Is tropical pus in the hand special? A retrospective study comparing hand infection cases in Darwin and Adelaide.

BACKGROUND: Hand infections are a common reason for presenting to hospital and can be associated with significant morbidity and prolonged antibiotic use. Factors recognized to influence patient outcomes include resistant organisms and delayed presentation. Surgeons working around Australia may assume that hand infections and appropriate treatment algorithms will be similar between sites. This is the first study to examine differences between hand infections presenting in Darwin (with its tropical climate) vs. those in a more temperate city (Adelaide). METHODS: This is a two-site retrospective study, where diagnostic discharge codes were used to identify cases for a 12-month period and patient age, sex and rurality, duration of hospital stay, microbiology results and subsequent trips to theatre were reviewed. RESULTS: Despite significant differences in rurality between FMC and RDH patients, there was no significant difference in length of hospital stay, duration of intravenous antibiotics or return trips to theatre across the two sites. RDH reported a 25% rate of MRSA, compared to 18% at FMC, as well as a statistically significant increase in uncommon microbes, with 30% compared to 12% of patients growing microbes that may not be covered by antibiotics routinely administered in metropolitan areas. A limitation of this study was that compliance with antibiotics and hospital stay were not accounted for. CONCLUSION: It is often our training years that determine our norms of everyday practice, but fewer Australian surgical training posts are located in tropical centres. The results of this study highlight the importance of not assuming that the spectrum of organisms causing hand infections are the same as that in the surgeons' state of origin.

Self-reported breast size, exercise habits and BREAST-Q data - an international cross-sectional study of community runners.

Women with larger breasts tend not to participate in high-intensity exercise and exercise less frequently. This study investigates how breast size impacts exercise habits and how breast reduction surgery changes women's participation in recreational exercise. Recruitment was generated via parkrun Limited (Richmond, UK), an organization offering weekly community-based runs. Female parkrun members aged over 18 years with no history of breast cancer were invited to complete a survey, including questions about their exercise habits, breast size, any breast alteration surgery, and BREAST-Q questionnaires. A total of 1987 women completed the survey, including 56 women who had undergone breast reduction. Results demonstrate that women with bigger breasts believe that reducing their breast size would improve their exercise performance and participation and that their breast size significantly impacts their type of exercise. Women who had undergone breast reduction reported increased overall frequency, enjoyment, and willingness to exercise in a group. Additionally, women that have undergone breast reduction report higher BREAST-Q scores than their non-surgical counterparts. This study supports the existing literature that breast size can impact exercise habits and demonstrates that women who have undergone breast reduction participate in healthier lifestyle practices. We suggest that if breast size impacts women's participation in sport and fitness, health practitioners and policymakers should advocate for better access to reduction mammoplasty in the publicly funded health sector.

A comparison of reconstructive outcomes following rotation flap approach (RoFA) versus standard mastectomy: a randomized controlled trial.

BACKGROUND: The rotation flap approach (RoFA) mastectomy is a skin-sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health-related quality of life between the ROFA mastectomy and standard mastectomy approach. METHODS: This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST-Q was administered pre-operatively and at 3-, 6-, 9- and 12-months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. RESULTS: A total of 100 participants were enrolled in the study; of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST-Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post-operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. CONCLUSION: The RoFA skin-sparing mastectomy incision showed no significant difference in results across patient-reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis.

Normative data for the Nasal Obstruction Symptom Evaluation Scale in the general Australian population.

BACKGROUND: Recent changes to the Australian Medicare Benefits Scheme have introduced the NOSE Score as a criteria threshold for funding rhinoplasty. On review of the literature, however, there is minimal normative Nasal Obstruction Symptom Evaluation (NOSE) score data to provide context for these changes. METHODS: Participants were recruited according to the general Australian population distribution of age (18-65 years), gender and geographical locations using the market research company Pureprofile. The data included demographic details, risk factors for nasal obstruction such as smoking, obstructive sleep apnoea, use of continuous positive airway pressure, history of nasal trauma, operations to the nose and a history of cleft lip/palate and each participant completed the NOSE Scale. Analysis of data included descriptive statistics, independent t-tests and one-way analysis of variances to assess differences in NOSE scores between risk factors. RESULTS: The NOSE score was completed by 247 males and 255 females with a mean age of 41(±13.39) years. The cohort had a mean NOSE score of 16 (±18.89) with a range from 0 to 95. A total of 48 respondents had a NOSE score greater than the Medicare threshold of >45. Cleft lip/palate, obstructive sleep apnoea and continuous positive airway pressure use were shown to have a statistically significant impact on NOSE score while other variables including body mass index, gender, smoking, location and other surgery to the nose were not shown to significantly impact results. CONCLUSIONS: This study found that 9.6% of the general Australian population would have a NOSE score >45 and qualify for the Medicare Benefits Scheme rhinoplasty benefit.

A preliminary investigation of the Partners in Health scale measurement properties in patients with end stage renal disease.

End-stage renal disease (ESRD) is becoming more prevalent in Australia. As a result, strategies to improve quality of life when living with ESRD are becoming increasingly important. The Flinders Program has been developed to help support and increase the self-management capacity of people living with chronic disease. The Partners in Health (PIH) scale is a self-management capacity assessment tool, which is an integral element of the Flinders Program. The primary aim of this study was to investigate the preliminary measurement properties of the PIH scale within the ESRD population. Forty participants took part in the study, which involved survey assessments at baseline and follow up and a semi-structured interview. Results indicated that the PIH scale had good internal reliability (α=0.85), moderate test-retest reliability (r=0.33) and face validity in ESRD patients. Areas for improving the instrument or data collection process were identified through qualitative interviews, and implications are discussed specific to ESRD patients.

Impact of stretching on the performance and injury risk of long-distance runners.

Stretching, either prior to exercise or at the end, or both, is typically carried out by all individuals undertaking sporting activity whether they be elite or recreational athletes. The many forms of stretching available to the athlete, either passive or active, have long been thought to improve performance, decrease injury and generally be advantageous to the athlete. This review examines the current state of the literature and evaluates what athletes can and should do with respect to this controversial topic.

An 18-month follow-up investigation of motor coordination and working memory in primary school children.

The aim of the current study was to examine the relationship between motor coordination and visual working memory in children aged 5-11 years. Participants were 18 children with movement difficulty and 41 control children, assessed at baseline and following an 18-month time period. The McCarron Assessment of Neuromuscular Development provided a measure of motor skills and the CogState One-Back task was used to assess visual working memory. Multi-level mixed effects linear regressions were used to assess the relationship between fine motor skills, gross motor skills, and visual working memory. The results revealed that for children with movement difficulty, better fine motor skills at baseline significantly predicted greater One-Back accuracy and greater (i.e., faster) speed at 18-month follow-up. Conversely, fine motor skills at baseline did not predict One-Back accuracy and speed for control children. However, for both groups, greater One-Back accuracy at baseline predicted better fine and gross motor skills at follow-up. These findings have important implications for the assessment and treatment of children referred for motor difficulties and/or working memory difficulties.

The paradox of HPV vaccines: how to reach sexually inexperienced women for protection against a sexually transmitted infection.

PURPOSE: The current study examined the impact of a human papillomavirus (HPV) vaccine message tailored for sexually inexperienced women. METHODS: We included 193 young women, aged 17 to 26, attending university, who completed an on-line questionnaire. The participants were randomly assigned to three conditions that manipulated the type of information they received on HPV and the vaccine: control (minimal information, sexual transmission information omitted), detailed (emphasized sexual transmission of HPV), or tailored (the same as detailed, but also emphasized the benefit to sexually inexperienced women). RESULTS: Women with no sexual experience intended to receive an HPV vaccine more in the tailored condition than the detailed condition (q = 3.46; p < .05) and the control condition (q = 5.11; p < .01). There was no difference between the detailed condition compared with the control condition (q = 1.45; p = NS). CONCLUSION: This study found that a message tailored for sexually inexperienced women resulted in higher intentions to receive the HPV vaccine compared with messages that were not tailored. When providing information about HPV vaccines to sexually inexperienced patients, it may be particularly important to emphasize that HPV vaccines are most efficacious if received before the onset of sexual activity. The results suggest that this is more effective in increasing sexually inexperienced women's interest in the vaccine than avoiding information about sexual transmission altogether.

Pharmacodynamics of controlled release verapamil in patients with hypertension: an analysis using spline functions.

AIMS: To use a nonparametric approach involving longitudinal splines to model the baseline blood pressure profile and investigate the impact of this modelling on the pharmacodynamic analysis for verapamil in patients with angina or hypertension. METHODS: Dose ranging studies were conducted in patients with hypertension and with angina. Subjects received doses of 120, 180, 360 or 540 mg racemic verapamil. Pharmacodynamic data were created by subtracting the (systolic) blood pressure following active drug from the placebo response, either by direct subtraction or after modelling the baseline with a longitudinal spline model fitted to the placebo data by nonlinear mixed effects modelling. An Emax model was then used to describe the relationship between change in blood pressure and (R-)verapamil plasma concentration. RESULTS: The maximum decrease in systolic blood pressure was found to be 57.6 (+/- 26.1) mm and the C50 was 420 (+/- 349) microg/l for the data obtained by direct subtraction of the placebo data. Similar results were obtained when a cubic spline model was used to describe each individual's placebo response. However, the use of a population spline model only allowed a linear pharmacodynamic model to be fitted to the resulting data. Sparse data were created by randomly removing 66% of the data from the placebo and active phases. The population spline model gave very similar parameter estimates for the linear model applied to the sparse data to those obtained from the complete data set. CONCLUSIONS: The use of a longitudinal spline model together with nonlinear mixed effects modelling to account for baseline blood pressure response can be very powerful in a sparse data environment.