摘要:

General practitioners (GPs) comprise the largest group of health professionals providing primary care services. They are frequently the first point of contact with the health care system, and see some 80% of the population each year. As such, they are an essential part of the health care system.'

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93842.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93843.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93844.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To determine the prevalence of premature ageing of the skin and to assess its associations with skin cancer and related risk factors in a Queensland population.Design:Community‐based prevalence survey of skin cancer and actinic skin damage.Setting:Population of Nambour, Queensland, in December 1986.Subjects:Random sample of 1539 residents aged 20 to 55 years for whom skin texture measurements were obtained, and a subsample of 807 whose skin reflectance was measured.Main outcome measures:Associations of premature ageing of exposed skin, assessed by silicone moulds of the dorsal skin of the hand, with present or past skin cancer, skin colour measured by reflectance and other related risk factors.Results:Skin texture changes consistent with moderate to severe ageing were observed in 72% of men and 47% of women under 30 years of age. Severity of skin ageing was significantly associated with increasing age, and independently, with the presence of solar keratoses (P<0.01) and skin cancer (P<0.05). Increased deterioration was also correlated with decreasing reflectance (darker colour) of sun‐exposed skin in both men (P<0.01) and women (P<0.05), but not with reflectance from sun‐protected skin, that is inherent skin colour. Photoageing among men was associated with outdoor occupations, outdoor leisure activities, a tendency to sunburn and previous skin cancer.Conclusions:Marked premature ageing of exposed skin is common in residents of Queensland and is evident among adults in their twenties. Public education programs about the ill‐effects of excessive sun exposure should emphasise not only the risk of skin cancer, but also the high risk of premature skin ageing.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93845.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To review the safety of team midwifery care, in terms of perinatal mortality, for pregnant women assessed at their first visit as being at low risk of complications.Design:A cohort study.Setting:Team midwifery unit (Birth Centre) in a tertiary hospital.Patients:All women who made a booking and met the selection criteria at their first antenatal visit (3085), excluding those with spontaneous or induced fetal loss before 20 weeks (89) and those who withdrew at their own request to seek an alternative form of care (138); the 2858 remaining women gave birth to 2874 infants.Main outcome measures:Perinatal mortality rate; and birthweight specific perinatal mortality ratio with reference values being specific rates for birthweight in Victoria for 1984–1985.Results:The perinatal mortality rate was 7.7 per 1000 births (95% confidence interval [CI] 4.8–11.6) for the whole cohort; for women beginning labour in the Birth Centre it was 1.3 per 1000 births (95% CI, 0.3–3.9). The birthweight standardised perinatal mortality ratio was 80 (95% CI, 50–122).Conclusion:Within this setting, with explicit criteria for booking and referral, and a framework for consultation, team midwifery care is as safe as the standard maternity care provided within the State.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93846.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To review experience with neutropenia related to low‐dose methotrexate therapy in patients with psoriasis and rheumatoid arthritis.Design:Retrospective review of medical records.Setting:A 509‐bed Melbourne teaching hospital.Patients:Five patients admitted in 1987 and 1988, with neutrophil counts of less than 1 times 109/L, given low closes of methotrexate for psoriasis or rheumatoid arthritis.Main outcome measures:Death, or length of hospital admission.Findings:Four patients were women, and one a man; three had been treated for psoriasis, and two for rheumatoid arthritis. Ages ranged from 56 to 91 years. The eldest patients, aged 77, 81 and 91 years, died. The other two were discharged after 43 and 48 days. Prior to or shortly after admission, four patients were treated with penicillin antibiotics which may have interfered with methotrexate excretion.Conclusions:Methotrexate clearances (related to creatinine clearance rates and presumably low) were probably reduced sufficiently by concomitant therapy to result in neutropenia. Practitioners using methotrexate should be aware of drug interactions resulting in delayed methotrexate excretion. Blood counts should be monitored after changes in therapy, especially in patients with impaired renal function, such as the elderly.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93847.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To describe the clinical picture of the syndrome of terminal restlessness in dying patients and the role and mode of administration of midazolam.Setting:Hospice unit of a public hospital.Design:Retrospective review of patient records and search of the literature for reports of the use of midazolam in palliative care from 1988 to 1990 and of the effects and side effects of drugs commonly used in the management of terminal restlessness.Patients and intervention:Eighty‐six patients with terminal restlessness received midazolam to alleviate their symptoms.Main outcome measures:Improved relaxation in the patients, a reduction in family anxiety and reduced staff stress.Results:Of the 86 patients with terminal restlessness, all but one obtained benefit. No apparent side effects or adverse reactions to the drug were observed.Conclusion:Midazolam given by the subcutaneous route can usually provide effective palliation of terminal restlessness when other measures are ineffective. The drug is also useful for providing short‐term sedation for uncomfortable procedures and for managing catastrophic terminal events.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93848.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To review the current status of the management of bipolar disorder (manic‐depressive illness).Data sources and study selection:Controlled clinical trials as well as some recent important open studies are examined.Data extraction and synthesis:Lithium carbonate remains the mainstay of both the acute and prophylactic treatment of this condition. We highlight specific contentious issues in prophylactic management with lithium, that is, indications for initiating long‐term treatment, preferred serum concentrations, timing of the dose, duration of treatment and frequency of laboratory monitoring. In recent years, several alternatives to lithium have been demonstrated as effective in both the acute and prophylactic treatment of patients either unable to tolerate or inadequately responsive to this agent. There is now considerable evidence that carbamazepine is of similar efficacy to lithium and more recent studies suggest that valproate may also be as therapeutic. We outline details of the clinical roles of each of these agents, with guidelines concerning monitoring and adverse effects.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93849.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:Pancytopenia is an unusual complication of low‐dose methotrexate therapy in rheumatoid arthritis. We report a near fatal case that followed an accidental overdose.Clinical features:An 80‐year‐old Caucasian woman with rheumatoid arthritis presented with pancytopenia and severe mucositis. She had taken her weekly methotrexate dose on four sequential days, due to an error in filling a “Dosette” box.Intervention and outcome:Following treatment with piperacillin, gentamicin and folinic acid, she recovered completely.Conclusions:Low‐dose methotrexate therapy is uncommonly associated with haematological toxicity. This generally occurs in patients with known risk factors for such reactions. Patient reliability should be considered if methotrexate therapy is contemplated.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93850.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93851.x

出版商:Wiley    

年代:1991

数据来源: WILEY