ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121211.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121212.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121213.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121214.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121215.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo present a report of the first two years of the Queensland Flying Obstetric and Gynaecology(FOG) Service which commenced operation in July 1988, and to assess the impact of the service on rural Queensland.DesignData were collected retrospectively for the surgical treatment and consultations provided by the FOG Service in its first two years, and for the obstetric and gynaecological surgery performed at Alpha Hospital, a typical rural hospital, before and after the inception of the service.SettingThe service provides specialist routine and emergency care for the women of 24 western Queensland towns scattered over approximately three‐quarters of the area of the State.ResultsIn the first two years of operation of the service, the team performed 4985 consultations, 1127 colposcopies, 1793 operations; 1143 ultrasound scans, answered 100 emergency calls and flew 318650 km, equivalent to eight times around the world. In the seven years before the FOG Service began, only 17 gynaecological operations were performed at Alpha Hospital; in the first two years of the service the team performed 47 operations in this town.ConclusionsThe FOG Service has made a very significant impact on the delivery of specialist services to the women of outback Queensland, and has also provided continuing education opportunities and professional support for remotely placed rural medical and nursing staff. The service has proved its worth in Queensland, and provides a model for the development of similar services in other large States of Australia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121216.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo identify any characteristics of patients that are associated with presentation with thick primary melanoma.DesignThis was a retrospective survey of the clinical records of 1300 patients attending the Newcastle Melanoma Unit. Characteristics of 131 patients with thick melanomas (defined as 3mm or greater in thickness) were compared with those of 543 patients with thin melanomas (defined as 0.75 mm or less in thickness). Comparisons were made using contingency table analysis, Wilcoxon rank sum tests, log rank analysis and logistic regression.SettingThe Newcastle Melanoma Unit is a tertiary referral centre for the treatment of primary melanoma.PatientsWe surveyed all 1300 patients attending the Newcastle Melanoma Unit over the years 1981‐1990. They represented approximately 90% of the patients in the Hunter region of New South Wales who developed Illelanoma during this period. Excluded from analysis were 39 patients with occult primary melanomas, 79 with multiple primary melanomas, 51 with primary melanomas of unknown thickness and seven with incomplete records, leaving 1124 patients in the study.Main outcome measuresThese were selected before the results were known. The hypothesis was generated following analysis of the data.ResultsPatients with thick primary melanoma were more likely to be men (68% men and 32% women in the thick melanoma group, compared with 45% and 55% respectively in the thin melanoma group, P<0.005) over 60 (75% were over 50 years of age in the thick group versus 33% in the thin melanoma group, P<0.001) with nodular melanoma(62%, versus 2% in the thin melanoma group, P<0.001) and with melanoma on the head and neck (27%, versus 12% in patients with thin melanoma, P<0.005). The time from detection of a change in skin to diagnosis was not longer for those with thick compared to those with thin melanomas.ConclusionThe greatest problem of detecting melanoma at an early (surgically curable) stage appears to be in patients over the age of 50 who have nodular melanoma, particularly in the head and neck.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121217.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveVarious methods are available to quantitate medicinal drug use in hospitals. These represent a hierarchy of clinical specificity, complexity and cost of acquisition. Similarly, various strategies and methods are available to modify prescribing patterns. The objectives of this study are to illustrate these processes of measurement of drug use and modification of prescribing patterns using specific examples derived from practice at three major Australian teaching hospitals over 15 years.Design, Setting, Main outcome measuresMethods to measure and modify drug usage in the three hospitals are outlined and 12 examples are presented by specific drug or drug category. Each example includes details of the methods used to detect inappropriate drug use (pharmacy purchases, pharmacy issues, prescription analysis, clinical record review, performance and outcome assessment), the intervention strategies used (re‐educative, persuasive, facilitative, power), the methods employed to alter drug prescribing and the relative effectiveness and cost‐efficiency of the interventions.ResultsReadily available, relatively cheap quantitative methods provide significant information and an efficient basis for planning definitive studies, and substantial modification of prescription patterns is possible through the strategic use of limited manpower and resources.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121218.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectivesTo assess the pathogenic significance ofBranhamella catarrhalisisolates in patients with respiratory infections and to define the clinical characteristics of such patients.Design and settingRespiratory specimens were assessed in a three‐year prospective study performed in a Brisbane metropolitan hospital. Assessment' of the pathogenic significance of isolates of B. catarrhalis was based on four predetermined criteria: (i) clinical evidence of respiratory infection based on history, examination and chest x‐ray; (ii) isolation of B. catarrhalis as the sole potential pathogen; (iii) absence of antibiotic treatment in the previous two weeks; and (iv) subsequent clinical response to an antibiotic to which the isolate was sensitive.ResultsB. catarrhalis was identified in 118 respiratory samples, 92 (78%) being from patients less than 10 years old. Infection with B. catarrhalis was more commonly seen in winter months and was community‐acquired in two‐thirds of cases. Isolation of this organism was associated with a broad variety of upper and lower respiratory 'tract syndromes..Isolates were considered to be of pathogenic significance (all four above criteria satisfied) in 35% of cases and of possible significance (the first and fourth criteria satisfied) iii a further 15% of cases. Isolates were more likely to be of pathogenic significance in older patients and in those with pre‐existing cardiorespiratory disease; however, a number of serious infections were observed in previously‐well children. Expectorated sputum and tracheal aspirates were more likely to yield a clinically significant isolate than nasopharyngeal aspirates. Production of β‐Iactamase was demonstrated in 88% of isolates.ConclusionB. catarrhalis causes respiratory infection more frequently than is generally appreciated. Isolation of this organism from the respiratory tract had pathogenic significance or possible pathogenic significance in 50% of our patients. If therapy is indicated in patients with respiratory infection caused by this organism, traditional β‐Iactam regimens cannot be relied upon, as shown by the high rate of β‐lactamase production in this study; a tetracycline, erythromycin, a second or third generation cephalosporin, or the combination of a penicillin derivative and β‐Iactamase inhibitor should be considered.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121219.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

The formation of the latest General Practice.Teaching Unit in an Australian hospital is part of a national trend to teach undergraduates and postgraduates about some parts of general practice using patients separated at triage from the accident and emergency departments. Planning this unit required much negotiating between several institutions and a set of guidelines on organisational relationships was created.Innovative features of the Modbury General Practice Teaching Unit include payment of teachers to attend compulsory medical education workshops. dividing the Family Medicine Programme trainee's time between the unit and a neighbouring practice and payment of non‐academic general practitioner teachers by the South Australian Government, which eliminates the risk that service interferes with teaching.The Modbury General Practice Teaching Unit is currently the only hospital based unit of this kind in South Australia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121220.x

出版商:Wiley    

年代:1991

数据来源: WILEY