Bruce Shadbolt

The Canberra Hospital, Canberra, Australian Capital Territory, Australia

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Publications (76)227.44 Total impact

  • W Wen · R Frampton · K Wright · S Fattore · B Shadbolt · S Perampalam ·
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    ABSTRACT: Aims: To identify the knowledge and management factors associated with glycaemic control among adults with Type 1 diabetes mellitus treated with insulin pump therapy (IPT). Methods: A cross-sectional study of adults with Type 1 diabetes mellitus on IPT for at least 12 months (n = 50, 18-70 years old) was undertaken between December 2013 and May 2014. A new questionnaire was developed to evaluate participants' knowledge and management related to IPT, which were correlated with insulin pump data, HbA1c and frequency of hypoglycaemia. Results: Participants who changed their insulin pump settings when indicated had significantly better glycaemic control than those who did not (P = 0.04). Multivariate logistic regression analysis found that better overall IPT management was a significant predictor of better glycaemic control (odds ratio 4.45, 95% confidence interval 1.61-12.3; P = 0.004) after adjusting for potential confounders including age, gender, duration of diabetes and IPT. However, overall IPT knowledge was not a significant predictor of glycaemic control (P = 0.058). There was no significant association between frequency of hypoglycaemia and IPT knowledge or management. Conclusions: We identified some key knowledge and management factors associated with glycaemic control in adults with Type 1 diabetes mellitus on IPT using a newly designed questionnaire. The pilot study assessed the clinical utility of this evaluation tool, which may facilitate provision of targeted education to IPT users to achieve optimal glycaemic control. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 10/2015; DOI:10.1111/dme.13001 · 3.12 Impact Factor
  • K Subramaniam · K Tymms · B Shadbolt · P Pavli ·
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    ABSTRACT: To determine self-reported prevalence of spondyloarthritis (SpA)-associated musculoskeletal manifestations in an inflammatory bowel disease (IBD) cohort on TNF inhibitors using a questionnaire incorporating Assessment of SpondyloArthritis International Society (ASAS) criteria. Consecutive IBD patients on TNF inhibitors attending a single IBD centre (May-September 2011) were asked to complete a SpA questionnaire. Data collected included SpA and IBD variables, demographics, concurrent medications, comorbidities and autoimmune serology. The 140-patient cohort included 96 suffering from Crohn's disease (CD) and 44 from ulcerative colitis (UC). The mean age of disease onset was 29.3 years and 45% were men. Concurrent or past history of inflammatory back pain was reported by 29% subjects. Using the imaging and clinical arms of the ASAS criteria 30% and 14% subjects respectively had axial SpA. Arthritis was reported by 34%, enthesitis 17%, dactylitis 4%, uveitis 6%, psoriasis 6% and a family history of SpA in 39%. Peripheral SpA was present in 41% by the ASAS criteria. There were no differences in these frequencies between CD and UC. A positive ANA (>1:80) was found in 19% before commencement of TNF inhibitor therapy and increased to 78% on therapy. Clinical drug-induced lupus erythematosus (CDLE) was uncommon (4%) and was characterised by new clinical signs and symptoms including arthralgia, rash with elevated dsDNA titres and positive ANA. IBD patients on TNF inhibitors frequently reported musculoskeletal manifestations. Increased recognition of SpA occurred with use of a SpA self-reported questionnaire in IBD patients: this could alter management and improve patient outcomes. CDLE was uncommon. This article is protected by copyright. All rights reserved.
    Internal Medicine Journal 09/2015; DOI:10.1111/imj.12891 · 1.64 Impact Factor
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    ABSTRACT: This is a retrospective analysis of a multicentre randomised controlled trial (RCT) where we concluded that CeasIng Cpap At standerD criteriA (CICADA) in premature babies (PBs) <30 weeks gestational age (GA) was the significantly better method of ceasing CPAP. To identify factors that may influence the number of attempts to cease CPAP, we reviewed the records of 50 PBs from the RCT who used the CICADA method. PBs were grouped according to number of attempts to cease CPAP (fast group ≤2 attempts and slow group >2 attempts to cease CPAP). There were 26 (fast group) and 24 (slow group) PBs included in the analysis. Results showed significant differences in mean GA (27.8 ± 0.3 vs 26.9 ± 0.3 [weeks ± SE], p = 0.03) and birth weight ([Bwt]; 1080 ± 48.8 vs 899 ± 45.8 [grams ± SE], p = 0.01) between groups. Significantly fewer PBs in the fast group had a patent ductus arteriosus (PDA) compared to the slow group (5/26 (19.2 %) vs 13/24 (54.2 %), p = 0.02). Bwt was a significant negative predictor of CPAP duration (r = -0.497, p = 0.03) and CPAP ceasing attempts (r = -0.290, p = 0.04). PBs with a higher GA and Bwt without a PDA ceased CPAP earlier using the CICADA method. Bwt was better than GA for predicting CPAP duration and attempts to cease CPAP. What is Known: • Our previous studies showed that CeasIng Cpap At standarD criteriA (CICADA) significantly reduces CPAP time, oxygen requirements and caffeine use. • Some PBs however using the CICADA method required >2 attempts to cease CPAP ('slow CICADA' group). What is New: • PBs in the 'fast CICADA' group (<3 attempts to cease CPAP) (a) have longer gestational age and higher birth weight, (b) shorter mechanical ventilation and (c) lower incidence of patent ductus arteriosus. • Attempts to cease CPAP decreased by 0.5 times per 1 week increase in GA and 0.3 times per 100-g increase in birth weight for PBs <30 weeks gestation.
    European Journal of Pediatrics 08/2015; DOI:10.1007/s00431-015-2603-8 · 1.89 Impact Factor
  • Mark D. Porter · Bruce Shadbolt ·
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    ABSTRACT: Background There is no consensus regarding the optimal management of the acutely ruptured Achilles tendon (TA). Functional bracing alone achieves outcomes similar to those of surgical repair. Surgical repair combined with immediate mobilization may improve the clinical outcome further. The purpose of our study was to determine if an accelerated rehabilitation programme following surgical repair of the ruptured TA could improve clinical outcome, relative to the standard protocol.Methods Patients with an acutely ruptured TA were randomly allocated to undergo an accelerated programme (AP) or standard programme (SP), following surgery. Outcome was assessed at 12 months post-surgery using the Achilles tendon Total Rupture Score (ATRS), the heel-raise height and the time taken to return to running.ResultsFifty-one patients completed the study, 25 in the AP group and 26 in the SP group. At 12 months post-surgery, the ATRS results were similar in the two treatment groups (87.46 in AP with standard error (SE) of 0.735 versus 87.12 in SP with SE of 0.75) while the AP group had less lengthening of the TA (0.385 cm, SE 0.166 versus 1.00 cm, SE 0.169) and a more rapid return to running (17.231 weeks, SE 0.401 versus 21.08 weeks, SE 0.409), than the SP group.Conclusion The accelerated rehabilitation programme resulted in less tendon lengthening, more rapid return to running, but similar ATRS relative to the standard rehabilitation. Immobilization following TA repair may prolong recovery.
    ANZ Journal of Surgery 12/2014; 85(5). DOI:10.1111/ans.12910 · 1.12 Impact Factor
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    ABSTRACT: Background Muscle wasting or sarcopenia arising from chronic inflammation is found in 60% of patients with Crohn's disease. Transcriptional protein NF-κB reduces muscle formation through MyoD transcription and increases muscle breakdown by proteolysis.AimAs TNF is a potent activator of NF-κB, and anti-TNF agent infliximab (IFX) prevents NF-κB activation, to determine whether or not Crohn's patients treated with IFX gain muscle volume and strength.Methods We performed a prospective, repeated-measures cohort study in adult Crohn's disease patients with an acute disease flare. Patients were instructed not to vary diet or activity. Concomitant medications were kept stable. At week 1 (pre-treatment), week 16 (post-IFX induction) and week 25 (post-first IFX maintenance dose), we assessed (i) MRI volume of quadriceps femoris at anatomical mid-thigh; (ii) maximal concentric quadriceps contractions strength at three specific speeds of contraction; (iii) physical activity by validated instrument (IPAQ); (iv) Three-day food record of intake and composition (food-weighing method); (v) Serum levels of IL6.ResultsNineteen patients (58% female; mean age 33.2 ± 10.7 years) were recruited. IFX increased muscle volume in both legs from baseline (right, 1505 cm3) to week 25 (right, 1569 cm3; P = 0.010). IFX also increased muscle strength in both legs from baseline (right 30°/s, 184.8 Nm) to week 25 (right 30°/s, 213.6 Nm; P = 0.002). Muscle volume gain correlated with male gender (P = 0.003). Significant gains in muscle volume and strength were unrelated to prednisolone use. Serum IL6 levels decreased by week 25 (P = 0.037).Conclusion The anti-TNF agent infliximab reverses inflammatory sarcopenia in patients with Crohn's disease.
    Alimentary Pharmacology & Therapeutics 12/2014; 41(5). DOI:10.1111/apt.13058 · 5.73 Impact Factor
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    ABSTRACT: Background We sought to determine if our regional program for pre-hospital STEMI diagnosis and direct transfer for primary PCI (PPCI) was associated with shorter ischaemic times and improved survival compared with ED diagnosis. Methods STEMI diagnosis was made at the scene by pre-hospital ECG or in local EDs depending on patient presentation. Ambulance ECGs were transmitted to our ED for cath lab activation. Patient variables and outcomes at 12 months were recorded. Results We treated 782 consecutive patients with PPCI during January 2008-June 2013. Cath lab activation was initiated prior to hospital arrival (pre-hospital) in 24% of cases and by ED in 76% of cases. Median total ischaemic time was 154 min for pre-hospital and 211 minutes for ED patients (p < 0.0001). Mortality at 12 months was 7.9% in the ED group compared with 3.7% in the pre-hospital group (p = 0.036). On multivariate Cox regression analysis including baseline and procedural variables, pre-hospital activation remained an independent predictor of mortality (HR 0.45, 95% CI 0.20-1.0, p = 0.03). Conclusions: Pre-hospital diagnosis of STEMI and direct transfer to the cath lab reduced total ischaemic time by 57 minutes and mortality by >50% following PPCI. Further efforts are needed to increase the proportion of STEMI patients treated using this strategy.
    Heart, Lung and Circulation 09/2014; 24(3). DOI:10.1016/j.hlc.2014.09.015 · 1.44 Impact Factor
  • Mark D Porter · Bruce Shadbolt ·
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    ABSTRACT: The ability of single-bundle anterior cruciate ligament (ACL) reconstruction to restore rotational control has been questioned by proponents of the double-bundle technique. The term anatomic positioning has become popularized in recognition of the incorrect positioning sometimes used in the past, which may have contributed to the lack of rotation control. The pivot-shift test remains the most clinically useful measure of ACL deficiency, and it is now possible to measure it both accurately and objectively using computer navigation.
    The American Journal of Sports Medicine 09/2014; 42(12). DOI:10.1177/0363546514549938 · 4.36 Impact Factor
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    ABSTRACT: Background/Aims: Indomethacin and ibuprofen are administered to close a patent ductus arteriosus during active glomerulogenesis. Light and electron microscopic glomerular changes with no change in glomerular number were seen following indomethacin and ibuprofen treatment during glomerulogenesis at 14 days after birth in a neonatal rat model. This present study aimed to determine whether longstanding renal structural changes are present at 30 days and 6 months (equivalent to human adulthood). Methods: Rat pups were administered indomethacin or ibuprofen antenatally on day18-20 (indomethacin 0.5 mg/kg/dose; ibuprofen 10 mg/kg/dose) or postnatally intraperitoneally from day 1 to 3 or day 1 to 5 (indomethacin 0.2 mg/kg/dose; ibuprofen 10 mg/kg/dose). Control groups received no treatment or normal saline intraperitoneally. Pups were sacrificed at 30 days of age and 6 months of age. Tissue blocks from right kidneys were prepared for light and electron microscopic examination, while total glomerular number was determined in left kidneys using unbiased stereology. Results: Eight pups were included in each group from 14 maternal rats. At 30 days and 6 months there were persistent EM abnormalities of the glomerular basement membrane in those receiving postnatal indomethacin and ibuprofen. There were no significant LM findings at 30 days or 6 months. At 6 months there were significantly fewer glomeruli in those receiving postnatal indomethacin but not ibuprofen (p=0.003) Conclusions: Indomethacin administered during glomerulogenesis appears to reduce the number of glomeruli in adulthood. Alternative options for closing a PDA should be considered including ibuprofen as well as emerging therapies such as paracetamol.
    American journal of physiology. Renal physiology 09/2014; 307(10). DOI:10.1152/ajprenal.00328.2014 · 3.25 Impact Factor
  • Mark Porter · Bruce Shadbolt · Robert Stuart ·
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    ABSTRACT: Background More than 20% of patients develop chronic instability following appropriate management of an ‘ankle sprain’. There is little research comparing surgical techniques. ‘Anatomical’ procedures, such as the modified Brostrom-Gould (MBG), are generally preferred. However, not all patients are suitable for this procedure. Augmentation of a primary repair using a synthetic ligament, such as the ligament augmentation reconstruction system (LARS), is another ‘anatomic’ option. Our objective was to compare the clinical outcome following the MBG with that following the LARS technique using a prospective randomized clinical trial.Methods Patients who satisfied the study criteria were randomly allocated to undergo the LARS procedure or the MBG procedure. All patients followed a similar rehabilitation programme. Patients completed the foot and ankle outcome score (FAOS) before surgery, and then at 1 year and 2 years following surgery. Statistical analysis was used to compare the groups (P < 0.05).ResultsForty-one patients took part in the study, 21 were randomized to the LARS group and 20 to the MBG group. The LARS group had a significantly better improvement in the total FAOS at both 1 year (25.5 standard error (SE) 3.8 versus 16.0 SE 3.3) and 2 years (27.1 SE 4.5 versus 15.8 SE 4.9) post-surgery.Conclusion Primary repair combined with LARS results in better patient-scored clinical outcome, at 2 years post-surgery, than the MBG procedure. Although longer follow-up is required, the LARS procedure may be considered as an alternative, especially in those patients for whom the MBG is relatively contra-indicated.
    ANZ Journal of Surgery 09/2014; 85(1-2). DOI:10.1111/ans.12837 · 1.12 Impact Factor
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    ABSTRACT: Objective: Pulmonary function abnormalities and hospital re-admissions in survivors of neonatal lung disease remain highly prevalent. The respiratory outcomes study (RESPOS) aimed to investigate the respiratory and associated atopy outcomes in preterm infants <30 weeks gestational age (GA) and/or birth-weight (BWt) <1000 g at primary school age, and to compare these outcomes between infants with and without chronic lung disease (CLD). Methods: In the RESPOS 92 parents of preterm infants admitted to the Neonatal unit in Canberra Hospital between 1/1/2001 and 31/12/2003 were sent a questionnaire regarding their respiratory, atopy management and follow-up. Results: Fifty-three parents responded, including 28 preterm infants who had CLD and 25 who had no CLD. The gestational age was significantly lower in the CLD group compared to the non-CLD group [26.9 (26.3-27.5) CLD and 28.6 (28.3-29.0) non-CLD] [weeks [95% confidence interval (CI)]], as was the birth weight [973 (877.4-1068.8) CLD versus 1221 (1135.0-1307.0) non-CLD] [g (CI)]. CLD infants compared to non-CLD infants were significantly more likely to have been: given surfactant, ventilated and on oxygen at 28 days and 36 weeks. These neonates were also more likely to have: been discharged from the neonatal unit on oxygen, exhibit a history of PDA or sepsis and to have a current paediatrician. However, despite these differences, there was no significant difference in the proportion of asthma or atopic disease between the two groups. Conclusions: The RESPOS could not demonstrate respiratory and/or atopy differences between the CLD and the non-CLD groups at primary school age.
    Journal of Asthma 08/2014; 52(1). DOI:10.3109/02770903.2014.952436 · 1.80 Impact Factor
  • R Heath Jeffery · DA Todd · M Broom · B Shadbolt ·
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    ABSTRACT: Our multicentre RCT showed that CeasIng Cpap At standarD criteriA (CICADA) compared to cycling off CPAP significantly reduced time on CPAP and weaning time.(1) We hypothesised that implementation of CICADA would reduce CPAP time. We compared premature babies (PB) <30 weeks gestation (GA) during the trial period (2007-2009) and post implementation of CICADA in our Neonatal Unit (2010-2012).
    Archives of Disease in Childhood - Fetal and Neonatal Edition 06/2014; 99(Suppl 1):A59-A61. DOI:10.1136/archdischild-2014-306576.170 · 3.12 Impact Factor
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    ABSTRACT: Background There is no evidence from randomized trials for the benefit of routine non-compliant balloon (NCB) post-dilation after stent deployment. Despite being the gold standard, intravascular ultrasound is infrequently performed due to time and cost constraints and a suitable alternative technology is required for routine assessment of stent expansion. The purpose of this study was to assess the contribution of NCB post-dilation in optimizing contemporary stents by using digital stent enhancement (DSE). Methods We treated 120 patients with stent insertion and assessed the stents with DSE before and after NCB use. Optimal expansion was defined as the minimum stent diameter (MSD) ≥ 90% of the nominal stent diameter, an adaptation of the MUSIC and POSTIT trial criteria. Stent deployment was performed at 12 atm pressure followed by routine NCB post-dilation at ≥ 14 atm. Results The mean reference diameter on QCA was 2.75 mm (SD 0.63) and mean stent diameter was 3.15 mm (SD 0.46). At a mean stent deployment pressure of 11.7 atm (SD 2.4), only 21% of stents were optimally expanded. After NCB inflation at a mean of 16.9 atm (SD 2.8), MSD increased by 0.26 mm (SD 0.24), optimal stent expansion increased from 21% to 58% and mean stent symmetry ratio increased from 0.83 to 0.87 (p < 0.0001). Conclusions Contemporary stents are sub-optimally expanded in the majority of cases after standard deployment compared with nominal sizes. Adjunctive NCB post-dilation optimized an additional 37% of stents. DSE analysis can assist in qualitative and quantitative stent assessments and can potentially facilitate a selective NCB post-dilation strategy to achieve optimal stent expansion.
    IJC Heart and Vessels 06/2014; 3:43–48. DOI:10.1016/j.ijchv.2014.03.006
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    ABSTRACT: Pegylated-interferon-α/ribavirin (PEG-IFN/RBV) treatment can cure hepatitis C virus (HCV) infection but has frequent neuropsychiatric side-effects. Patients with pre-existing psychiatric illness may not be offered therapy. We established prevalence of self-reported psychiatric comorbidity among HCV-infected patients in a hospital-liver clinic, and determined the impact of such diagnoses on uptake and tolerance to PEG-IFN/RBV. All HCV cases referred for assessment in Australian Capital Territory/surrounding regions April 2004–March 2012 were entered into a clinical database. We conducted univariate and multivariate analyses of variables correlating with uptake of antiviral therapy and frequency of treatment-related side-effects. Of 773 referred patients, 235 (30%) described pre-existing psychiatric illness. Among these, 26% received antiviral therapy, compared with 30% of 538 without psychiatric comorbidity. History of depression (usually validated by liaison psychiatry) was associated with higher incidence of treatment-related neuropsychiatric side-effects (odds ratio 2.79 [1.35–5.70], P < 0.05) but did not affect treatment outcome. Twenty-seven patients reported schizophrenia: three (11%) received antiviral therapy, compared with 30% admitting depression and 20% with bipolar affective disorder (all assessed by psychiatrist). In most schizophrenia cases, the reason for not offering antiviral treatment was psychological illness, yet none of five treated (these three plus two others in a psychiatric rehabilitation facility) experienced worsening psychiatric symptoms. A history of depression is common with hepatitis C but does not affect initiation of antiviral treatment, despite substantially increased risk of psychiatric side-effects. In contrast, pre-existing schizophrenia appears to influence treatment decisions, despite little evidence that PEG-IFN/RBV exacerbates the psychiatric condition, and well-supervised antiviral therapy can have good outcomes.
    Journal of Gastroenterology and Hepatology 06/2014; 29(6):1258-64. DOI:10.1111/jgh.12515 · 3.50 Impact Factor
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    ABSTRACT: In our previous randomised controlled trial (RCT), we have shown in preterm babies (PBs) <30 weeks gestation that CeasIng Cpap At standarD criteriA (CICADA (method 1)) compared with cycling off continuous positive airway pressure (CPAP) gradually (method 2) or cycling off CPAP gradually with low flow air/oxygen during periods off CPAP (method 3) reduces CPAP cessation time in PBs <30 weeks gestation. This retrospective study reviewed weight gain, time to reach full feeds and time to cease caffeine in PBs previously enrolled in the RCT. Data were collected from 162 of the 177 PBs, and there was no significant difference in the projected weight gain between the three methods. Based on intention to treat, the time taken to reach full feeds for all three methods showed no significant difference. However, post hoc analysis showed the CICADA method compared with cycling off gradually just failed significance (30.3±1.6 vs 31.1±2.4 (weeks corrected gestational age (Wks CGA±SD)), p=0.077). Analysis of time to cease caffeine showed there was a significant difference between the methods with PBs randomised to the CICADA method compared with the cycling off method ceasing caffeine almost a week earlier (33.6±2.4 vs 34.5±2.8 (Wks CGA±SD), p=0.02). This retrospective study provides evidence to substantiate the optimum method of ceasing CPAP; the CICADA method, does not adversely affect weight gain, time to reach full feeds and may reduce time to cease caffeine in PBs <30 weeks gestation.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 05/2014; 99(5). DOI:10.1136/archdischild-2013-304581 · 3.12 Impact Factor

  • Gastroenterology 05/2014; 146(5):S-597. DOI:10.1016/S0016-5085(14)62164-8 · 16.72 Impact Factor
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    ABSTRACT: Anti-tumour necrosis factor (TNF) agents are used as induction and maintenance therapy in ulcerative colitis (UC) refractory to standard therapy and as rescue therapy in acute severe ulcerative colitis (ASUC). To determine long-term outcomes including colectomy rates, predictors of maintenance of response and remission, risk of serious adverse events by reviewing 12-year clinical experience from a single centre in Australia. 71 patients with moderate-severe UC [Mayo score ≥6] (n = 52) and ASUC (n = 19) treated with anti-TNF agents were included. Primary endpoints were colectomy at 12 weeks and colectomy-free survival at last follow-up. Secondary endpoints included clinical response (decrease in Mayo score of ≥3) and remission (Mayo score ≤2). Colectomy at 12 weeks was 1% and colectomy-free survival was 69%. Using full Mayo score, at 3 months, 32/37 (87%) refractory and 9/12 (75%) ASUC patients responded to anti-TNF therapy; 19/37 (51%) refractory and 8/12 (67%) ASUC patients were in remission. Long-term response rates (mean follow-up 37.4 months) were 24/44 (55%) and 11/15 (73%) in refractory and ASUC groups respectively. Long-term remission rates were 43% in refractory and 60% in ASUC patients. 22/71 (31%) underwent colectomy (mean time 50.4 months). Clinical non-response at 3 months was a predictor of colectomy (HR = 9.346; p = 0.001). ASUC predicted long-term maintenance of response (OR 19.4; p=0.013) and remission (OR 6.13; p=0.037). 2/71 patients had serious infections. Anti-TNF therapy is effective in both refractory and ASUC. We argue that early anti-TNF therapy may improve outcome in UC.
    Internal Medicine Journal 02/2014; 44(5). DOI:10.1111/imj.12397 · 1.64 Impact Factor
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    ABSTRACT: Cardiovascular disease is a major cause of death in patients with stage 4-5 Chronic Kidney disease (CKD, eGFR < 30). There are only limited data on the risk factors predicting these complications in CKD patients. Our aim was to determine the role of clinical and echocardiographic parameters in predicting mortality and cardiovascular complications in CKD patients. We conducted a prospective observational cohort study of 153 CKD patients between 2007 and 2009. All patients underwent echocardiography at baseline and were followed for a mean of 2.6 years using regular clinic visits and review of files and hospital presentations to record the incidence of cardiovascular events and death. Of 153 patients enrolled, 57 (37%) were on dialysis and 45 (78%) of these patients were on haemodialysis. An enlarged LV was present in 32% of patients and in 22% the LVEF was below 55%. LV mass index was increased in 75% of patients. Some degree of diastolic dysfunction was present in 85% of patients and 35% had grade 2 or higher diastolic dysfunction. During follow up 41 patients (27%) died, 15 (39%) from cardiovascular causes. Mortality was 24.2% in the non-dialysis patients versus 31.6% in patients on dialysis (p = ns). On multivariate analysis age >75 years, previous history of MI, diastolic dysfunction and detectable serum troponin T were significant independent predictor of mortality (P < 0.01). Patients with stage 4-5 CKD had a mortality rate of 27% over a mean follow up of 2.6 years. Age >75 years, history of MI, diastolic dysfunction and troponin T were independent predictors of mortality.
    BMC Nephrology 12/2013; 14(1):280. DOI:10.1186/1471-2369-14-280 · 1.69 Impact Factor
  • Bianca L Preo · Bruce Shadbolt · David A Todd ·
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    ABSTRACT: AimsTo measure inspired gas humidity and temperature delivered by a Stephanie neonatal ventilator with variations in (i) circuit length; (ii) circuit insulation; (iii) proximal airway temperature probe (pATP) position; (iv) inspiratory temperature (offset); and (v) incubator temperatures. Methods Using the Stephanie neonatal ventilator, inspired gas humidity and temperature were measured during mechanical ventilation at the distal inspiratory limb and 3cm down the endotracheal tube. Measurements were made with a long or short circuit; with or without insulation of the inspiratory limb; proximal ATP (pATP) either within or external to the incubator; at two different inspiratory temperature (offset) of 37(-0.5) and 39(-2.0)degrees C; and at three different incubator temperatures of 32, 34.5, and 37 degrees C. ResultsLong circuits produced significantly higher inspired humidity than short circuits at all incubator settings, while only at 32 degrees C was the inspired temperature higher. In the long circuits, insulation further improved the inspired humidity especially at 39(-2.0)degrees C, while only at incubator temperatures of 32 and 37 degrees C did insulation significantly improve inspired temperature. Positioning the pATP outside the incubator did not result in higher inspired humidity but did significantly improve inspired temperature. An inspiratory temperature (offset) of 39(-2.0)degrees C delivered significantly higher inspired humidity and temperature than the 37(-0.5)degrees C especially when insulated. Conclusions Long insulated Stephanie circuits should be used for neonatal ventilation when the infant is nursed in an incubator. The recommended inspiratory temperature (offset) of 37(-0.5)degrees C produced inspired humidity and temperature below international standards, and we suggest an increase to 39(-2.0)degrees C.
    Pediatric Anesthesia 06/2013; 23(11). DOI:10.1111/pan.12206 · 1.85 Impact Factor
  • Sheila Rahman · Bruce Shadbolt · Dipti Talaulikar ·
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    ABSTRACT: Introduction: The International Council for Standardisation in Haematology (ICSH) recently introduced consensus guidelines on the reporting of bone marrow biopsies (BMB). Aim: To determine the potential impact of ICSH guidelines on routine reporting of BMB at Canberra Hospital. Methods: Laboratory data on BMB from 2009 [indications, nucleated differential cell count (NDC), iron studies, ancillary investigations and turnaround times (TAT)] were analysed and compared to previous years (1997, 2000 and 2004) using SPSS version 18.0. Results: The number of BMB increased over time (1997, n = 429; 2009, n = 624). An NDC of > 300 and >500 was performed in 82.7% and 12.5% of diagnostic BMB, respectively. Iron stains were performed in 86.2% of all BMB, including 85.3% of follow-up cases. Ancillary investigations were performed on 515 BMB (82.5%); flow cytometry and cytogenetics were most common (63.6% and 42.3% of all BMB, respectively), and increased over time. The mean TAT decreased over time (1997, 10.9 days; 2009, 6.7 days; p < 0.05). Conclusions: Current practice in our institution is congruent with ICSH recommendations although higher NDC are required in diagnostic cases. Despite increased numbers of BMB and reporting complexity, the average TAT has decreased. Rationalisation of iron stains may improve TAT. Reference 1. Lee SH, Erber WN, Porwit A, et al. ICSH guidelines for the standardization of bone marrow specimens and reports. Int J Lab Hematol 2008; 30: 349-64.
    Pathology 02/2013; 45:S96. DOI:10.1097/01.PAT.0000426988.51337.d4 · 2.19 Impact Factor
  • Titi Chen · Anne McDonald · Bruce Shadbolt · Dipti Talaulikar ·
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    ABSTRACT: Introduction: In Non-Hodgkin Lymphoma (NHL), bone marrow histology is the gold standard against which ancillary investigations such as immunophenotyping and gene rearrangement studies are interpreted. There is currently no data on the reproducibility of histological findings. This study was conducted to determine the rates of inter- and intra-observer agreement in histological detection of bone marrow involvement in the two major subtypes of NHL, Diffuse Large B-cell Lymphoma (DLBCL), and Follicular Lymphoma (FL). Methods: The bone marrow slides of randomly selected DLBCL and FL cases were independently examined by two hematologists using standardized reporting criteria on two occasions at least two weeks apart. Samples included both aspirate and trephine biopsy slides. Weighted kappa statistics were used to examine agreement for the discrete measures. Results: Weighted kappa analyses showed variable inter-observer agreement in 38 DLBCL cases [aspirate=0.52; trephine= 0.77] and 38 FL cases [aspirate=0.48; trephine=0.77]. Conclusion: Overall, higher agreement rates were noted with trephine biopsies than with aspirates. Except for the high intra-observer agreement on trephine biopsy assessment in FL, there is poor agreement in histological staging of both FL and DLBCL which demonstrates the limitations of histological diagnosis and the futility of interpreting ancillary tests against histology.
    Clinical and investigative medicine. Medecine clinique et experimentale 12/2012; 35(6):E358. · 1.23 Impact Factor

Publication Stats

1k Citations
227.44 Total Impact Points


  • 2002-2015
    • The Canberra Hospital
      • Department of Renal Medicine
      Canberra, Australian Capital Territory, Australia
  • 1997
    • University of Western Sydney
      Penrith, New South Wales, Australia