ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94130.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94131.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94132.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94133.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94134.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

AbstractObjective:To review the clinical features and response to treatment of hyperthyroidism in elderly hospitalised patients.Participants and setting:Sixty patients over the age of 70: 41 admitted to a geriatric hospital and 19 to an acute‐care hospital, 1990–1993.Methods:Thyroid function tests were performed routinely in the geriatric hospital but only on demand at the acute‐care hospital. Hyperthyroidism was defined as elevation of plasma free thyroxine (FT4) or total tri‐iodothyronine (T3) level and suppression of thyroid‐stimulating hormone (TSH) level. Seventy‐seven per cent of patients were seen personally; in the remainder details were obtained from their hospital records. Outcome was assessed by clinical and biochemical improvement.Results:Clinical features— Fifty‐two women and eight men with hyperthyroidism were identified. Their average age was 80.2 years (range, 70–101; median, 80.0). The most common clinical features were weight loss (83%) and atrial fibrillation (60%); 58% were agitated and 15% apathetic. Fifty‐two per cent had cognitive impairment with either dementia or confusion. The diagnosis was not initially suspected in 62%. Thyroid antibodies were absent in 35/40 and an isotope scan showed a nodular thyroid in 27/29. Contrast radiography with iodine‐containing media had been performed within the preceding six months in 23% of patients.Treatment and outcome— Forty‐seven patients were treated with antithyroid drugs in standard doses and 21 received radioactive iodine. In 35 adequately assessed patients, including 21 with dementia, clinical improvement and normal results of thyroid function tests were achieved, but five patients died with uncontrolled hyperthyroidism.Conclusions:Hyperthyroidism in the elderly is usually due to autonomous thyroid nodules, and in about 20% of hospitalised patients may follow a contrast radiography procedure. The more common clinical features of hyperthyroidism occur frequently as unrelated symptoms in the elderly so that the diagnosis is often not apparent, particularly in the presence of cognitive impairment. As the response to standard biochemical treatment is rewarding, screening of the elderly with thyroid function tests should be done routinely.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94135.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

AbstractObjective:To describe the circumstances of death and toxicological findings in all heroin‐related deaths in New South Wales in 1992.Design:Coronial files of all cases of heroin‐related deaths were reviewed. A standardised form was used to collect information on sociodemographics, history of drug use, circumstances of death, and results of toxicological analysis for each case.Results:152 heroin‐related deaths were identified. Subjects had a mean age of 29.7 years, 82% were male, and 98% were not enrolled in a methadone treatment program at the time of their deaths. Deaths occurred in the home environment in 68% of cases and in the company of at least one other person in 58%. There was intervention before the subject's death in only 21% of cases. Two or more drug classes were detected in 71 % of subjects; alcohol was detected in 45%, with a mean blood alcohol concentration of 0.14g/100mL.Conclusions:Fatal heroin overdose is potentially preventable. Educating users about the risks of co‐administering alcohol and other depressant drugs with heroin, the comparative safety of injecting heroin in the company of others and the need to call for intervention sooner may reduce the frequency of heroin‐related deaths.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94136.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94137.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

AbstractObjective:To evaluate apparent discontinuation rates in patients newly prescribed lipid‐lowering drugs.Design and setting:A prospective survey of 12 months' dispensing data in 138 community pharmacies across metropolitan Sydney.Patients:610 adults (49% men) with a mean age of 58 years; 91 % of prescriptions were from general practitioners; prescribed drugs were simvastatin (54%), pravastatin (31%) and gemfibrozil (15%).Main outcome measure:The number of patients failing to collect prescription refills.Results:60% of patients (95% confidence interval [CI], 56%–64%) apparently discontinued their medication over 12 months. Half of the apparent discontinuations occurred within three months and a quarter within one month of starting treatment. The predominant reasons for discontinuation were: patient unconvinced about need for treatment (32%), poor efficacy (32%) and adverse events (7%). Only half of those experiencing poor efficacy were switched to another drug. The relative risk (RR) of discontinuation was lower in older patients (age 65+ v.<50 years: RR 0.66; 95% CI 0.47–0.93) and in those using other cardiovascular drugs (RR 0.69; CI 0.56–0.86), but was increased in those showing early evidence of poor compliance (RR 1.77; CI 1.33–2.35). Discontinuation appeared to be unrelated to sex, the source of the prescription (general practitioner or specialist), past use of lipid‐lowering drugs or the cost of medication.Conclusions:High apparent discontinuation rates with lipid‐lowering drugs suggest significant wastage of resources in treatments that are initiated but not continued and a lost opportunity for heart disease prevention. Many patients appear to discontinue therapy for illogical reasons and this may be amenable to intervention.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94138.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb94139.x

出版商:Wiley    

年代:1996

数据来源: WILEY