Search

Problem: Establishment of Birthing on Country services owned and governed by Aboriginal and Torres Strait Islander Community Controlled Health Services has been slow., Background: Birthing on Country services have demonstrated health and cost benefits and require redesign of maternity care. During the Building On Our Strengths feasibility study, use of endorsed midwives and licensing of birth centres has proven difficult., Question: What prevents Community Controlled Health Services from implementing Birthing on Country services in Queensland and New South Wales?, Methods: Participatory action research identified implementation barriers. We conducted iterative document analysis of instruments to inform government lobbying through synthesis of policy, economic, social, technological, legal, and environmental factors., Findings: Through cycles of participatory action research, we analysed 17 documents: 1) policy barriers prevent Community Controlled Health Services from employing endorsed midwives to provide intrapartum care in public hospitals; 2) economic barriers include lack of sustainable funding stream and inadequate Medicare-billing for endorsed midwives; and 3) legal barriers require a medical practitioner in a birth centre. While social barriers (e.g., colonisation, medicalisation) underpin regulations, these were beyond the scope; technological and environmental barriers were not identified., Discussion: Findings are consistent with the literature on barriers to midwifery practice. Recommendations include a national audit of barriers to Birthing on Country services including healthcare practice insurance, and development of a funding stream. Additionally, private maternity facility regulation must align with evidence on safe birth centre operation., Conclusion: Government can address barriers to scale-up of Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services., Competing Interests: Conflict of interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The Australian Nurse-Family Partnership Program is based on the Nurse-Family Partnership program from the United States, which was designed to support first-time mothers experiencing social and economic disadvantage from early in pregnancy until their child's second birthday. International trials have demonstrated this program measurably improves family environment, maternal competencies, and child development. The Australian program has been tailored for mothers having a First Nations baby., Aim: This study aimed to understand how the program impacts self-efficacy using a qualitative interpretive approach., Methods: The study took place in two sites within one Aboriginal Community Controlled Health Service in Meanjin (Brisbane), Australia. Twenty-nine participants were interviewed: first-time mothers having a First Nations baby who had accessed the program (n = 26), their family members (n = 1), and First Nations Elders (n = 2). Interviews were conducted either face-to-face or by telephone, using a yarning tool and method, to explore women's experiences and perceptions. Yarns were analysed using reflexive thematic analysis., Findings: Three main themes were generated: 1) sustaining connections and relationships; 2) developing self-belief and personal skills; and 3) achieving transformation and growth. We interpret that when the program facilitates the development of culturally safe relationships with staff and peers, it enables behaviour change, skill development, personal goal setting and achievement, leading to self-efficacy., Discussion: Located within a community-controlled health service, the program can foster cultural connection, peer support and access to health and social services; all contributing to self-efficacy., Conclusion: We recommend the program indicators are strengthened to reflect these findings and enable monitoring and reporting of activities that facilitate self-efficacy, growth, and empowerment., (Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Enhanced Maternity Care (EMC) is a new standard of care for women who become unwell during or shortly after pregnancy. Yorkshire and the Humber Maternity Clinical Network established the Maternal Enhanced and Critical Care Group (MEaCC) to create regional guidance with a focus on maternity staff training, development of the MEaCC database and data collection. This article describes the introduction of the MEaCC and regional data collection., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

The inclusion of eating quality traits in sheep genetic improvement programmes is desirable. Intramuscular fat (IMF) plays a key role in ensuring consumer satisfaction when eating lamb, but genetic progress for IMF is constrained by a lack of routine data collection. This study investigated the potential for IMF predictor traits to substitute for measured IMF in genetic improvement programmes. Carcass and predicted IMF (near-infrared estimated IMF and marbling score) data were available on 10,113 New Zealand lambs, 1678 of which also had measured chemical IMF on a slice of M. longissimus lumborum on which the predictions of IMF had been made. Genetic antagonisms were observed between carcass lean traits and IMF. The genetic correlation between the predictors and measured IMF approached one, indicating that predictors of IMF can be used in genetic improvement programmes. Through using selection indexes, simultaneous increases in IMF and the existing terminal selection index are possible, provided all traits are measured. This study highlights the importance and potential of predicted IMF to achieve genetic improvement in traits of importance to consumers., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest associated with the manuscript ‘Potential of in-plant intramuscular fat measures to enable sheep breeders to incorporate consumer preferences in breeding programmes’., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Real world patterns of cannabis use for health concerns are highly variable and rarely overseen by a physician. Pragmatic effectiveness studies with electronic daily diaries that capture person-specific patterns of cannabis use and health symptoms may help clarify risks and benefits., Methods: As part of a larger, randomized trial (NCT03224468), adults (N = 181) seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or a waitlist control (WLC) and completed 12-weeks of daily web-based surveys on cannabis use and sleep, pain, and depressive symptoms., Results: Completion rates of daily surveys were moderate to high (median completed: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency in the 12 weeks following randomization, while WLC did not. Among the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, consistent with increasing cannabis frequency. No improvements were found for pain or depressive symptoms., Conclusion: Cannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred in the context of increased frequency of cannabis use, raising the risk for cannabis use disorder. Daily web-based assessments of cannabis appear valid and feasible in adults seeking cannabis for health concerns, providing a flexible, complementary method for future real-world effectiveness studies with expanded and objective measures., Competing Interests: Conflict of Interest No conflict Declared., (Copyright © 2023. Published by Elsevier B.V.)

Background: The use of anticoagulant medications leads to a higher risk of developing traumatic intracranial hemorrhage (tICH) after a mild traumatic brain injury (mTBI). The management of anticoagulated patients can be difficult to determine when the initial head computed tomography is negative for tICH. There has been limited research on the risk of delayed tICH in patients taking direct oral anticoagulant (DOAC) medications., Objective: Our aim was to determine the risk of delayed tICH for patients anticoagulated with DOACs after mTBI., Methods: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched several medical databases to examine the risk of delayed tICH in patients on DOACs., Results: There were 1252 nonduplicate studies that were identified through an initial database search, 15 of which met our inclusion and exclusion criteria and were included in our analysis after full-text review. A total of 1375 subjects were combined among the 15 studies, with 20 instances of delayed tICH after mTBI. Nineteen of the 20 patients with a delayed tICH were discharged without any neurosurgical intervention, and 1 patient on apixaban died due to a delayed tICH., Conclusions: This systematic review confirms that delayed tICH after mTBI in patients on DOACs is uncommon. However, large, multicenter, prospective studies are needed to confirm the true incidence of clinically significant delayed tICH after DOAC use. Due to the limited data, we recommend using shared decision-making for patients who are candidates for discharge., (Copyright © 2020 Elsevier Inc. All rights reserved.)

There has been an increase in the number of laboratories and researchers adopting new sequencing technologies, known as next-generation sequencing (NGS). An understanding of the behaviour of NGS DNA profiles is needed to enable for the development of probabilistic genotyping methods for the interpretation of such profiles. In this work, we investigate NGS analyte signal variation, specifically heterozygous balance and stutter variability from profiles generated using the ForenSeq™ DNA Signature Prep Kit, DNA Primer Mix B. We also investigate additivity of analyte signals in NGS profiles for overlapping allelic and stutter signals originating from the same or different contributors. We describe models that can be used to inform a continuous method for the interpretation of DNA profiling data., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Australian policy encourages multiagency partnerships between hospitals and Aboriginal Community Controlled Health Organisations to improve the health of Aboriginal and Torres Strait Islander people. Service planners remain unsure about how to implement such partnerships in maternity care, and there is a lack of appropriate tools designed to gauge the state of such partnerships for the Australian Indigenous context. In 2013, two Aboriginal health services and a major tertiary hospital partnered to deliver best practice maternity care to Indigenous families in Brisbane, Australia. A participatory action research approach underpinned this study. Semi-structured qualitative interviews and focus groups were conducted with 21 of the partnership staff. All interviewees emphasized the partnership's commitment to improving long-term health and wellbeing for Indigenous families. Strategic planners were more likely to report a positive partnership than staff involved in service delivery who had diverse views. This highlights the challenges of change management when conducting such a significant service redesign in this cross-cultural context. We detail changes made within the partnership in response to the findings and provide suggestions for future development of an evaluation tool to review the state of Aboriginal-Mainstream Partnerships., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Problem: It is not well known how to prepare new multidisciplinary teams aiming to provide culturally safe maternity care for Aboriginal and Torres Strait Islander families in an urban setting., Background: National policies recommend increasing the Aboriginal and Torres Strait Islander workforce and cultural competencies of the non-Indigenous workforce as key drivers of culturally safe care., Question: What are the key learnings from staff experiences establishing multidisciplinary teams aiming to provide culturally safe maternity care that aims to privilege Indigenous ways of knowing, being and doing?, Methods: As part of a larger participatory action research project, semi-structured qualitative interviews were conducted December 2014-April 2015 with 21 Aboriginal and Torres Strait Islander and non-Indigenous healthcare staff. Thematic analysis was used to identify learnings for practice., Findings: Four key learnings were identified for forming new teams aiming to provide culturally safe care: (a) having a shared understanding of what characterises cultural safety in the local program context; (b) understanding and valuing different roles and knowledges people bring to the team; (c) acknowledging the influence of race and culture on staff behaviour; and (d) acting on individual and organisational responsibilities for continuous improvement towards cultural safety., Discussion: We present recommendations from our participatory action research approach to respond to these learnings in practice., Conclusion: A deliberate workforce investment at the early stages of team development is crucial when aiming to provide culturally safe maternity care that can respond to the unique needs of Aboriginal and Torres Strait Islander women and families., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing., Question: How can we implement Birthing on Country services for Aboriginal and/or Torres Strait Islander families across Australia?, Methods: We have developed a framework from theoretical, policy and research literature on Birthing on Country; Aboriginal and Torres Strait Islander voices from across Australia; reviews exploring programs that have improved outcomes for Indigenous mothers and infants; and the retrospective synthesis of learnings from two empirical studies that have redesigned maternal infant health services and improved outcomes for Aboriginal and Torres Strait Islander families., Results: The RISE Framework has four pillars to drive important reform: (1) Redesign the health service; (2) Invest in the workforce; (3) Strengthen families; and, (4) Embed Aboriginal and/or Torres Strait Islander community governance and control. We present the evidence base for each pillar and practical examples of moving from the standard 'western' model of maternity care towards Birthing on Country services., Conclusions: Application of the RISE framework to plan, develop and monitor Birthing on Country services is likely to result in short and long-term health gains for Aboriginal and Torres Strait Islander families., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Multi-sire mating of a mob of ewes is commonly used in commercial sheep production systems. However, ram mating success (defined as the number of lambs sired by an individual) can vary between rams in the mating group. If this trait was repeatable and heritable, selection of rams capable of siring larger numbers of lambs could reduce the number of rams required for mating and ultimately lead to increased genetic gain. However, genetic correlations with other productive traits, such as growth and female fertility, could influence the potential for ram mating success to be used as a selection trait. In order to investigate this trait, parentage records (including accuracy of sire assignment) from 15 commercial ram breeding flocks of various breeds were utilised to examine the repeatability and heritability of ram mating success in multi-sire mating groups. In addition, genetic and phenotypic correlations with growth and female fertility traits were estimated using ASReml. The final model used for the ram mating success traits included age of the ram and mating group as fixed effects. Older rams (3+years old) had 15% to 20% greater mating success than younger rams (1 or 2 years of age). Increasing the stringency of the criteria for inclusion of both an individual lamb, based on accuracy of sire assignment, or a whole mating group, based on how many lambs had an assigned sire, increased repeatability and heritability estimates of the ram mating success traits examined. With the most stringent criteria employed, where assignment of sire accuracy was >0.95 and the total number of lambs in the progeny group that failed to have a sire assigned was<0.05, repeatability and heritability for loge(number of lambs) was 0.40±0.09 and 0.26±0.12, respectively. For proportion of lambs sired, repeatability and heritability were both 0.30±0.09. The two ram mating traits (loge(nlamb) and proportion) were highly correlated, both phenotypically and genetically (0.88±0.01 and 0.94±0.06, respectively). Both phenotypic and genetic correlations between ram mating success and growth and other female fertility traits were low and non-significant. In conclusion, there is scope to select rams capable of producing high numbers of progeny and thus increase selection pressure on rams to increase genetic gain.

Introduction: There are an estimated 2.75 million electronic cigarette (EC) users in the United States. ECs have become the most commonly used nicotine-containing product in young adults ages 18-24 years. Thermal, blast, and missile injuries from EC explosions has grown rapidly in recent years. Burn surgeons must remain up to date regarding management and treatment of burn injuries related to EC device ignition., Methods: An IRB approved retrospective review of all patients admitted to the Massachusetts General Hospital Burn Center from January 2015 to April 2017 was performed. Fourteen patients with injuries associated with EC use were identified. Patient demographics, injury location, size and degree of burn, treatments required, length of stay (LOS), time to 95% closure, associated complications and injuries, and the circumstances that led to the injury were identified., Results: The mean age was 28.6±8.6 years with a range of 19-50 years (n=14). EC burns occurred in males 93% (13/14) of the time. The majority of EC explosions caused 2nd and 3rd degree burns (57%) within the same wound bed, followed by deep 2nd degree (29%), and superficial 2nd degree (14%). The average TBSA from EC burns was 4.7±2.4% with a range of 1-10%. The most common location of the device or battery at the time of the injury was a pant pocket 86% (12/14), followed by 7% hand (1/14) and 7% purse (1/14). Isolated lower extremity burns occurred in 43% (6/14) of patients, while lower extremity and hand burns occurred in 21% (3/14) of patients. Nine of 14 patients required an operating room encounter under general anesthesia. Eight of 14 patients required skin grafting for definitive wound closure. The mean hospital length of stay was 6.6±4.7 days with a range of 0-15 days. Time to 95% wound closure was 18.4±10.8 with a range of 8-40 days., Conclusion: Thermal and blast injuries associated with EC device failure tend to cause small TBSA burns that are deep 2nd and 3rd degree wounds. The most common location for EC device storage among males was the front pants pocket. EC device users should be made aware of the dangers associated with EC use and advised to carry EC devices away from their body in dedicated carrying cases without loose metallic items., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Objective: The objective of this study is to review our experience incorporating Interactive Home Telehealth (IHT) visits into follow-up burn care., Methods: A retrospective review of all burn patients participating in IHT encounters over the course of 15 months was performed. Connections were established through secure video conferencing and call-routing software. Patients connected with a personal computer or tablet and providers connected with a desktop computer with a high-definition web camera. In some cases, high-definition digital images were emailed to the provider prior to the virtual consultation. For each patient, the following was collected: (1) patient and injury demographics (diagnosis, prognosis, and clinical management), (2) total number of encounters, (3) service for each encounter (burn, psychiatry, and rehabilitation), (4) length of visit, including travel distance and time saved and, (5) complications, including re-admissions and connectivity issues., Results: 52 virtual encounters were performed with 31 patients during the first year of the pilot project from March 2015 to June 2016. Mean age of the participant was 44 years (range 18-83 years). Mean total burn surface area of the participant was 12% (range 1-80%). Average roundtrip travel distance saved was 188 miles (range 4-822 miles). Average round trip travel time saved was 201min (range 20-564min). There were no unplanned re-admissions and no complications. Five connectivity issues were reported, none of which prevented completion of the visit., Conclusions: Interactive Home Telehealth is a safe and feasible modality for delivering follow-up care to burn patients. Burn care providers benefit from the potential to improve outpatient clinic utilization. Patients benefit from improved access to multiple members of their specialized burn care team, as well as cost-reductions for patient travel expenses. Future studies are needed to ensure patient and provider satisfaction and to further validate the significance, cost-effectiveness and safety., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Constitutional mosaicism for trisomy 3 is extremely rare, with only a few postnatally diagnosed cases reported in the literature. We report a case of constitutional trisomy 3 mosaicism in a 16-year-old female, who presented with chronic joint pain, easy bruising, joint hypermobility and dysmorphic features, including long, thin facies, over-folded dysplastic ears, and Pierre-Robin sequence (PRS) with cleft palate. The patient was small at birth, had cleft palate repair, developed chronic joint pain at age 12, and has a history of mild leukopenia and mild thrombocytopenia. Microarray analysis was consistent with a mosaic gain of an entire chromosome 3. FISH analysis of peripheral blood and buccal cells showed the presence of the supernumerary chromosome 3 in a low percentage of cells in both tissues, suggesting that the nondisjunction event occurred prior to the germ cell layer differentiation. Since trisomy 3 has been observed somatically in lymphoma, a Hematology/Oncology consultation was provided for the patient. The oncologist's evaluation for malignancy was unremarkable. A review of findings from other trisomy 3 patients reported in the literature reveals a diverse phenotypic spectrum and does not show a correlation between the proportion of abnormal cells observed in peripheral blood and the patients' clinical features or severity. This case demonstrates that the clinical presentation of an individual with trisomy 3 is highly individualized and the clinical course is difficult to predict., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The objective of this study was to determine the genetic parameters of methane (CH4) emissions and their genetic correlations with key production traits. The trial measured the CH4 emissions, at 5-min intervals, from 1225 sheep placed in respiration chambers for 2 days, with repeat measurements 2 weeks later for another 2 days. They were fed in the chambers, based on live weight, a pelleted lucerne ration at 2.0 times estimated maintenance requirements. Methane outputs were calculated for g CH4/day and g CH4/kg dry matter intake (DMI) for each of the 4 days. Single trait models were used to obtain estimates of heritability and repeatability. Heritability of g CH4/day was 0.29 ± 0.05, and for g CH4/kg DMI 0.13 ± 0.03. Repeatability between measurements 14 days apart were 0.55 ± 0.02 and 0.26 ± 0.02, for the two traits. The genetic and phenotypic correlations of CH4 outputs with various production traits (weaning weight, live weight at 8 months of age, dag score, muscle depth and fleece weight at 12 months of age) measured in the first year of life, were estimated using bivariate models. With the exception of fleece weight, correlations were weak and not significantly different from zero for the g CH4/kg DMI trait. For fleece weight the phenotypic and genetic correlation estimates were -0.08 ± 0.03 and -0.32 ± 0.11 suggesting a low economically favourable relationship. These results indicate that there is genetic variation between animals for CH4 emission traits even after adjustment for feed intake and that these traits are repeatable. Current work includes the establishment of selection lines from these animals to investigate the physiological, microbial and anatomical changes, coupled with investigations into shorter and alternative CH4 emission measurement and breeding value estimation techniques; including genomic selection.

Background: The past decade has seen the development of an array of emerging psychoactive substances (EPS), however, there is minimal information on the extent of their use outside Europe. This study aimed to determine the extent of use of EPS from stimulant (such as mephedrone) and psychedelic classes (such as 5-methoxy-dimethyltryptamine [5-MeO-DMT]) among an Australian sample of regular ecstasy users (REU). Further, to determine if consumers of these drugs represent a distinct subgroup of REU., Methods: Australian national cross-sectional surveys of 693 regular (at least monthly) ecstasy users conducted during 2010., Results: More than one quarter (28%) of REU had used an EPS in the past six months, most commonly from the stimulant class (20%, typically mephedrone, 17%) rather than the psychedelic class (13%). Demographics and risk behaviours of REU that used stimulant EPS were largely no different from non-EPS consuming REU. Those using psychedelic EPS were distinct, initiating ecstasy use earlier, more frequently using multiple substances (cannabis, inhalants, GHB, ketamine) and more commonly experiencing legal, psychological and social problems., Conclusions: Psychedelic EPS use appears largely restricted to a distinct subset of REU with high-level non-injecting polydrug use, but use appears generally limited. The demographic similarity of stimulant EPS consumers with 'mainstream' REU, in conjunction with positive responses to the psychoactive effects of these drugs and declining ecstasy purity, suggests strong potential for stimulant EPS to expand further into ecstasy markets. Such drugs may have a greater public health impact than ecstasy, and merit careful monitoring into the future., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

A trial was carried out over a 7-year period (1999 to 2005 calf crops) to compare indicators of seasonality in Angus cattle, which were part of a long-term genetic selection experiment. Divergent selection was applied for early ('AGE-') or late ('AGE+') age at puberty (AP) in heifers, and selection lines differed over the 7-year period by 62 days (15% of the mean). The primary measures of seasonality studied in 629 heifer progeny (59 sire groups) were serum concentration of prolactin (PRL), and winter and summer hair growth. Serial samples were obtained for PRL from 11 to 18 months of age, and data were analysed with adjustment for cortisol concentration. Using restricted maximum likelihood procedures with an animal model, heritability estimates were: AP, 0.26 ± 0.03; log(e)PRL concentration, 0.23 ± 0.07; log(e)cortisol concentration, 0.22 ± 0.07; hair weight, 0.21 ± 0.04; and hair length, 0.09 ± 0.05. Corresponding repeatability estimates for the last four traits were 0.49 ± 0.03, 0.38 ± 0.03, 0.21 ± 0.04, and 0.64 ± 0.02, respectively. The genetic correlation between AP and log(e)PRL concentration was estimated at -0.29 ± 0.13 (P < 0.05). PRL concentration in the AGE- line after passing through puberty was 11 ± 5% lower than in the AGE+ line (P < 0.05). Line effects were not significant for hair weight or hair length. It was concluded that divergent selection for AP changed PRL concentration, which may partly reflect sensitivity to changing day length.

In the European Union (EU), interest in risk analysis as applied to micronutrients is being stimulated by the increasing availability and marketing of food (dietary) supplements, functional and fortified foods. There is also strong inter-governmental interest in harmonizing methods regionally and globally. Various models are being evaluated in the EU for the purposes of developing Community-wide, mandatory maximum (and minimum) permitted levels, as required by EC Directive 2002/46/EC and Regulation (EC) No 1925/2006 on food supplements and fortified foods, respectively. This paper provides a scientific critique of models currently proposed in the EU and demonstrates weaknesses in both the risk assessment methods used to determine upper tolerable levels (ULs) as well as the risk management approaches being considered for the determination of maximum levels, particularly as applied to food supplements. Methods for ameliorating existing models are proposed here, including a proposal for using decision science as the underlying methodology in nutrient risk analysis. Risk management approaches based on more plausible scientific methods would avoid unnecessarily restrictive policy-based levels that would adversely impact consumer choice, while contributing to a 'better regulation' approach. Scientifically robust and rational methods of nutrient risk analysis are consistent with disease risk reduction, health management and consumer protection strategies., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

The purpose of this case-control study was to assess the frequency of the inappropriate diagnosis of reflex sympathetic dystrophy (RSD) in patients who presented with dysfunctional postures of the upper extremity (n = 43). This group of patients with a dysfunctional posture was compared with a randomly selected control group of patients who presented with pain but no dysfunctional posture (n = 88). The patients underwent radiographic evaluation after review of previous medical records and history and physical examination. Patients with dysfunctional postures had a significantly higher frequency (63%) of a previous inappropriate diagnosis of RSD compared with the control group (6%). None of the patients in either group had objective findings consistent with a diagnosis of RSD. Patients presenting with dysfunctional postures of the upper extremity may be misdiagnosed as having RSD and rarely meet the criteria for this diagnosis.

Recovery from outpatient anaesthesia with propofol was followed in 10 patients, using a semantic recognition memory test (SemRT) (in a new implementation on a Psion hand-held microcomputer), choice reaction time (CRT) and critical flicker fusion threshold (CFFT). Group analysis of results revealed an effect on psychomotor performance as measured by the SemRT and CFFT (but not the CRT), 30 min after the end of the procedure. Performance on all three tasks had returned to baseline values within 60 min of completing the anaesthetic. Group analysis, however, masks individual impairment which may be clinically important. There was no statistically significant correlation between post-anaesthetic task performance and age, sex, dose of propofol, anxiety or depression score.