ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124551.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Invasive procedures should only be done when absolutely necessary

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124552.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Medical paternalism is dead. Is medical consumerism the way of the future?

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124553.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

Sport is part of the Australian way of life, but the injury rate could be lower

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124554.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

The benefits of food fortification outweigh the possibility of adverse effects

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124555.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo examine patterns of use and clinical outcomes of total parenteral nutrition (TPN).DesignA prospective six‐month audit (December 1992 ‐June 1993).Patients and settingAll inpatients administered TPN at a metropolitan teaching hospital during the audit period.Main study measuresProcess measures included data about TPN initiation (bodyweight, period not receiving oral/nasogastric feeding, serum albumin level, compliance with hospital guidelines), TPN delivery data (kilojoules, and nutrient and electrolyte content), and bases for cessation or changes of TPN (biochemistry data, gastric and intestinal function). Outcome measures included body mass change, infection rate, detection of biochemical abnormalities, and death.ResultsDuring the audit 168 consecutive patients received 175 TPN courses. These patients were followed until discharge or death; 49 patients (29%) died. Intensive care units accounted for 57.7% of TPN use. Deviations from approved hospital guidelines for initiation of TPN were common. Only a minority of patients were malnourished on objective audit criteria; 18% of men and 13% of women were underweight by body mass index criteria and 36% were malnourished when serum albumin level (<30g/L) was considered. Early initiation of TPN outside accepted guidelines was common. Complications included bacteraemia (9.1% of patients tested) and catheter‐tip sepsis (55.2% of 87 catheters tested). Four patients died; line sepsis caused one death and probably a further two. The incidence of glucose intolerance was 36.5%, and 25% had markers of abnormal liver function.ConclusionsTPN use is associated with a high risk of morbidity, and a 1.7% mortality. We recommend better patient selection for TPN, more appropriate use of enteral feeding, better infection control procedures, avoidance of substrate overload (particularly glucose), and earlier change to enteral nutrition.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124556.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine the prevalence of antibiotic resistance among common respiratory pathogens circulating in the community.DesignSurvey of common respiratory pathogens isolated from nasal discharges.Setting117 childcare centres and kindergartens in metropolitan Melbourne between May and July 1991‐1993 and 42 from sociodemographically matching suburbs in Sydney between May and July, 1993.SubjectsChildren aged six years and under with nasal discharge.Outcome measures: Resistance to penicillins, erythromycin and tetracycline among isolates ofHaemophilus influenzae, Streptococcus pneumoniae,Moraxella (Branhamella) catarrhalisandStaphylococcus aureus.ResultsA total of 2286 nasal discharge swabs were collected. Amoxycillin resistance was detected in 99 of 711 isolates ofH. influenzae(13.9%) and penicillin resistance in 781 of 834 isolates of A1.catarrhalis(93.6%), 342 of 375 isolates ofS. aureus(91.2%), and 30 of 781 isolates ofS. pneumoniae(3.9%). Of 86 strains ofH. influenzaetype b isolated, 20 (23.3%) produced $bT‐lactamase. Penicillin resistance tended to become more common among isolates ofH. influenzaeand .S',pneumoniaeduring the three‐year period.ConclusionAntibiotic resistance, mediated by $bT‐lactamase or altered penicillin‐binding proteins, among respiratory pathogens carried by preschool children was significant and possibly increasing. This highlights the impact of prescribed antibiotics in the community and the folly of prescribing the limited store of antibiotics for viral infections.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124557.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo report the occurrence of uncommon but catastrophic eye and testicle injuries to rugby league and rugby union footballers in New South Wales.MethodsA retrospective review of players who had permanent football‐related injuries and who claimed financial compensation from a voluntary sports injury insurance scheme from 1978‐1994.ResultsAn average of 100000 rugby league and rugby union players per year were registered with the insurance scheme in NSW. As a consequence of playing football, 15 players lost 90%‐100% vision in one eye, five lost 75% vision in one eye, four lost 50% of vision in one eye and two lost 75% vision in both eyes. Eye injuries were caused by “gouging” with fingers, kicks, or blows from fists, elbows and knees; five cases appeared to be intentional. Fourteen players had testicular injuries: in 11 players this resulted in complete loss of one testicle, and in three partial loss of one or both testicles. The immediate cause of the injuries to the testicles was kicking and kneeing, usually during tackles; at least three of the injuries appeared to be intentional.RecommendationsRules relating to tackles, kicks and other assaults to the head or groin should be strengthened and policed. Officials, players, parents and the public should be educated to support this.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124558.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo document the factors associated with general practitioner (GP) use of Pap smear reminder/recall systems and to canvass options for coordinating these GP‐based systems with similar centrally based schemes.MethodsA questionnaire survey of a random sample of South Australian GPs.Results259 (78%) of 334 GPs returned questionnaires. 117 (45.2%) GPs had practice‐based reminder/recall systems, with a higher prevalence among metropolitan GPs with a computer and who had been in practice for less than 20 years. 91.9% of GPs reported that the central register would be of some help in ensuring regular cervical screening. 38.2% of the GPs preferred reminder letters from the register to be sent to their practice; 27.8% preferred them to be sent directly to women and 22.8% opted for letters to be sent from the register via the laboratories to their practice. 61.4% of respondents had a method of recording women with abnormal smears and 95.6% of these actively recalled such women.ConclusionSubstantial variation exists in the use of practice‐based reminder/recall systems among GPs. A central register would assist most GPs by providing a back‐up reminder service to follow‐up women for cervical screening.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124559.x

出版商:Wiley    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo examine the psychosocial effects of donor insemination on couples.DesignQuestionnaire survey of couples who had a child by donor insemination at four NSW clinics over a 15‐year period.ResultsForty‐seven per cent of couples thought their marriage had improved, while 3% thought their marriage had deteriorated as a result of having a child by donor insemination. Seventy‐six per cent felt it had a positive personal effect and almost all couples had no regrets about having a child this way. Over 90% of respondents felt very close to these children. In those who also had children not conceived by donor insemination (60 couples), men were significantly closer to their children by donor insemination than to their “other” children (P<0.001). There was a significant sex difference in perceptions of the child's resemblance (P<0.0001): 61% of women thought their child conceived by donor insemination resembled their partner, while 89% of men thought the child resembled their partner. Twenty‐one per cent of couples were concerned about having to tell the child about donor insemination.ConclusionDonor insemination can have positive psychosocial effects on couples and close relationships exist between the parents and their children conceived by donor insemination. The concern about the physical appearance of children conceived by donor insemination can be allayed by our finding that the majority of couples see a resemblance between the child and their partner.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1995.tb124560.x

出版商:Wiley    

年代:1995

数据来源: WILEY