ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93882.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93883.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93884.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To show the trends in the rate and type of skiing injuries in Australia.Design:A retrospective analysis of skiing injuries in the Snowy Mountains from 1962 to 1988.Setting:All injuries were seen and treated at the Ski Injury Clinic in Perisher Valley.Patients:A total of 22 261 injuries were seen over this 27 year period (data for 1963, 1964, 1966, 1977, 1978, 1981 and 1982 were missing).Interventions:Injured skiers were treated at the Clinic with a small number sent to main centres for tertiary care.Main outcome measures:The overall injury rate (1962–1988) and the specific injury rate for six subgroups of injuries (1974–1988) were calculated.Results:The overall injury rate declined dramatically over this period. The incidence of tibial fractures, ankle injuries and lacerations also declined. Upper body injuries continue to rise although this trend was not statistically significant. There was a statistically significant increase in knee injuries.Conclusions:The trends reported here are similar to those overseas except that the incidence of thumb injuries has not changed in Australia. The changes in the rates of lacerations, and tibial and ankle injuries can be related to improvements in ski bindings and boots.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93885.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated.Design:Prospective recruitment of consecutive referrals.Setting:The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney.Patients:Two hundred and forty‐six patients with diabetes (10% insulin dependent), aged 20–86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients.Interventions:Data for the study were gathered by interview and questionnaire during first assessment at the clinic.Main outcome measures:Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners.Results:Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under‐emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over‐using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making.Conclusions:Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93886.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To draw attention to the occurrence of hypophosphataemia in anorexia nervosa and to suggest that it may be a factor contributing to cardiac arrhythmia, a potentially fatal complication.Design:A retrospective study of patients under the consultant care of one of us. All were adolescent girls or young women aged 14 to 31.Clinical course:During the index admission, three became acutely hypophosphataemic while receiving saline and potassium intravenously to correct hypokalaemia. Four patients were subsequently treated with phosphate supplementation. Two patients died, and three recovered.Conclusion:Hypophosphataemia in anorexia nervosa patients may play a role in the development of cardiac arrhythmia and delirium.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93887.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To determine the economic cost of asthma to the New South Wales community.Design:Direct costs (both health‐care and non‐health‐care) plus indirect costs (loss of productivity) were estimated from various sources to assess retrospectively the dollar costs of asthma. Intangible costs (such as quality of life) were not included.Setting:Estimates of costs were made at all levels of medical care of asthma patients, including inpatient and outpatient hospitalisations, emergency department visits, and visits to general practitioners and specialist physicians, plus costs of pharmaceuticals, nebulisers and home peak‐flow monitoring devices. The cost of time lost by the patient attending for medical visits and loss of productivity due to absence from employment as a result of asthma were also included.Results:The total cost of asthma in New South Wales was $209 million in 1989. This was made up of $142 million in direct health‐care costs, $19 million in direct non‐health‐care costs and $48 million in indirect costs.Conclusion:Although we believe that our estimate is an underestimate of the true dollar cost of this disease to the community, it represents $769 per asthmatic person per year, assuming a current prevalence rate for asthma in New South Wales of 6%. The cost effectiveness of any new treatment of asthma should be estimated to ensure that the economic cost to the community does not rise unnecessarily.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93888.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To determine the frequency and features of alcohol‐related cardiomyopathy in the Seychelles.Design and subjects:The study was multifaceted investigation involving: a randomised cross‐sectional survey of drinking habits in the general population; a cross‐sectional survey of blood alcohol levels in patients admitted to hospital; a prospective case series of all consecutive patients hospitalised with alcohol‐related cardiomyopathy; a retrospective review of medical records of patients with alcohol‐related diseases; a retrospective review of autopsy records; and an analysis of volatile oils and trace metals in alcoholic drinks.Setting:Data on drinking habits were obtained from a randomised sample of 1309 adults from the total population of the Seychelles (66 000). All clinical data were obtained from patients in the Victoria Hospital, which is the single reference hospital of the country.Intervention:Hospitalised patients with alcohol‐related cardiomyopathy were treated initially with vitamin B1and/or diuretics.Results:The survey of alcohol habits revealed that 75% of the male population were regular alcohol consumers, with 19% of men consuming more than 100 g of alcohol per day. The estimated annual consumption of alcohol per capita was 26.4 L for men and 3.5 L for women. The survey of blood alcohol levels showed that 28% of male and 13% of female patients had raised alcohol levels at hospital admission. Throughout 1989, 96 patients were diagnosed as having alcohol‐related cardiomyopathy and 12 of these had beriberi. The majority of young patients responded with marked diuresis within four hours of a single administration of thiamine. Overall, one‐third of all male medical admissions were due to alcohol‐related disease. The pathological effects of alcohol consumption were detected in 47% of autopsies and in 20% there was evidence of alcohol‐related cardiomyopathy.Conclusions:These findings confirm the high frequency of alcohol‐related disease in general and cardiomyopathy in particular. (Med J Aust 1991; 155: 529–532)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93889.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Perhaps the best and simplest definition of the general practitioner's job is that he should provide personal health care that is primary, continuous and comprehensive.1

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93890.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Acute lower respiratory infections are important causes of mortality and morbidity in Australia. Assessment, diagnosis and management in general practice can be improved by using very simple clinical protocols to identify serious problems early, to reduce reliance on investigations and overuse of antibiotics, and to involve the patients more in their own management.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93891.x

出版商:Wiley    

年代:1991

数据来源: WILEY