ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138256.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138257.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138258.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138259.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138260.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

In 1979 an outbreak of tuberculosis occurred in medical students at the University of Sydney. Eight of 35 Mantoux‐negative students who attended the autopsy of an immunosuppressed patient with unsuspected active tuberculosis became infected and one developed clinical disease. A report of the incident was prepared for publication because it supported the then controversial University policy of recommending BCG vaccination to medical and dental students in a country where the reported prevalence of tuberculosis is very low. The report was never published, mainly in order to protect the privacy of the individual students involved, but also because it was felt by the administration of the time that it might undermine confidence in infection control procedures in the autopsy room.The original report, updated and reproduced here, suggested that tuberculosis might be an emerging nosocomial problem. This has been all too clearly realised since its re‐emergence as an opportunistic infection in AIDS patients. Worldwide, the problem of antibiotic resistance inMycobacterium tuberculosis1,2, provides an added risk of a return to the situation which prevailed early this century when tuberculosis was a major occupational risk for young health care workers. Infection often restricted career choices, even in those whose disease was relatively benign. Our purpose in bringing this incident to light after so many years is to point out the relevance of the extensive studies of the problem which were conducted in the 1930s and 1940s to the current situation and to suggest that health care students are vulnerable to airborne infections as well as those spread by inoculation injuries. In retrospect, our 1979 conclusions about prospects for preventing nosocomial tuberculosis appear optimistic.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138261.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine the incidence of needlestick injuries and the prevalence of hepatitis B vaccination among medical students, dentistry students, and hospital staff.Design and subjectsAnonymous survey of final year medical students and dentistry students enrolled at Sydney University in 1992, and nursing staff and doctors employed in the wards and emergency department of Royal Prince Alfred Hospital, Sydney.ResultsDuring their clinical training, 22%of medical students and 72% of dentistry students had received one or more contaminated, penetrating “Sharps” injuries. Of hospital staff, 50% of ward nurses, 71% of ward doctors, and 50% of emergency staff had received this type of injury during the previous two years. Students were significantly more likely to be vaccinated against hepatitis B than hospital staff(P<0.001) — 98% of medical students and 95% of dentistry students had received a full course of vaccination. The rate of vaccination among hospital staff ranged from 79% in emergency staff to 85% in ward nurses.ConclusionsClinical students sustain needlestick injuries at a rate comparable with hospital personnel and therefore face a significant risk of exposure to transmissible pathogens, including hepatitis B virus, HIV, and hepatitis C virus. The rate of hepatitis B vaccination is high among clinical hospital staff and almost universal among medical and dentistry students.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138262.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine whether doctors who abuse substances differ from controls in terms of their physical and psychological well‐being, and their marital and occupational functioning.Design and participantsThe 44 doctors concerned in all cases of substance abuse which came before the Medical Board of Victoria between 1984 and 1990 were invited to complete a demographic questionnaire, psychological tests and a semi‐structured interview. A control group of 42 doctors, obtained from the Medical Register, was also invited, and the groups were compared.SettingThe study was carried out at St Vincent's Hospital, Melbourne, under the auspices of the Medical Board of Victoria.ResultsQuestionnaires were returned by 70% of the drug‐dependent doctors and 83% of the controls. However, interviews were given by only 20% of the drug‐dependent doctors. The groups differed significantly in terms of marital status (P<0.002), overall health (P<0.003), general well‐being (P<0.0009), and having experienced physical illness (P<0.02) and psychiatric illness (P<0.006) since graduation. No differences were found on the standardised questionnaires; this may reflect successful treatment.ConclusionSubstance abuse in medical practitioners is a major problem and is associated with considerable morbidity. Prevention and early intervention are crucial.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138263.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine if there is any association between childhood sexual assault and maladaptive coping behaviour in adult life.DesignA case‐control study.Setting and patientsData from 707 psychiatric patients consecutively examined by one psychiatrist in a rural practice were analysed. Forty‐four female patients who were victims of childhood sexual assault were identified and were age matched in a random manner with 88 control patients who denied being sexually assaulted as children.ResultsThe two groups were similar in occupational level, employment and marital status, and the only diagnostic difference between them was that there was a trend in the sexually assaulted group for more of these patients to be diagnosed as having personality disorder. On a variety of other outcome factors, however, the two groups differed widely. The sexually assaulted women were more frequently victims of domestic violence (odds ratio [OR], 6.4), made suicide attempts (OR, 3.4) and abused alcohol (OR, 3.0) or tranquillisers (OR, 4.6) more often than the non‐assaulted women. There was a definite association between childhood sexual assault and maladaptive coping behaviour in adult life, although the association is not necessarily causal, and the childhood sexual assault may, in fact, be a symptom of familial neglect.ConclusionThis study provides clear evidence of the need to follow up victims of childhood sexual assault and reinforces the importance of enquiring about this trauma.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138264.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo assess the degree to which limb‐sparing surgery is implemented in patients with soft‐tissue sarcoma, and its outcome.Design and settingA detailed review of 40 patients who were all tertiary referrals to one surgeon, and general review of all 215 patients with sarcoma treated in South Australia between 1986 and 1992.InterventionsConservation of the limb by wide resection or marginal resection of soft tissue, combined when necessary with radiotherapy. Amputation was used when limb conservation failed or was not possible.Main outcome measuresMedian survival time after treatment.ResultsLimb‐sparing treatment was successful in 37 of the group of 40 patients. Thirty‐two patients received adjuvant radiotherapy, and 19 received chemotherapy. Median survival time was 35 months. Review of all 215 patients with sarcoma revealed a higher initial amputation rate and a lower use of combined treatment methods than in our series. Twenty‐six patients (65%) were initially incorrectly diagnosed before referral, resulting in a median delay in treatment of 16 weeks.ConclusionsThe concept of limb‐sparing surgery is well established, but is not yet as widely practised for limb sarcomas as it could be. Delay in diagnosis is a significant problem.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138265.x

出版商:Wiley    

年代:1994

数据来源: WILEY