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Background During 2008, the Royal Brisbane and Women's Hospital became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding. The cost of performing robotic surgery in the public sector is a contentious issue. This study is a single centre, cost analysis comparing open radical prostatectomy ( RRP) and robotic-assisted radical prostatectomy ( RALP) based on the newly introduced pure case-mix funding model. Methods A retrospective chart review was performed for the first 100 RALPs and the previous 100 RRPs. Estimates of tangible costing and funding were generated for each admission and readmission, using the Royal Brisbane Hospital Transition II database, based on pure case-mix funding. Results The average cost for admission for RRP was A$13 605, compared to A$17 582 for the RALP. The average funding received for a RRP was A$11 781 compared to A$5496 for a RALP based on the newly introduced case-mix model. The average length of stay for RRP was 4.4 days (2-14) and for RALP, 1.2 days (1-4). The total cost of readmissions for RRP patients was A$70 487, compared to that of the RALP patients, A$7160. These were funded at A$55 639 and A$7624, respectively. Conclusions RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector. [ABSTRACT FROM AUTHOR]

Aim The advent of rescue medical therapy (cyclosporin or infliximab) and laparoscopic surgery has shifted the paradigm in managing steroid refractory acute severe ulcerative colitis (ASUC). We investigated prospectively the impact of rescue therapy on timing and postoperative complications of urgent colectomy and subsequent restorative surgery for steroid refractory ASUC. Method All consecutive presentations of steroid refractory ASUC at the Royal Brisbane Hospital (1996-2009) were entered in the study. Data collated included demographics, clinical and laboratory parameters on admission, medical therapy and operative and postoperative details. Steroid refractory ASUC patients undergoing immediate colectomy were compared with those failing rescue therapy and requiring same admission colectomy. Results Of 108 steroid refractory ASUC presentations, 19 (18%) received intravenous steroids only and proceeded directly to colectomy. Rescue medical therapy was instituted in 89 (82%) patients with 30 (34%) failing to respond and proceeding to colectomy. There was no significant difference in the median time from admission to colectomy for rescue therapy compared with steroid-only cases (12 vs 10 days, P = 0.70) or 30-day complication rates (27% vs 47%, P = 0.22). The interval from colectomy to a subsequent restorative procedure was significantly longer for patients who failed rescue therapy (12 vs 5 months, P = 0.02). Furthermore 30-day complications following pouch surgery were significantly higher in patients who failed rescue therapy (32% vs 0%, P = 0.01). Conclusion Rescue therapy in steroid refractory ASUC is not related to delay in urgent colectomy or increased post-colectomy complications. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study is to identify factors predictive of outcome after open globe injury in 273 patients admitted to the Royal Brisbane Hospital, Queensland, Australia between 1992 and 2003. Methods: Data were collected retrospectively regarding demographic and geographical factors, injury circumstances, initial visual acuity (VA), injury parameters, details of initial and subsequent surgery, final best corrected VA and complications. Multivariate analysis using binary logistic regression was utilized to identify which factors were related to outcome. Results: 83% of patients were male, with a mean age of 38.3 years. The mean duration of follow up was 16.6 months and 58% of patients (135 of 231) achieved an overall improvement in their vision. Forty-one cases (15%) were enucleated, with half of these cases performed primarily. The prognostic factors indicating the likelihood of a VA of counting fingers or worse were poor initial VA, a large laceration >10 mm and the presence of a relative afferent pupil defect. Rural patients had a significantly worse final VA than city dwellers and had higher rates of endophthalmitis and enucleation. Conclusions: Assessment of prognostic factors at the time of presentation of an open globe injury enables realistic expectations of final visual outcome by the doctor and the patient. In order to improve outcomes in patients from rural areas, access to specialized eye services need to be upgraded. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to analyse the reasons for a major increase in expenditure on inpatient pharmaceutical costs over a two year period and to describe strategies developed to prevent further increases. Conclusions: By educating our medical staff on the costs of the most commonly prescribed medications and favouring cost effective medications such as risperidone over olanzapine we have been able to contain our inpatient drug costs and achieve a 14% reduction this financial year. [ABSTRACT FROM AUTHOR]

Presents two cases of mesenteric panniculitis (MP), a non-specific inflammation of the mesenteric adipose tissue, encountered at the Royal Brisbane Hospital in Brisbane, Queensland. Unknown etiology and pathogenesis of MP; Manifestations of the disease; Most significant feature of MP.

The article presents a case report on the application of telemedicine in a trauma debriefing conducted by the Royal Brisbane Hospital in Queensland. According to the author, who provided regular telemedicine supervision sessions to the Alice Springs mental health team, during 1996, telemedicine seem to be an ideal medium for delivering the various types of psychological and psychiatric services, allowing traumatized people who are in isolated areas to receive immediate specialist counseling and support.

The article presents a conversation with Professor Bruce Tonge, the retired head of the Centre for Developmental Psychology and Psychiatry at Monash Medical Centre in Melbourne, Victoria, about his career in child and adolescent psychiatry. He claimed that his internship at the Royal Brisbane Hospital has stimulated his interest in psychological medicine. He describes the squiggle technique which he used on a child with school refusal problems.

The article discusses the development of renal care in Australia. It noted the many changes in health care delivery, the emergence of specialised renal health care for people with acute and chronic kidney disorders between 1960 and 1980. It further states that the first acute renal failure dialysis was performed by Dr. Georg Haas in 1924. Meanwhile, Dr. John Dique had successfully performed haemodialysis for acute renal failure at the Royal Brisbane Hospital in 1954. In addition, the first kidney transplant procedure was performed in Australia in 1963.

This reports on a pilot study of the use of sleeve gastrectomy in morbidly obese patients with inflammatory bowel disease. Background: The management of obesity is an increasingly important issue in health care. Bariatric surgery is now well established as the only modality which can effect significant, sustained weight loss and thus control of subsequent complications. With increasing experience of the Bariatric Unit at the Royal Brisbane and Women's Hospital we are looking at special cases in obesity surgery. Sleeve Gastrectomy and IBD: Sleeve gastrectomy (SG) is a laparoscopic surgical technique which is increasing in application. It is effective for weight reduction and early studies show low morbidity and mortality. The technique involves stapled resection of much of the greater curve of the stomach, leaving a remnant gastric tube. In comparison to other bariatric surgery techniques we feel sleeve gastrectomy is particularly useful in obese patients with IBD. Whilst morbid obesity is an infrequent issue in the inflammatory bowel disease patient cohort, the surgical management presents particular issues for customary techniques. SG does not require implantation of foreign material, open surgery or surgery upon the small bowel. Furthermore this cohort has specific issues where obesity may impact upon their IBD, resulting in specific indications for bariatric surgery. We report on the outcomes from our early experience. [ABSTRACT FROM AUTHOR]