摘要:

ObjectiveTo document aspects of the management of 15 patients with workers' compensation injuries which led to opioid dependence and suggest preventive strategies.MethodDetails of general practitioner and deputising service visits for a 38‐week period, 1 May 1991 ‐22 January 1992, were obtained from WorkCover case files and general practitioners' patient records, and claims for reimbursement for afterhours home visits (Item 97) were obtained from the Health Insurance Commission (HIC) for the years 1991, 1992 and 1993.ResultsFourteen of the patients had a lumbosacral injury. A total of 2489 deputising service visits were provided on 3227 days (0.77/day). A statistically significant 20% higher visit rate occurred on Sundays and public holidays compared with the rate for the rest of the week. Deputising service practitioners provided 4.7 times as many services as general practitioners. In 1299 visits to 12 of these patients, parenteral drugs administered included 108 385 mg pethidine, 2680 mg morphine, and 20 400 mg promethazine. All 15 patients were independently assessed as having features indicating opioid dependence. In only one patient was there evidence of opioid dependence before injury. An alternative management plan not requiring deputising service visits was instituted early in 1992. The number of claims from the HIC for afterhours visits to these 15 patients rose from 125 in 1991 to 630 in 1992, while 409 were provided in 1993.ConclusionAppropriate strategies, such as restricting the ability of deputising services to bill directly for the services they provide, and a sharing of information between the HIC and other statutory authorities, should prevent a similar occurrence in the future.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124521.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo discuss the implications of recent studies on carotid endarterectomy for asymptomatic carotid stenosis.Data sourcesTrials of the effectiveness of carotid endarterectomy in asymptomatic carotid stenosis, including the Asymptomatic Carotid Atherosclerosis Study (ACAS).ResultsIn the ACAS study, carotid endarterectomy for asymptomatic moderate to severe carotid stenosis (60%‐99% luminal obstruction) reduced the absolute risk of ipsilateral stroke or death at five years by 5.9%. This means that about 17 patients need to be operated on to prevent one stroke or death over five years. To operate on all Australians with asymptomatic 60%‐99% carotid stenosis would cost an estimated $ A 1.24 billion and prevent 800 strokes per year, or only 3% of all first strokes in Australia.RecommendationsIn order to identify who will benefit from carotid endarterectomy and who will remain symptom‐free without it, patients should continue to be allocated to the ongoing Asymptomatic Carotid Surgery Trial. Otherwise, carotid endarterectomy should be reserved for patients at high risk of stroke (i.e., with 95%‐99% carotid stenosis) who are medically fit for surgery and willing to take the small short term risk of surgery for a possible greater long term benefit.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124522.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124524.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

The legislative response to assisted reproduction technology has been inappropriate and inflexible for such a rapidly developing area of medicine. A national system of regulation, consisting of a merger of components of already established committees and based on the United Kingdom system introduced in 1990, would overcome the legislative differences between States, and provide a more responsible and responsive regulatory system.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124525.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124527.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124531.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Coronary artery disease is the greatest threat to the long term survival of patients with heart transplants

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124532.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124533.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Second‐line agents (disease‐modifying agents or slow‐acting antirheumatoid drugs) are well established for synovitis that persists despite treatment with non‐steroidal anti‐inflammatory agents. Indications for their use in the elderly are similar to those in younger people, but the elderly are at higher risk of adverse reactions. Therefore, lower doses, more cautious patient selection and more frequent monitoring for adverse reactions are recommended. Low dose corticosteroids are often effective in the elderly and obviate the need for second‐line agents.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124534.x

出版商:Wiley    

年代:1995

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124535.x

出版商:Wiley    

年代:1995

数据来源: WILEY