomography with contrast showed a large popliteal aneurysm. This was replaced with a vein graft. The right popliteal artery showed milder changes, and this was repaired in 1999.
Popliteal aneurysms develop most often in older vasculopaths with multiple risk factors; connective tissue disorders have rarely been associated with their presence in younger patients. Polycystic kidney disease has been associated with several aneurysms, most notably cerebral, but not popliteal. The patient's marfanoid habitus also may have played a part. This case emphasises the mixed aetiology of popliteal aneurysms.
PMCID: PMC1742787  PMID: 12954963
9.  Uveitis initiating an autoimmune reaction resulting in Goodpasture’s syndrome in a Chinese man 
The British Journal of Ophthalmology  2002;86(10):1188-1190.
PMCID: PMC1771299  PMID: 12234906
uveitis; autoimmune reaction; Goodpasture’s syndrome; Chinese race
10.  Nephrotic syndrome and mesenteric infarction secondary to metastatic mesothelioma 
Postgraduate Medical Journal  2001;77(907):333-334.
Malignant mesothelioma can present insidiously with progressive breathlessness and chest pain. Paraneoplastic, or non-chest related, presentations are very rare. The case of an elderly man with occupational exposure to asbestos who presented with nephrotic syndrome due to minimal change nephropathy in the context of advanced pleural mesothelial malignancy is reported.

Keywords: malignant mesothelioma; minimal change nephropathy; nephrotic syndrome
PMCID: PMC1742010  PMID: 11320279
11.  End stage renal disease among ceramic workers exposed to silica 
OBJECTIVES: To evaluate whether ceramic workers exposed to silica experience an excess of end stage renal disease. METHODS: On the basis of a health surveillance programme, a cohort of 2980 male ceramic workers has been enrolled during the period 1974-91 in Civitacastellana, Lazio, Italy. For each worker, employment history, smoking data, and x ray film readings were available. The vital status was ascertained for all cohort members. All 2820 people still alive and resident in the Lazio region as in June 1994 were searched for a match in the regional end stage renal diseases registry, which records (since June, 1994) all patients undergoing dialysis treatment in public and private facilities of the region. Expected numbers of prevalent cases from the cohort were computed by applying the rate of patients on dialysis treatment by the age distribution of the cohort. RESULTS: A total of six cases was detected when 1.87 were expected (observed/expected (O/E) = 3.21; 95% confidence interval (95% CI) 1.17 to 6.98). The excess risk was present among non-smokers (O = 2; O/E = 4.34) and smokers (O = 4; O/E = 2.83), as well as among workers without silicosis (O = 4; O/E = 2.78) and workers with silicosis (O = 2; O/E = 4.54). The risk was higher among subjects with < 20 years since first employment (O = 4; O/E = 4.65) than among those employed > 20 years. CONCLUSION: These results provide further evidence that exposure to silica dust among ceramic workers is associated with nephrotoxic effects.
PMCID: PMC1757772  PMID: 10492655
12.  Pediatric Cancer CareLink--supporting home management of childhood leukemia. 
We conducted a descriptive evaluation of an Internet-based system designed to support home management of childhood leukemia (Pediatric Cancer CareLink). Twenty-five parents of children with ALL and thirty-four clinicians were interviewed to identify functional requirements and to demonstrate the system's potential to improve the experience and outcomes of children with acute lymphoblastic leukemia (ALL). Parental interviews focused on: medication and side effect management in the home; communication with the health care team; and the use of a computer for ALL home management. Results from these interviews provide strong evidence that parents of children with ALL are struggling to manage the complexity of their children's care in the home. Parents revealed an urgent need for tools that would help them to safely organize the medicines that their children receive while on ALL protocols. Forty percent of parents needed to know more about what to expect during their child's therapy and how to be prepared for it. Clinician interviews focused on the clinical impact and workflow issues associated with such a system. Decision support, prescription refill management, and educational and emotional support functions were considered key components. Clinicians were concerned that such a system would increase their already overburdened workload. Conversely, parents believed that access to such a system would eliminate unnecessary phone calls to the care team. Our findings show that parents would embrace collaborative Internet-based tools that would help with the home management of their child's leukemia.
PMCID: PMC2244563  PMID: 12463833
13.  Hypertension and renal failure. 
Postgraduate Medical Journal  1998;74(871):263-265.
PMCID: PMC2360912  PMID: 9713602
16.  Reversible acute renal failure induced by losartan in a renal transplant recipient. 
Postgraduate Medical Journal  1997;73(856):105-107.
A 56-year-old man who received a live-related renal transplant in 1988 was started in 1995 on the selective angiotensin II antagonist losartan (Dupont-Merke) to treat worsening hypertension. Two months later because of pulmonary oedema, loop diuretics were started. Within two weeks, serum creatinine had increased from 245 to 571 mumol/l, and the patient became oliguric. A systolic bruit was noted over the graft. Renal angiography showed a 90% stenosis of the transplant renal artery. Losartan was withdrawn, with prompt improvement in renal function. A successful percutaneous transluminal angioplasty performed a few days later resulted in further improvement in renal function accompanied by a significant diuresis.
PMCID: PMC2431233  PMID: 9122087
17.  Tingling extremities in a young man. 
Postgraduate Medical Journal  1996;72(848):380-382.
PMCID: PMC2398484  PMID: 8758026
18.  Vasculitis and rapidly progressive glomerulonephritis in the elderly. 
Postgraduate Medical Journal  1996;72(843):41-44.
The proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or over has risen from about 10% in the 1980s to over 30% in series reported in the 1990s. This study was undertaken to examine the presentation and outcome of such older patients. Seventeen of 56 patients (30%) who presented at two renal units were aged 70 years or over. Mean creatinine level at presentation was 530 mumol/l, and five patients received dialysis at presentation. Outcome was dependent on three factors, namely comorbid pathology, response to immunosuppressive therapy, and the occurrence in three cases of temporary spontaneous partial remission. Overall patient survival at one and two years was 62.5% and 50%, respectively, and 90% and 100% of surviving patients were independent of dialysis at one and two years, respectively. Response to chemotherapy was excellent, with full rehabilitation in many cases and no deaths directly attributable to adverse effects of immunosuppressive therapy. We conclude that diagnosis of vasculitis and rapidly progressive glomerulonephritis by renal biopsy and the subsequent administration of chemotherapy (including cyclophosphamide in many cases) resulted in a worthwhile benefit in these elderly patients.
PMCID: PMC2398323  PMID: 8746284
19.  Using the Web to reduce postoperative pain following ambulatory surgery. 
To test the hypothesis that educational information provided via the web would not only be accessed by our patients, but could also reduce postoperative pain following ambulatory surgery, we enrolled 195 patients into a randomized controlled study. Fifty-two percent of our ambulatory surgery patients already knew how to use and had access to the Internet. Eighty-five percent of our study patients accessed the resources made available to them on the web site. Patients who had access to the pain management information on the ambulatory surgery web site reported significantly less postoperative pain on arrival to their home after surgery (p < 0.016) and into the night after surgery (p < 0.013). These patients also reported significantly less postoperative pain for the day immediately following surgery (p < 0.037). We conclude that using the Internet to provide just-in-time patient education can significantly effect the clinical outcome of care.
PMCID: PMC2232814  PMID: 10566466
21.  The treatment of nephrotic syndrome caused by primary (light chain) amyloid with vincristine, doxorubicin and dexamethasone. 
British Journal of Cancer  1998;78(6):774-776.
Three out of four patients with primary (light chain) amyloid nephrotic syndrome treated with vincristine, doxorubicin and dexamethasone (VAD) induction obtained a partial response and are alive in continuing remission at 4.1, 6.5 and 9.3 years. These preliminary results are of considerable interest and suggest that prospective evaluation of this regimen is warranted in patients with this condition.
PMCID: PMC2062981  PMID: 9743299
22.  Severe theophylline poisoning: charcoal haemoperfusion or haemodialysis? 
Postgraduate Medical Journal  1995;71(834):224-226.
Theophylline poisoning with a blood level of 183 mg/l in a 38-year-old man was treated with activated charcoal by mouth, but despite this the blood level of theophylline rose and there was circulatory collapse with rhabdomyolysis, acute renal failure and hyperthermia. Treatment with charcoal haemoperfusion and simultaneous haemodialysis was given, followed by continuous arteriovenous haemodialysis (CAVHD). Mean extraction rates of theophylline were 26% during CAVHD, and 86% during combined dialysis and charcoal haemoperfusion. During combined treatment, the mean extraction rate of haemodialysis was 62%, compared with 48% for charcoal haemoperfusion. In summary, activated charcoal given by mouth may be unable to prevent a rise in blood levels and the development of complications after substantial theophylline overdose. If theophylline is to be removed from the blood, a combination of charcoal haemoperfusion and haemodialysis will give the best clearance, but haemodialysis alone may be effective.
PMCID: PMC2398059  PMID: 7784283
23.  Secondary oxalosis and sperm granuloma of the epididymis. 
Journal of Clinical Pathology  1994;47(5):470-471.
A 30 year old man with a 20 year history of chronic renal failure who presented with a testicular lesion is described. The lesional pathology, secondary oxalosis, and associated sperm granuloma of the epididymis was clinically considered to be an intrascrotal tumour. The oxalate crystal deposition was present within the rete testis, the ductuli efferents, and the epididymis along with sperm granulomata. This seems to be a rare complication of secondary oxalosis associated with chronic renal failure and having both clinical and pathological implications.
PMCID: PMC502031  PMID: 8027405

Results 1-25 (30)