ORCID Profile
0000-0002-1836-6831
Current Organisation
Royal Brisbane and Women's Hospital
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: SAGE Publications
Date: 22-06-2021
Abstract: Airway Management is the key for anaesthetists dealing with patients undergoing diagnostic procedures and surgical interventions. The present coronavirus pandemic underpins even more how important safe airway management is. It also highlights the need to apply stringent precautions to avoid infection and ongoing transmission to patients, anaesthetists and other healthcare workers (HCWs). In light of this extraordinary global situation the aim of this article is to update the reader on the varied aspects of the ever-changing tasks anaesthetists are involved in and highlight the equipment, devices and techniques that have evolved in response to changing technology and unique patient and surgical requirements.
Publisher: MDPI AG
Date: 12-06-2023
DOI: 10.20944/PREPRINTS202306.0745.V1
Abstract: Angiogenesis is new blood vessel formation from existing vessels and is a critical first step in tissue repair following chronic disturbances in healing and degenerative tissues. Chronic pathoanatomic tissues are characterized by a high number of inflammatory cells, overexpression of inflammatory mediators, such as tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1), the presence of mast cells, T cells, reactive oxygen species, and matrix metalloproteinases, and a decreased angiogenic capacity. Multiple studies have demonstrated that autologous orthobiological cellular preparations (e.g., platelet-rich plasma [PRP]) im-prove tissue repair and regenerate tissues. There are many PRP devices on the market. Unfortunately, they differ greatly in platelet numbers, cellular composition, and bioformulation. PRP is a platelet concentrate consisting of a high concentration of platelets with or without certain leukocytes, platelet-derived growth factors (PGFs), cytokines, molecules, and signaling cells. Several PRP products have immunomodulatory capacities that can influence resident cells in a diseased microenvironment, inducing tissue repair or re-generation. Generally, PRP is a blood-derived product, regardless of its platelet number and bioformulation, and the literature indicates both positive and negative patient treatment outcomes. Strangely, the literature does not designate specific PRP preparation qualifications that can potentially contribute to tissue re-pair. Moreover, the literature scarcely addresses the impact of platelets and leukocytes in PRP on (neo)angiogenesis other than a general one-size-fits-all statement that “PRP has angiogenic capabilities.” Here, we review the cellular composition of all PRP constituents, including leukocytes, and describe the importance of platelet dosing and bioformulation strategies in orthobiological applications to initiate angiogenic pathways that re-establish microvasculature networks, facilitating the supply of oxygen and nutrients to impaired tissues.
Publisher: SAGE Publications
Date: 28-07-2022
DOI: 10.1177/0310057X221082665
Abstract: Despite the self-evident importance of hospital funding, many anaesthetists remain unsure of exactly how their daily work relates to hospital reimbursement. A lack of awareness of the nuances of the Australian hospital activity–based funding system has the potential to affect anaesthetic department reimbursement and thus resourcing. Activity-based funding relies on clinical coders reviewing clinical documentation and quantifying the care given to a patient during an admission. Errors in funding allocation may arise when there is a disconnect between the work performed and the information coded. In anaesthesia, there are several factors impeding this process, including clinical understanding of coding, system setup and coders’ understanding of anaesthesia. This article explores these factors from the clinical anaesthetist’s point of view and suggests solutions, such as awareness and education, clinician–coder cooperation and redesign of documentation systems at a systems level that anaesthetic departments can incorporate.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-04-2021
Abstract: Subclinical left ventricular dysfunction detected by 2‐dimensional global longitudinal strain post breast radiotherapy has been described in patients with breast cancer. We hypothesized that left ventricular dysfunction postradiotherapy may be site specific, based on differential segmental radiotherapy dose received. Transthoracic echocardiograms were performed at baseline, 6 weeks, and 12 months postradiotherapy on 61 chemotherapy‐naïve women with left‐sided breast cancer undergoing tangential breast radiotherapy. Radiation received within basal, mid, and apical regions for the 6 left ventricular walls was quantified from the radiotherapy treatment planning system. Anterior, anteroseptal, and anterolateral walls received the highest radiation doses, while inferolateral and inferior walls received the lowest. There was a progressive increase in the radiation dose received from basal to apical regions. At 6 weeks, the most significant percentage deterioration in strain was seen in the apical region, with greatest reductions in the anterior wall followed by the anteroseptal and anterolateral walls, with a similar pattern persisting at 12 months. There was a within‐patient dose–response association between the segment‐specific percentage deterioration in strain at 6 weeks and 12 months and the radiation dose received. Radiotherapy for left‐sided breast cancer causes differential segmental dysfunction, with myocardial segments that receive the highest radiation dose demonstrating greatest strain impairment. Percentage deterioration in strain observed 6 weeks postradiotherapy persisted at 12 months and demonstrated a dose–response relationship with radiotherapy dose received. Radiotherapy‐induced subclinical cardiac dysfunction is of importance because it could be additive to chemotherapy‐related cardiotoxicity in patients with breast cancer. Long‐term outcomes in patients with asymptomatic strain reduction require further investigation.
Publisher: Wiley
Date: 29-01-2021
DOI: 10.1111/JOCN.15654
Abstract: Approximately 80% of patients admitted to acute hospitals have at least one peripheral intravenous catheter inserted during their admission, for the administration of fluids and medicines, and/or diagnostic tests, so the failure rate is concerning. New technology may decrease these rates even when used by inexperienced inserters. The choice of insertion site for an intravenous catheter is a known predictor of catheter failure. Therefore, the objective for this study was to evaluate the utility of vessel locating devices for novice clinicians to select catheter insertion sites in the forearm. An inter‐subject incomplete counterbalanced research design was employed with healthy volunteers. Novice clinicians used either a vessel locating device using light or sound waves or they used palpation to identify relatively superficial veins in the forearm. This was compared to site selection performed by an expert clinician using palpation method only. Measurements of differences were analysed from photos of chosen sites. Bland–Altman agreement analysis was used to plot novice expert agreement. The STROBE checklist was followed in reporting this study (Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices (Appendix S1)). A total of 32 novice clinicians used three vessel locating devices and a palpation technique. Novice clinicians did not choose more veins for optimum catheter placement when assisted with vessel locating devices compared to palpation techniques. All methods had a similar mean difference between novice and expert measurements and a similar percentage difference in distance from the expert choice. Bland–Altman agreement analysis did not identify any advantage for the novice with vessel locating devices over palpation. Vessel locating devices do not enhance the ability of novice clinicians any greater than palpation when selecting suitable forearm veins. If vessel locating device approaches are to be adopted in clinical practice to support better insertion outcomes then current PIVC teaching techniques should include structured vessel locating devices theory and practice. Successful insertion of a peripheral intravenous catheter (PIVC) on the first attempt is a challenging procedure for nurses. Careful consideration of the selected site of insertion could modify this risk factor for catheter failure. The choice of PIVC insertion site by a novice clinician compared to an expert does not necessarily improve with the use of vein locating technology. While there is a range of technological devices available to assist with locating vessels, there needs to be more emphasis from educators on how to select an appropriate insertion site for intravenous therapy.
Publisher: MDPI AG
Date: 24-01-2022
DOI: 10.3390/HEALTHCARE10020219
Abstract: Measurement of core body temperature—clinical thermometry—provides critical information to anaesthetists during perioperative care. The value of this information is determined by the accuracy of the measurement device used. This accuracy must be maintained despite external influences such as the operating room temperature and the patient’s thermoregulatory defence. Presently, perioperative thermometers utilise invasive measurement sites. The public health challenge of the COVID-19 pandemic, however, has highlighted the use of non-invasive, non-contact infrared thermometers. The aim of this article is to review common existing thermometers used in perioperative care, their mechanisms of action, accuracy, and practicality in comparison to infrared non-contact thermometry used for population screening during a pandemic. Evidence currently shows that contact thermometry varies in accuracy and practicality depending on the site of measurements and the method of sterilisation or disposal between uses. Despite the benefits of being a non-invasive and non-contact device, infrared thermometry used for population temperature screening lacks the accuracy required in perioperative medicine. Inaccuracy may be a consequence of uncontrolled external temperatures, the patient’s actions prior to measurement, distance between the patient and the thermometer, and the different sites of measurement. A re-evaluation of non-contact thermometry is recommended, requiring new studies in more controlled environments.
Publisher: Springer Science and Business Media LLC
Date: 17-12-2021
DOI: 10.1007/S10877-021-00780-3
Abstract: Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip. Both devices are made up of two interlocking components-the SAD and a videoscope. The 3rd generation, direct vision SADs allow vision-guided insertion, corrective manoeuvres, if needed, and correct placement in the hypopharynx and possess additional features which permit insertion of a gastric tube and endotracheal intubation should the need arise. This article describes the two new devices' physical characteristics, features, rationale for use, advantages and limitations in comparison to existing devices. Each of the two new devices-the Video Laryngeal Mask (VLM
Publisher: Wiley
Date: 29-11-2020
DOI: 10.1111/AAS.13727
Abstract: Oropharyngeal leak pressure (OLP) is considered a measure of successful placement, adequate performance and is a useful comparator between supraglottic airway devices (SADs). OLP measurement is based on the premise that the SAD is sited properly in the hypopharynx after blind placements, but the evidence suggests otherwise. Several limitations and controversies surround OLP. This editorial addresses the uses and pitfalls of OLP, the rationale for and methods of ascertaining OLP, the pros and cons of OLP measurement and newer modalities to improve its accuracy.
Publisher: Springer Science and Business Media LLC
Date: 15-06-2020
Publisher: MDPI AG
Date: 13-03-2021
DOI: 10.3390/HEALTHCARE9030323
Abstract: Accurate noninvasive blood pressure (NIBP) measurement requires use of an appropriately sized cuff. We aimed to improve the perioperative allocation of NIBP cuffs in patients with Class II–III obesity. In the baseline evaluation, we measured the mid-arm circumference (MAC) of 40 patients with BMI 35 kg/m2, documenting the corresponding cuff allocated by pre-operative nurses. The intervention consisted of the introduction of cuff allocation based on MAC measurement and augmented NIBP cuff supplies. We completed a re-evaluation and evaluation of the intervention by staff survey, using 5-point Likert scales and free text comments. At baseline, the correct cuff was allocated in 9 of 40 patients (22.5%). During the intervention, education occurred in 54 (69.2%) peri-operative nursing staff. Upon re-evaluation, the correct cuff was allocated in 30 of 40 patients (75.0%), a statistically significant improvement (χ2 = 22.1, p 0.001). Ninety-three of 120 staff surveys were returned (78%). Eleven out of 18 preoperative staff surveyed (61.1%) felt confident measuring the arm and selecting the correct cuff. Six (33%) agreed that taking the arm measurement added a lot of extra work. Equipment shortages, accuracy concerns, and clinical workarounds were reported by staff. Our intervention increased the proportion of correct cuffs allocated, but equipment and practical issues persist with NIBP cuff selection in obese patients.
Publisher: Informa UK Limited
Date: 02-11-2022
DOI: 10.1080/17434440.2022.2142558
Abstract: Video laryngeal masks have become alternatives to classical supraglottic airway devices in recent years. This review provides information on the background of these new medical devices, the most popular and widely used video laryngeal masks, their advantages, disadvantages and their main applications in airway management. In this review, the physical differences between video laryngeal masks and second-generation laryngeal mask airways, and their properties in specific clinical settings are discussed. To limit airway-related morbidity, an optimal position of supraglottic airway devices must be the primary goal. Extensive research has shown that blindly inserted laryngeal mask can be malpositioned in 50% to 80% of the cases. Therefore, blind insertion should be the exception rather than the rule unlike current practice. Video laryngeal mask airways have clear advantages in routine use and in difficult airway management since they allow a vision-guided technique. Henceforth, the properties perceived in clinical practice must be endorsed with quality clinical evidence.
Publisher: Informa UK Limited
Date: 07-2021
DOI: 10.2147/JMDH.S313310
Publisher: Wiley
Date: 09-06-2021
DOI: 10.1111/AAS.13840
Abstract: Health service professionals do not have perfect vigilance. There will always be the possibility that a serious untoward incident can occur due to crossover injections of medication being administered via the wrong route. The universality of the Lüer connector made it very easy to connect several medical devices for different therapeutic uses. Although this was considered a bonus, it also showed the downside as a string of incidents, leading to permanent harm and even death, occurred, warranting actions to prevent the chance of misconnections and wrong‐route injections. The International Organisation for Standardisation introduced specific ISO 80 369 connectors for use in different medical systems, with the ISO 80369‐6 series of standards specifically designed to improve safety in regional anaesthesia. Human error can never be completely eliminated, but the risk of a patient inadvertently suffering from an inadvertent wrong‐route injection can be reduced through the use of new ‘fit and no‐fit’ technology. This article focuses on the universality of the Lüer connector and the introduction of the newly engineered non‐Lüer connectors, for specific use in medical systems.
Publisher: Wiley
Date: 27-10-2022
DOI: 10.1111/IMJ.15939
Abstract: Globalisation has increased human movements around the world, spurring greater connectiveness and opportunities to collaborate. In an increasingly connected world, quality assurance among professionals is paramount, particularly in medical research where PhD (Doctor of Philosophy) degree holders are expected to be at the peak of their field and play advanced‐level research, education and leadership roles. While some regional efforts have been made to ensure comparability in the standards of advanced degree training, no previous study has compared these standards for a PhD in medicine across the globe. To explore the structural ersity of medical PhD degrees and identify which aspects benefit from greater harmonisation. In 2021, the 10 best‐ranked universities from each of the top five Western countries, and the top Asian country, were identified based on Quacquarelli Symonds World University Ranking. Data were collected for each university based on in idual website information regarding the level of degree required to gain entry into a PhD programme in medicine and requirements for completion of coursework, journal publication and oral defence. Significant variations exist in the requirements for medical PhDs across the world in terms of prerequisite degree and inclusion of coursework. Oral defence is near universal, but a mandatory requirement for publication is largely absent. Harmonisation of medical PhD degrees through international standards should be considered to encourage quality improvement and benchmarking between institutions, as well as to facilitate greater ease of movement within the medical research community, improving international collaboration and in idual career opportunities accordingly.
Publisher: MDPI AG
Date: 22-12-2022
DOI: 10.3390/HEALTHCARE11010038
Abstract: Physicians are required to move and manipulate equipment to achieve motor tasks such as surgical operations, endotracheal intubations, and intravenous cannulation. Understanding how movements are generated allows for the analysis of performance, skill development, and methods of teaching. Ecological-Dynamics (ECD) is a theoretical framework successfully utilized in sports to explain goal-directed actions and guide coaching and performance analysis via a Constraint-Led Approach (CLA). Its principles have been adopted by other domains including learning music and mathematics. Healthcare is yet to utilize ECD for analyzing and teaching practical skills. This article presents ECD theory and considers it as the approach to understand skilled behavior and developing training in medical skills.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 14-03-2018
DOI: 10.1002/LARY.27177
Publisher: Korean Pain Society
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 16-03-2023
Publisher: Springer Science and Business Media LLC
Date: 22-08-2021
Publisher: Informa UK Limited
Date: 07-2021
DOI: 10.2147/MDER.S310415
Publisher: MDPI AG
Date: 06-07-2023
DOI: 10.3390/BIOMEDICINES11071922
Abstract: Angiogenesis is the formation of new blood vessel from existing vessels and is a critical first step in tissue repair following chronic disturbances in healing and degenerative tissues. Chronic pathoanatomic tissues are characterized by a high number of inflammatory cells an overexpression of inflammatory mediators such as tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) the presence of mast cells, T cells, reactive oxygen species, and matrix metalloproteinases and a decreased angiogenic capacity. Multiple studies have demonstrated that autologous orthobiological cellular preparations (e.g., platelet-rich plasma (PRP)) improve tissue repair and regenerate tissues. There are many PRP devices on the market. Unfortunately, they differ greatly in platelet numbers, cellular composition, and bioformulation. PRP is a platelet concentrate consisting of a high concentration of platelets, with or without certain leukocytes, platelet-derived growth factors (PGFs), cytokines, molecules, and signaling cells. Several PRP products have immunomodulatory capacities that can influence resident cells in a diseased microenvironment, inducing tissue repair or regeneration. Generally, PRP is a blood-derived product, regardless of its platelet number and bioformulation, and the literature indicates both positive and negative patient treatment outcomes. Strangely, the literature does not designate specific PRP preparation qualifications that can potentially contribute to tissue repair. Moreover, the literature scarcely addresses the impact of platelets and leukocytes in PRP on (neo)angiogenesis, other than a general one-size-fits-all statement that “PRP has angiogenic capabilities”. Here, we review the cellular composition of all PRP constituents, including leukocytes, and describe the importance of platelet dosing and bioformulation strategies in orthobiological applications to initiate angiogenic pathways that re-establish microvasculature networks, facilitating the supply of oxygen and nutrients to impaired tissues.
Location: Australia
Location: Switzerland
Location: Belgium
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Andre Van Zundert.