Health Issues Facing Indigenous Australians, Categories of Hypoxia, and Types of Transfusion Reactions - Assignment Example

Medical Assignment Student’s Name Course code and name Instructor’s name Learning Institution City, State Date of submission 1. Briefly outline some of the major health issues facing indigenous Australians, and current proposed strategies in reducing the gap in health outcomes that currently exist There are a number of health problems affecting indigenous Australians that has resulted into a considerable reduction in adult life expectancy. An example of such a problem is chronic conditions that involve heart diseases, stroke, diabetes failure of the renal system and an increasing burden for the indigenous Australians in terms of costs of maintaining health (Barash, 2009). The incidence of these diseases has been common among the Aboriginal and Torres islanders in comparison with non-aboriginal groups. These impacts have been experienced among the older population as well as the younger people in the population. The main contributing factor has been explained to be persistent social and economic disadvantages in addition to lack of adequate access to health care and proper nutrition. There has been an increase in the gap between life expectancy and mortality rates when compared with other countries such as New Zealand, Canada and the United States. There has also been concern with regards to infant mortality rates among the aboriginal and Torres islanders when compared to non-islanders (Behrendt, 2012). Mortality rates of children have been explained to be contributed by poor medical services to mothers during birth. It is estimated that the infant mortality rates among the Aboriginal groups is 14.3 per 1000 live births compared to a country such as Canada where infant mortality rate is 6.4 per 1000 births. Consequently, a number of strategies have been formulated to enable control of disparity in health conditions of Australians. Focus has been put towards allocation of resources with the focus on health infrastructure such as primary care and provision of adequate housing and better lifestyles towards reducing mortality rates among the Aboriginal Australians. This has resulted into the observation of improvement of health status of the indigenous Australians to a small extent (Blakeley, 2008). In addition, medical staff training has been increased with the focus on providing the aboriginal groups with high quality medical services in case of illnesses. This is aimed at addressing a shortfall of more than 400 doctors that is currently experienced among the aboriginal groups. A ten-year program has also been developed for aboriginal and Torres Islander doctors, nurses, dentists and other health professionals for the purpose of bridging the gap between the Aboriginal and Torres strait islanders people as well as the general population of Australia, in the areas such as provision of supports in education of these professionals (Borowski, Encel & Ozanne, 2007). In addition, steps have been taken to improve health responsiveness to health needs of the aboriginal people and Torres Islanders. Strategies are also underway to reduce inequities in access to hospital procedures among the Aboriginal groups of people by enabling them have access to screening services, cardiac rehabilitation and hearing rehabilitation services. Finally, there has been increased support for maternal care through maternal and child health programs with Aboriginal health services in various parts of Australia. 2. Discuss the categories of hypoxia, giving an example of a condition and explanation of the mechanism by which hypoxia develops for each subtype Generally, hypoxia refers to a condition where there is inadequate supply of oxygen to a particular part of the body. Despite the fact that the condition is pathological, changes in arterial oxygen concentration is an example of the normal physiology such as during training and involvement in strenuous exercise. An example of a type of hypoxia is hypoxic hypoxia. This is characterized by the total or local disturbance of the circulation, venous stagnation as a result of closure of the arteries (Cheng, Kotler & Lee, 2011). It is main characteristics include reduced oxygen tension in the capillaries and low oxygen pressure in the inhaled air when the lungs are not adequately ventilated or as a result of pathological conditions in the respiratory system which results into blockage of the alveoli. The main methods by which this type of hypoxia develops is as a result of high altitude or when there is inadequate amount of oxygen to breathe despite the existence of normal pressure such as when cellars are filled with CO2 rather than oxygen. Another type of hypoxia is anemic hypoxia that results from a decrease in transport capacity of oxygen in the blood fluids (Courtney & Thomas, 2005). This can be contributed by lack of enough hemoglobin in various forms of anemia and lack of adequate functionality of hemoglobin such as when there is a blockage in transport capacity o hemoglobin. There is also circulatory hypoxia which is a form of hypoxia that develops when the supply of blood to the tissues is not sufficient while the blood is adequately supplied with oxygen. This may develop through ‘total circulatory hypoxia’ which results from insufficient output of the left ventricle or vasoconstriction and stagnation of blood in certain times during circulation (Dufour & Clavien, 2010). Another contributing factor to this type of hypoxia may be arterial thrombosis such as myocardial infarction, embolism and stagnation of blood. In addition, there is histotoxic hypoxia which results from inability of cells to utilize oxygen, caused by a disturbance to the mitochondria despite the existence of sufficient oxygen in the arterial blood (Farmar-Bowers, Higgins & Millar, 2013). It is mainly observed when a person is intoxicated with cyanides, which result into blockage of cytochromoxidase. It also occurs when the enzymes of the Krebs cycle are damaged with monobromacetone or when anesthetics are damaged resulting into an interference with the system of dehydrogenases. 3. Discuss what the oxygen hemoglobin curve represents, and why it has a sigmoid shape, what a leftward or rightwards shift of the curve signifies and what factors signify such shifts. The oxygen-hemoglobin curve represents the relationship between the available oxygen and the amount of oxygen contained in the haemoglobin. The affinity for oxygen in hemoglobin increases continuously as additional oxygen molecules bind to its wall. More molecules are attached to hemoglobin as partial pressure of oxygen increases until a maximum amount that can be transported by the hemoglobin binds to its walls. The horizontal axis of the curve represents the amount of oxygen available while the vertical axis represents the amount of haemoglobin saturated with oxygen. When the oxygen-haemoglobin curve reaches 60mmHg, the curve assumes a flat shape indicating little change in saturation above this pressure. Consequently, oxygen availability at or above 6ommHg is usually inadequate as a result of saturation of the red blood cells (Garibaldi, 2009). This explains the sigmoid nature of the oxy-hemoglobin curve. There are a number of factors that impacts the affinity for oxygen by the haemoglobin. These factors include pH, temperature, concentration of CO2 and DPG a metabolic regulator that competes with oxygen for the active sites in the hemoglobin. For instance, changes in pH of blood such as a decrease in the value of pH results into the shift of the curve towards the right while an increase results into the shift to the left. This condition is referred to as the Bohr Effect. In the case of temperature, hyperthermia contributes to a shift of the curve towards the right and hypothermia results into a leftward shift (Garibaldi, 2009). The effect of DPG contributes to adaptive capabilities of hemoglobin, because when it is produced there are a number of conditions that increases the affinity for oxygen in the presence of low oxygen concentrations such as during hypothermia, lung disease, anaemia or congestive heart failure. The effect of carbondioxide is that it affects the pH between the cells and causes generation of carbamino compounds through chemical processes which contribute to the shift of the curve either to the right or to the left. These factors result into the shits of the curve either to the left or to the right: resulting into processes called ‘left shift’ and ‘right shifts’. Left shift is a condition that results into increase in oxygen affinity for hemoglobin active sites. During the left shift condition, the available oxygen in the haemoglobin increases at a particular value of available oxygen, however more of it will be retained in the haemoglobin and be conveyed back to the lungs without being utilized by the body. It is a process that is also referred to as alkalosis or hypothermia. As a result, there is a likelihood of tissue hypoxia despite the possibility of sufficient oxygen in blood. During the right shift, there is usually low oxygen affinity by the haemoglobin. This shift is also referred to as acidosis or fever. During this shift, blood will release oxygen easily and it will be possible to release oxygen to the cells and there will be less oxygen transferred from the lungs. 4. List the various types of transfusion reactions and explain the causes and effects of each. There are various types of transfusion reactions when patients are provided with blood from donors. An example of such a reaction is acute hemolytic reaction (Harrison, 2011). It is a reaction that results from errors caused by humans such as wrong labeling of pretransfusion specimen or using a labeled blood to the wrong person or a s a result of clerical errors at the Blood Bank. It results into a reaction between the transfused red blood cells with the circulating antibody when the recipient has a resultant intravascular hemolysis. The main effects include fevers, chills, feeling of pains in the veins where transfusion has been carried out, pain in the lumbar region and chest pains. The person may also have a feeling of impending doom during the early stages of the reaction. The main effects in anesthetized patients include uncontrollable bleeding resulting from disseminated intravascular coagulation. Another example of transfusion reaction is delayed hemolytic reaction. The causative factors of this reaction include development of antibodies from the previous transfusion or when a person is pregnant but the antibody is not well developed during transfusion to be detected by regular methods (Hoffman, 2005). When transfusion is carried out with red blood cells with similar antigen, an anamnesis antibody response and hemolysis is experienced. The main effects of this reaction include haemolytic reactions that usually occur about 4-8 days following transfusion. It is also possible to experience hemoglobinuria and a mild increase in serum bilirubin. It is also possible to experience high fever and leukocytosis thus having a feeling of occult infection. Another form of transfusion reaction is febrile reaction. This a reaction that results from the reaction between cytokines, antibodies and leukocytes fragments. The main effects of this reaction is fever A and a rise in temperature by 1.8 F from the normal temperature. Another form of transfusion reaction experienced by most patients is Allergic-uricaria that is mainly caused by foreign plasma proteins (McConnell, 2007). These reactions result into impacts such as allergic reactions that are associated with laryngeal edema and bronchospasm. When in combination with another sign, such as fever it will be possible to achieve an evaluation for a hemolytic reaction. In addition, there is Allergic-Anaphylaxis which is caused by anti-IgA and the effects include anaphylactic Respiratory involvement with dyspnea and reactions are mainly visible in cardiovascular instability such as hypertension, lack of consciousness, cardiac arrhythmia and cardiac arrest. There is also the Tralli form of reaction that is caused by the existence of antibodies in the plasma of the donor and production of inflammatory mediators when blood components are stored. 5. Describe the pre-hospital (ambulance) and hospital treatment of asthma and compare the delivery of medication by nebulizer and spacer, describing the pros and cons of each. During prehospital treatment for patients with asthma, there is the need to ensure they are provided with oxygen through artificial methods. This can be achieved through the use of spacers and nebulizers (Norton, 2008). When spacers and nebulizers are compared, it is found that they contribute equally towards delivery of bronchodilator among patients with asthma. The limitation associated with the use of spacer has been difficulties with valve movements as well as moderate withdrawal rate due to lack of tolerance when spacer is used. When an equivalent amount of dose is delivered using nebulizer and spacer, it has been found that the average amount of dose delivered by a spacer is more effective compared to the dose delivered by a nebulizer. Despite the nebulizer being the standard method of providing aerosolized therapies, the output from the nebulizer system is greatly impacted by the type and brand of nebulizer used and the method of its operation (Miller & Eriksson, 2009). However, when the spacer and nebulizer are compared, it is found that spacer is more appropriate due to fewer difficulties with movement of valves as a result of flow of air. This is due to close application of the mask to face resulting into an efficient seal. Despite the acceptance of nebulizer as the standard method of providing care for patients with acute asthma, there are a number of limitations which makes it unsuitable for use. They are noisy when being used and the patent has to sit still for a relatively long duration. They are also likely to breakdown thus the need for regular maintenance while some have not been efficient in delivery of a better respirable output. The efficiency of a spacer when compared with a nebulizer arises from the fact that time to deliver a dose is usually shorter and it is more efficient in dose delivery since fewer doses is required for the same broncholization (Moksness, Dahl & Stottrup, 2009). There are also fewer side effects due to lower hear rate response when treatment is performed using a spacer compared with nebulizer. The higher heart rate indicated by a nebulizer is an indication of unresolved asthma and a poor therapeutic index of bronchodilator when this device is used. When doses are delivered using a nebulizer, there is a greater facial and orophangeal deposition of medication, which is followed by a systemic absorption and side effects (Myers, Neighbors & Tannehill-Jones, 2002). When a spacer is used in delivery, targeting medication is improved by ensuring it goes to the lungs and not diverted to other areas, thus contributing to a reduction in amount of medication available for systemic absorption. Another advantage of a spacer over nebulizer is that it is relatively cheap and does not require external power source to operate thus enabling its use in most settings. 6. What are the main principles of treatment of rain injury secondary to stroke or trauma and what impact does hyperglycaemia have on outcome? The main principle involved in treatment of a person with brain injury is stabilization of the patient so that further injury does not take place. This is done by provision of the right amount of oxygen to the brain and ensuring the body is in a resting position, and an adequate blood flow is maintained while blood pressure is controlled. This is followed by opening the patient’s airways or performance of procedures aimed at making the patient breathe. This may be followed by treatment of the injuries to ensure bleeding is controlled (O'Connor-Fleming & Parker, 2008). Due to the possibility of injury to the spinal cord, care must be taken during transportation of the patient. In most cases, the patient is placed in a back-board in a neck restraint. This ensures the patient is immobilized and further injury to the head and spinal cord is prevented. When the medical personnel have stabilized the head-injured patient, the condition of the patient is assessed through measurements of important signs and reflexes as well as neurological tests. In addition, the body temperature of the patient is checked. Other examinations performed include blood pressure, pulse, breathing rate and size of the pupil. Glasgow Coma Scale is used to assess the patient’s level of consciousness and functions of the neurological system. Glasgow Coma scale refers to a 15-point test that implements three measures-opening of the eye, verbal response, responses of the motors so that the severity of the patient’s injury can be examined. There are many impacts brought by hyperglycemia on the outcome of treatment process. For instance, hyperglycaemia is associated with high cerebral lactate that contributes to a local brain tissue acidosis. This results into worsening of mitochondrial activities in the penumbra as well as contributing to an increased cerebral infarct size (O'Leary, Tabuenca & Capote, 2008). In addition, hyperglycemia is associated with adverse impacts on ischemic brains through disruption of blood-brain barrier and promotion of cerebral adema. Furthermore, hyperglycemia contributes to negative impacts stroke patients who have been treated with early reperfusion therapy. According to studies, when glucose levels are increased, there is impaired cerebrovascular reactivity in the microvasculature. These conditions result into a reduction in reperfusion after tissue plasmogin activator induced recanalization, resulting into a worsened neurologic impact. 7. Explain the mechanism behind haemodialysis and peritoneal dialysis treatment, when they are indicated as well as the dietary restrictions, if any, imposed on the patient undergoing them. Haemodialysis refers to a process where a man-made membrane is used to achieve the function of filtering wastes, removal off excess fluid from blood, restoration of fluid part of blood and other chemicals that are important during blood functions and elimination of blood fluids. Before the commencement of haemodialysis process, an access to where the flow of blood can take place is established by joining artery and vein located in the arms. Alternatively, this function may be achieved through the use of a small tube that creates a connection between the artery and vein. This process is mainly carried out in hospitals or centers set aside specifically for dialysis (Ronco, 2006). The process is mainly carried out 3 times a week and takes at least 3 hours a day to perform. In a case where the process is carried out at home, it can be done in a number of days. Peritoneal dialysis is also used to perform a similar function as haemodialysis but involves the use of a membrane in the abdomen to perform filtering functions. This type of dialysis does not require travel to dialysis center and can be done within the patient’s residence, at night or when the patient is asleep (Ronco, Bellomo & Kellum, 2009). However, in this form of dialysis, daily repetition of the process is required. In order to carry out peritoneal dialysis, the fill process is carried out. This is the process where the dialysis solution enters the peritoneal cavity. The next stage is the dwell stage which involves travelling of extra fluid from the body travels across the membrane into the dialysis fluid (Schrier, 2007). The third stage which is the final step is the drain stage. This is where the dialysis solution flows out after a few hours followed by replacement with a new solution. During dialysis process, there may be a number of dietary restrictions on the patient. For instance, during haemodialysis process, the patient is required to eat high amounts of proteins because dialysis contributes to a loss of between 10-12 grams of amino acids which are the main building blocks and there is also the possibility of a loss in at least 5 grams of protein during treatment (Smith, 2008). As a result of these losses of proteins, the patient is required to eat a lot of protein products such as meat, poultry, fish and eggs. Haemodialysis patients are however, restricted from taking high amounts of sodium. This is because a normal person’s diet usually contains adequate amounts of sodium so it is recommended that small amount of salt should be added to food. This is aimed at reducing impacts of high sodium intakes such as thirst, swelling, shortened breath and high blood pressure. The consumption of calcium is also restrict6ed to 2000 mg on daily basis whether a person is undergoing haemodialysis treatment or not. The dietary restrictions for a person undergoing peritoneal d8ialysis include restricted intake of phosphorus. This is because high intake of phosphorus can result into complications in the body of the patient such as weak bones, heart problems, pains in the joints and skin ulcers (Weissleder, 2010). In addition, it is recommended that intake of sodium should be restricted because it results into increased thirst which can result into fluid intake that exceeds the recommended amount. This can result into swellings, shortness of breath and increased pulse. 8. How is severe acute anaphylaxis treated both pre-hospital (ambulance) and in the emergency department? How do these measures alleviate or reverse symptoms? Anaphylaxis refers to a condition where the patient experiences an acute allergic reaction and mainly occurs when least expected leading to a worsening situation that can result into death if not properly treated. There are various treatment options for pre-hospital state and when the patient is in the hospital. For instance, in the pre-hospital state, an adrenaline is administrated to the patient using a prefilled needle which is sometimes referred to as adrenaline pen Willis, E., (Reynolds & Keleher, 2009). This process can also be performed individually by the person affected by anaphylactic reaction or by a bystander who has the skill of using it. It can also involve cardiopulmonary resuscitation (CPR) when the person does not respond and not breathing. For people who are not medically trained or do not have the skills of performing CPR with recues breaths, it is recommended that Hands-only CPR should be provided. This involves a restriction of mouth-to-mouth resuscitation or kiss of life (Xi & Serebrovskaya, 2012). If the person has collapsed and not breathing, it is important to call the emergency service followed by chest compressions. The purpose of this is to bring the person out of cardiac arrest. It will also contribute to pumping of blood to various parts of the body, such as brain which will be supplied with a considerable amount of oxygen from blood that flows through it. Hospital treatment for this condition may involve a number of activities. They can be treated with resuscitation method in the emergency room. They may also be treated using adrenalin, which is given through injection into the muscles of the thigh. In addition, a sequence will be followed during resuscitation process such as making the patient lie flat to keep the airway open followed by giving the patient oxygen with a face mask and finally intravenous access such as the use of fluids to maintain the blood pressure and ensure blood circulation is constant round the body (Yeung & Escalante, 2002). Another method that contributes significantly towards treatment of anaphylaxis is the use of antihistamines and hydrocortisone. In some cases, a nebulizer is used. In this method, a medicine called salbutamol is inhaled like a fine mist, via the device. This results into opening up of the bronchioles thus allowing ease in breathing. During the treatment process, the person is closely monitored in terms of observing blood flow and monitoring levels of oxygen in the blood. The patient is then kept in hospital for a minimum of 6 hours so that the condition can be monitored (McConnell, 2007). There may also be outpatient blood tests for detecting allergies such as skin prick testing or a prescription for adrenaline auto-injector device. These measures result into a reversal of symptoms in a number of ways such as enabling breathing and gaining consciousness for people who have become unconscious. It also results into prevention of consequences of the condition such as myocardial ischemia or electrocardiograph changes in the affected person. It also results into alleviation of the patient from life-threatening conditions such as increased pulse rate, reduced blood pressure such as the feeling of fainting, decreased consciousness and signs of shock. 9. What is negative pressure pulmonary oedema and how does it develop? Negative pressure pulmonary oedema refers to a complication of anesthesia that results from laryngospasm in the process of extubation. Despite lack of commonness and treatability of the condition, it is important that the professional involved in anesthesia provision to identify the signs and symptoms so that a relevant treatment method can be determined. Those who are at risk of the condition are young people and people of male sex. The stimuli involved include blood, gastric fluids and changes in temperature (Harrison, 2011). When smooth and skeletal muscles are stimulated, there is a possibility of coughing, bronchospasm and closure of vocal code as a result of dysregulation from higher centers. When there is continued laryngospasm, hypoxia results. At this stage, there is an increase in sympathetic stimulation which overcomes parasympathetic innervations contributing to tachycardia and high blood pressure. This condition develops irrespective of the normal functioning of the heart and lungs within the expected levels. The condition starts with closure of the airway, resulting into development of a very large pressure within the thoracic region of the patient. This negative pressure can be as high as -100mmH2O. As a result of this negative pressure there is a development of high intraventricular pressure. In addition, this pressure results into a reduction in intramural hydrostatic pressure. There is also a reduction in pulmonary vascular resistance which results into dilation of the right ventricles, a shift in intraventricular septum to the left and dysfunction of left ventricular diastolic function (Hoffman, 2005). These conditions contribute towards an increase in heart loading conditions which result into a condition referred to as intramural hydrostatic pressure. Various studies have been conducted to understand the development of NPPE such as transudation of fluid from pulmonary capillaries into spaces between the cells and the alveoli. The main divisions that have been used to explain negative pulmonary oedema are two. The first being the one that occurs after an acute obstruction of the epiglottis. The other type is the one that occurs when there is a relief in the chronic upper airway (McConnell, 2007). A contributing factor to slow development of NPPE after the relief of the upper airway has been suggested to be the loss of ‘auto-DEEP’ condition. Inspiration that counteracts the closure of the epiglottis is achieved through the function of expiration against the same closed epiglottis. As a result of the relief to the closed epiglottis, there is a rapid resolution of the airway pressure in comparison to an increase in venous hydrostatic pressure. Various methods have been used to treat this condition such as administration of 100% oxygen, ceasing stimulation to the patient, making the airways free from secretions, and creating high pressure in the airways. If this strategy does not create a solution for the condition, the patient should be provided with an intravenous succinychlorline as a treatment option. If the condition goes beyond the laryngospasm episode, there is the need to provide the patient with muscle relaxant (Miller & Eriksson, 2009). There is the need for a chest radiograph for another diagnostic procedure. In addition, chest x-ray can be performed as a diagnostic procedure. During the chest x-ray, a gastric tube can be used to stimulate the oropharynx and upper part of the larynx that results into another episode of laryngospasm. When diagnosis and confirmation of post-obstructive pulmonary oedema has been done, there is the need to provide treatment with the focus on improving respiratory functions and ensuring lungs are protected from damage. It can involve maintaining the airways and provision of additional oxygen (Garibaldi, 2009). There may also be the need for additional mechanical ventilations. When there is improvement as a result of conservative therapy, it is important to use intravenous diuretics despite lack of evidence with regards to clinical benefits. 10. Explain the Frank-Sterling and Laplace Laws in relation to the heart. How do these laws explain the underlying pathology of heart failure? Various laws have been used to explain heart failure. An example of such a law is the Frank-Sterling law. This refers to a law which states that the volume of the heart increases as the volume of blood entering into it increases with the assumption that other factors do not change. As a result of increase in flow of blood into the heart, there is a stretch in the walls of the ventricles resulting into a forceful contraction of muscles in a process called Frank-Sterling mechanism (Norton, 2008). There may be an increase in contractility of the muscles of the heart in cases of strenuous exercises, irrespective of the diastolic volume. When there is a greater stretch in the muscle fibers, it counteracts muscle contraction by creating a high affinity for calcium in the myofibrils, which results into a higher number of actin-myosin in the muscle fibers. The resulting force from a single muscle fiber contributes to the total force that contracts the stretching force as a result of influx of blood into the heart (O'Halloran, McGregor-Lowndes & Simon, 2008). Frank-Sterling Law enables understanding of the pathology of heart failure by explaining that when the heart is fatigued during the process of countering tension in the ventricles, it can fail to function thus resulting into heart failure. Another law that that has been used to explain the failure of the heart is Laplace law (Ronco, 2006). This law tastes that if the radius of the heart is increased excessively in the process of dilation, while there has been a plateau in tension during contraction, the resulting pressure falls, resulting into a reduction in stroke volume. Tension can be defined as a product of stress and wall thickness while stress refers to force per unit cross sectional area of the wall. When there is an increase in radius, curvature reduces, resulting into entanglement of a smaller section of the wall tension to the cavity, thus a high pressure is generated (Dufour & Clavien, 2010). The curvature of the wall of the ventricle determines the efficiency of conversion of wall tension into intraventricular pressure. As a result of an over dilated heart, there is low output of blood which is at low pressure, thus not reaching all parts of the body. This has an impact on the amount of blood returning to the heart thus resulting into heart failure. It has been suggested that if an over dilated heart has been identified; there is the need to perform treatment as fast as possible before fatal stages are reached. References Barash, P. G. (2009). Clinical anesthesia. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Behrendt, L. (2012). Indigenous Australia for dummies. Richmond, Vic: John Wiley & Sons. Bell, E. (2010). Research for health policy. Oxford: Oxford University Press. Blakeley, S. (2008). Renal failure and replacement therapies. London: Springer. Borowski, A., Encel, S., & Ozanne, E. (2007). Longevity and social change in Australia. Sydney: UNSW Press. Bowie, M. J., & Schaffer, R. (2012). Understanding ICD-9-CM coding: A worktext. Clifton Park, NY: Delmar Cengage Learning. Cheng, H., Kotler, P., & Lee, N. (2011). Social marketing for public health: Global trends and success stories. Sudbury, Mass: Jones and Bartlett. Courtney, F., & Thomas, D. (2005). Excel HSC & preliminary personal development, health and physical education. Glebe, N.S.W: Pascal Press. Couzos, S., Murray, R., Kimberley Aboriginal Medical Services' Council., & National Aboriginal Community Controlled Health Organization. (2008). Aboriginal primary health care: An evidence-based approach. Melbourne, Vic: Oxford University Press. Dufour, J.-F., & Clavien, P.-A. (2010). Signaling pathways in liver diseases. Heidelberg: Springer. Farmar-Bowers, Q., Higgins, V., & Millar, J. (2013). Food Security in Australia: Challenges and Prospects for the Future. Berlin [etc.: Springer. Garibaldi, B. (2009). The internal medicine work-up. Philadelphia, Pa: Lippincott Williams & Wilkins. Harrison, M. (2011). Revision Notes for MCEM Part A. Oxford: OUP Oxford. Hoffman, R. (2005). Hematology: Basic principles and practice. Philadelphia, Pa: Elsevier Churchill Livingstone. Hunter, B., & Australian National University. (2006). Assessing recent evidence on Indigenous socioeconomic outcomes: A focus on the 2002 NATSISS. Canberra: ANU E Press. McConnell, T. H. (2007). The nature of disease: Pathology for the health professions. Baltimore, Mar: Lippincott Williams & Wilkins. Miller, R. D., & Eriksson, L. I. (2009). Miller's anesthesia. Philadelphia, PA: Churchill Livingstone/Elsevier. Moksness, E., Dahl, E., & Stottrup, J. G. (2009). Integrated Coastal Zone Management. Chichester: John Wiley & Sons. Myers, J. W., Neighbors, M., & Tannehill-Jones, R. (2002). Principles of pathophysiology and emergency medical care. Albany: Delmar/Thomson Learning. Norton, J. A. (2008). Surgery: Basic science and clinical evidence. New York, NY: Springer. O'Connor-Fleming, M. L., & Parker, E. A. (2008). Introduction to public health. Sydney, N.S.W: Elsevier Churchill Livingstone. O'Halloran, K., McGregor-Lowndes, M., & Simon, K. W. (2008). Charity law & social policy: National and international perspectives on the functions of the law relating to charities. Dordrecht: Springer. O'Leary, J. P., Tabuenca, A., & Capote, L. R. (2008). The physiologic basis of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Ronco, C. (2006). Peritoneal dialysis: A clinical update ; 20 tables. Basel: Karger. Ronco, C., Bellomo, R., & Kellum, J. A. (2009). Critical care nephrology. Philadelphia: Saunders/Elsevier. Schrier, R. W. (2007). Diseases of the kidney & urinary tract. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Smith, T. (2008). Fundamentals of anaesthesia. Cambridge: Cambridge University Press. Talbot, L., & Verrinder, G. (2010). Promoting health: The primary health care approach. Chatswood, N.S.W: Elsevier. Weissleder, R. (2010). Molecular imaging: Principles and practice. Shelton, Conn: People's Medical Pub. House--USA. Willis, E., Reynolds, L. E., & Keleher, H. (2009). Understanding the Australian health care system. Chatswood, N.S.W: Churchill Livingstone/Elsevier. Xi, L., & Serebrovskaya, T. V. (2012). Intermittent hypoxia and human diseases. London: Springer. Yeung, S.-C. J., & Escalante, C. P. (2002). Oncologic emergencies. Hamilton, Ont. ; London: BC Decker. Read More