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Biomedical subjects

P Cameron

Publications and source records attributed to P Cameron.

At least 19 recordsLinked to original sources
PubMed2004

Febrile adults presenting to the emergency department: outcomes and markers of serious illness.

OBJECTIVES: To determine outcomes and markers of serious illness for febrile patients presenting to an adult emergency department. METHODS: A prospective cohort study of patients presenting to the emergency department with a temperature >or=38 degrees C. Medical staff obtained demographic data and risk factor profiles while assessing each febrile patient. All were followed up to determine death, admission to intensive care, length of stay in hospital, or subsequent admission to hospital within 30 days. Univariate and multivariate analysis determined which factors were markers of serious illness. RESULTS: For febrile adults admitted to hospital 3.0% died, 6.1% were admitted to intensive care, median length of stay in hospital was 7.2 days. Independent risk factors were-death: age (OR = 1.04), respiratory rate (OR = 1.06), white cell count (OR = 1.02), cardiac disease (OR = 3.3), and jaundice (OR = 21.4). Admission to intensive care: respiratory rate (OR = 1.1), pulse rate (OR = 1.03), and jaundice (OR = 5.1). Increased length of hospital stay: age (p<0.01), jaundice (p<0.01), respiratory rate (p = 0.01), focal neurological signs (p = 0.01), and changed mental state (p = 0.04). For febrile adults sent home 7.9% required admission to hospital within 30 days. Risk factors were respiratory rate (OR = 1.2), being female (OR = 5.36), malignancy (OR = 15.3), and cardiac disease (OR = 19.7). Initially having no focus of infection was protective (OR = 0.13). No febrile patient sent home from the emergency department died or required admission to intensive care. CONCLUSIONS: Few febrile adults presenting to the emergency department suffer an adverse outcome suggesting effective risk stratification is occurring. The identification of factors associated with adverse events may further improve this process.

Adult↗
PubMed2003

Non-invasive ventilation in acute respiratory failure: a randomised comparison of continuous positive airway pressure and bi-level positive airway pressure.

OBJECTIVES: To determine whether there is a difference in required duration of non-invasive ventilation between continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) in the treatment of a heterogeneous group of emergency department (ED) patients suffering acute respiratory failure and the subgroup of patients with acute pulmonary oedema (APO). Secondary objectives were to compare complications, failure rate, disposition, length of stay parameters, and mortality between the treatments. METHODS: This prospective randomised trial was conducted in the emergency departments of three Australian teaching hospitals. Patients in acute respiratory failure were randomly assigned to receive CPAP or BiPAP in addition to standard therapy. Duration of non-invasive ventilation, complications, failure rate, disposition, length of stay (hospital and ICU), and mortality were measured. RESULTS: 101 patients were enrolled in the study (CPAP 51, BiPAP 50). The median duration of non-invasive ventilation with CPAP was 123 minutes (range 10-338) and 132 minutes (range 20-550) for BiPAP (p = 0.206, Mann-Whitney). For the subgroup suffering APO, 36 were randomised to CPAP and 35 to BiPAP. For this group the median duration of non-invasive ventilation for CPAP was 123 minutes (range 35-338) and 133 minutes (range 30-550) for BiPAP (p = 0.320, Mann-Whitney). CONCLUSIONS: These results suggest that there is no significant difference in the duration of non-invasive ventilation treatment between CPAP and BiPAP when used for the treatment of acute respiratory failure in the ED. There was also no significant difference between the groups in secondary end points.

Acute Disease↗
PubMed2002

Impact of early intervention on outcome following mild head injury in adults.

BACKGROUND: The impact of mild head injury is variable and determinants of outcome remain poorly understood. Results of previous intervention studies have been mixed. OBJECTIVES: To evaluate the impact on outcome of the provision of information, measured in terms of reported symptoms, cognitive performance, and psychological adjustment three months postinjury. METHODS: 202 adults with mild head injury were studied: 79 were assigned to an intervention group and were assessed one week and three months after injury; 123 were assigned to a non-intervention control group and were seen at three months only. Participants completed measures of preinjury psychological adjustment, concurrent life stresses, post-concussion symptoms, and tests of attention, speed of information processing, and memory. Subjects seen at one week were given an information booklet outlining the symptoms associated with mild head injury and suggested coping strategies. Those seen only at three months after injury did not receive this booklet. RESULTS: Patients in the intervention group who were seen at one week and given the information booklet reported fewer symptoms overall and were significantly less stressed at three months after the injury. CONCLUSIONS: The provision of an information booklet reduces anxiety and reporting of ongoing problems.

Adult↗
PubMed2001

Dipstick urinalysis and the accuracy of the clinical diagnosis of urinary tract infection.

The aim of this study was to determine whether dipstick urinalysis (DU) augmented the accuracy of clinical assessment in the diagnosis of urinary tract infection (UTI). The study was performed in 627 consecutive patients attending an adult emergency department (ED) in whom the clinical diagnosis of UTI was considered. We excluded 227 patients. Treating clinicians gave the probability of a UTI on an ordinal and continuous scale, before and after DU. The assigned clinical probabilities were then compared to the results of formal urine culture. The areas under receiver-operating characteristic curves (AUC) were calculated. We found that clinical assessment alone was effective in detecting those patients with a UTI from those without (AUC 0.75; p < 0.0001). There was, however, a statistically significant difference in the accuracy of diagnosing UTI after DU (AUC 0.87; p < 0.0001). Proportionately more patients with a moderate pre-test probability of UTI were re-assigned to a different probability rating following DU, compared to the low or high pre-test probability groups (p < 0.001). We conclude that DU in combination with clinical assessment is a superior method for diagnosing UTI than clinical assessment alone.

Adult↗
PubMed2001

Predicted impact on Victoria's ambulance services of a new major trauma system.

BACKGROUND: In 1999, a new major trauma system was proposed for the state of Victoria, Australia. The guidelines for the new system were aimed at delivering major trauma cases to definitive trauma care in the least time possible. The aim of the present study was to analyse the potential effect of this system on Victoria's ambulance services. METHODS: The present study modelled the workload of major trauma cases in Victoria's ambulance service for one year pre- and post-introduction of the guidelines. Cases were analysed regarding whether their first hospital destination would change under the proposed guidelines, and, subsequently, whether they would require interhospital transport to a higher level trauma service. The impact on the ambulance services was modelled as annual changes in distances travelled due to predicted changes in hospital destinations. RESULTS: Analysis of the predicted changes indicated that, in general, Victoria's metropolitan and rural road ambulance crews would not be greatly affected. However, some metropolitan road crews may have to travel extra distances for up to 110 cases per year. The major impact was on air retrieval crews, where the annual number of interhospital transfers is predicted to increase from approximately 150 to 330. CONCLUSIONS: The present study demonstrated that most of the impact of a new trauma system on Victoria's ambulance services could be readily absorbed into the current workload. However, it also highlighted areas affected disproportionately within the ambulance services; in particular, air retrieval. Such studies are important to enable the effective implementation of new trauma systems.

Aged↗
PubMed2001

Impact of early intervention on outcome after mild traumatic brain injury in children.

OBJECTIVE: The impact of mild head injury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psychological adjustment in children 3 months after injury. METHODS: A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 children with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N = 45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury behavior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested coping strategies. Those seen 3 months after injury only did not receive this booklet. RESULTS: Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behavioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury. CONCLUSIONS: Providing an information booklet reduces anxiety and thereby lowers the incidence of ongoing problems.

Adaptation, Psychological↗
PubMed2001

Green, Mandel, Hotvedt, Gray, and Smith's study of 50 lesbian mothers and their children: inconsistencies in four published reports of the data.

The 1986 study of 50 lesbian mothers by Green, et al. may be the most influential concerning homosexual parenting. However, after setting standards for--and noting preliminary evidence of--gender identity confusion in 1980 and 1982, confirmatory findings in 1986 were not included in the report's abstract and conclusions. Numerous discrepancies in different published accounts of this study--including number of subjects and how, subjects were matched and analyzed--cannot be reconciled. The earliest reports were not cited in the final report which led to treatment in the literature as separate studies. The inconsistencies between the published accounts are substantive and numerous enough to recommend that the authors issue a complete and detailed report of the study.

Adult↗
PubMed2000

Observation of a hybrid spin resonance

A new type of spin depolarization resonance has been observed at the Brookhaven Alternating Gradient Synchrotron (AGS). This spin resonance is identified as a strong closed-orbit sideband around the dominant intrinsic spin resonance. The strength of the resonance was proportional to the 9th harmonic component of the horizontal closed orbit and proportional to the vertical betatron oscillation amplitude. This "hybrid" spin resonance cannot be overcome by the partial snake at the AGS, but it can be corrected by the harmonic orbit correctors.

Journal Article↗
PubMed2000

Factors influencing outcome following mild traumatic brain injury in adults.

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS-R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI.

Adolescent↗
PubMed1999

Cognitive and behavioral outcome following mild traumatic head injury in children.

OBJECTIVES: To investigate outcome in children with mild traumatic head injury (THI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. DESIGN: Postconcussional symptomatology, behavior ratings, and neuropsychological test performance were examined at 1 week and 3 months postinjury. SETTING: Participants were recruited from successive presentations to emergency departments of two major hospitals. PARTICIPANTS: 130 Children with mild THI were compared with 96 children having other minor injuries as controls. RESULTS: Children with mild THI experienced headaches, dizziness, and fatigue but exhibited no cognitive impairments, relative to controls, at 1 week postinjury. By 3 months, symptoms had resolved. However, 17% of children showed significant ongoing problems. They were more likely to have a history of previous head injury, learning difficulties, neurological or psychiatric problems, or family stressors. CONCLUSIONS: Persisting problems following mild head injury in children are more common in those with previous head injury, preexisting learning difficulties, or neurological, psychiatric, or family problems. These "at-risk" children should be identified in the emergency department and monitored.

Adolescent↗
PubMed1999

Homosexual parents: why appeals cases approximate the "gold standard" for science--a reply to Duncan.

Unlike the unverifiable claims of volunteers in studies of homosexual parenting, an alert ex-spouse is ready to testify as to the falsity of any claim by the other spouse in custody proceedings. Further, a greater variety of professionals are involved in getting at the "truth." We argue that examination of an unbiased corpus of such appeals cases is far more apt to reflect the underlying "reality" about homosexual parenting than studies performed on volunteers.

Homosexuality↗
PubMed1999

Homosexual parents: testing "common sense"--a literature review emphasizing the Golombok and Tasker longitudinal study of lesbians' children.

Counter to claims by the American Psychological Association and the National Association of Social Workers as well as numerous reviewers that children raised by homosexuals and married heterosexuals do not differ, the elaborate social-personality theory called "common sense" predicts that because "like produces like" and because psychopathy/sociopathy informs the major expressions of social deviance including homosexuality, children of homosexuals will (1) be more frequently subjected to parental instability (of residence and sexual partners) and (2) have poorer peer and adult relationships. Also, as is held to be true of their parents, homosexuals' children will be more apt to (3) become homosexual, (4) be unstable (have emotional problems and difficulty forming lasting bonds) with reduced interest in natality, and (5) be sexually precocious and promiscuous. Differences between homosexual and heterosexual comparison groups that bore on "common sense" were considered suggestive "bits" of empirical evidence. Differences that emerged within studies conducted by sympathetic researchers utilizing volunteer samples were considered bits of adverse evidence. Of 171 bits, 82 adverse and 55 nonadverse bits supported, while 34 bits fell against "common sense." From this tentative method of counting, support was found for common sense beliefs that children of homosexuals will be more apt to become homosexual and have poorer peer relationships, while weaker support was found for some of the other predictions. As assessed in this way, the empirical evidence in the literature tended to lean against claims of "no differences" between children raised by homosexuals and heterosexuals. In particular, the strongly worded official claims of there being "no differences" are overstatements. They amount to the organizations and some prominent researchers asserting that they have proven the null hypothesis, which is fundamentally impossible. It is likely that the nonsignificant statistical findings stressed thus far include Type Two errors created by use of volunteer samples, inadequate identification and measurement of likely differences, and refusal to interpret results in ways contrary to the sympathies of subjects, investigators, and the organizations.

Adult↗
PubMed1998

The management of anterior abdominal stab wounds in Australasia.

BACKGROUND: The low incidence of stab wounds in Australasia has led to a more operative approach for the management of anterior abdominal stab wounds. A survey of Australasian surgeons interested in trauma was undertaken to analyse current practice. METHODS: Ninety-seven early management of severe trauma surgical instructors (known as ATLS in Australasia) were surveyed using a four-part, single-page questionnaire. RESULTS: Sixty-five instructors completed the survey. Thirty-nine instructors stated that they would admit patients with stab wounds even if the wound appeared superficial or 'skin only'. For 14 surgeons the decision to perform a laparotomy was dependent on fascial penetration and for 17 the decision depended upon peritoneal penetration. Six felt that all but the most superficial wounds should have a laparotomy. Laparoscopy, diagnostic peritoneal lavage and other investigations were also thought to be helpful. Thirteen surgeons felt that the presence of peritonism or tenderness were the most important determinants. There was no hospital protocol for 44 respondents and there was a wide variation in individual approach to this problem. However, all agreed that peritonism and haemodynamic instability were indications for immediate laparotomy. CONCLUSIONS: There is still a low threshold for laparotomy in Australasia and this approach is not without risks. However, the alternative of using serial observation should be regarded as an active form of management and protocols must be established to ensure regular repeat examinations by experienced personnel. The low incidence of abdominal stab wounds in Australasia makes this approach difficult. A safe approach for the Australasian situation is described.

Abdominal Injuries↗
PubMed1998

What proportion of newspaper stories about child molestation involves homosexuality.

Do homosexuals disproportionately molest children? A survey of 8 of the nation's newspaper news stories of child molestation during the first 9 months of 1995 showed that about 40% of child molestation stories in the major cities involve homosexuality. An Internet survey of FirstSearch for 1989 through 1995 indicated 46%, and of Newsbank for 1990 through 1995 60% of molestations were homosexual. About half of teachers, day care workers and other professionals caught molesting children assaulted them homosexually. It is argued that large unbiased sets of newspaper news stories appear to approximate the figures for incidence of child molestation by those occupying a newsworthy status but overreport homosexual molestation in general.

Adolescent↗
PubMed1998

Homosexual parents: a comparative forensic study of character and harms to children.

40 appeals cases of custody disputes drawn systematically from all cases involving a homosexual parent in the United States were compared to 38 appeals cases involving heterosexual custody disputes drawn randomly from listings under parental "character" and 18 appeals cases drawn randomly from "general" cases in Dicennial Digest from 1966 to 1991. Each case involving homosexual vs heterosexual claimants was examined for recorded information about (1) the character of the homosexual parent, the associates of the homosexual parent, the heterosexual parent, and the associates of the heterosexual parent, (2) the effects, particularly harms, upon the child(ren), and (3) psychiatric opinion. 82% of the homosexual vs 18% of the heterosexual parents and 54% of the homosexual's associates vs 19% of the heterosexuals' associates were recorded as having poor character in cases involving a homosexual claimant. Of the 66 recorded harms, e.g., molestation, physical abuse, to the 73 children, homosexual persons accounted for 64 (97%). Of the 32 lesbians, 6 were recorded as having engaged in criminal activity and 3 of bringing false charges of child sexual abuse against the father. Psychiatric opinion, however, ran 25 to 12 in favor of custody for the homosexual parent. In the 56 heterosexual vs heterosexual comparison cases, 38% of the heterosexual parents and 28% of their associates were recorded as having poor character. Six harms to their 105 children and 3 instances of criminality but no false charges of sexual abuse were recorded. In the appeals court literature, homosexual parents were disproportionately of poor character and disproportionately associated with various harms to their children.

Adolescent↗