ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122041.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Eligibility for insurance payments is a powerful, if controversial, strategy for ensuring that guidelines are adhered to in clinical practice

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122042.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Funding is needed to allow access to highly effective laser treatment

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122043.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Powerful antiemetics are making the patient's treatment slightly more tolerable

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122044.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Estimated annual treatment costs of $779 million for osteoporotic fractures underline the need for urgent preventive action

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122045.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo assess the ability of an algorithm for thyroid‐function testing (based on assay of thyroid‐stimulating hormone [TSH]) to discern euthyroidism in patients with and without conditions affecting thyroid function.DesignThe Australian Health Insurance Commission (HIC) specifies clinical categories for which Medicare rebate is given for assay of both TSH and free thyroxine (FT4), but otherwise rebates for thyroid function testing are given for TSH assay only. A prospective study was made of paired TSH and FT4results of 1000 consecutive assays categorised by indication for testing. An FT4value within the reference range was accepted as indicating euthyroidism; the reliability of an initial TSH measurement as the sole indicator of thyroid disease was assessed against this criterion standard.SettingA large suburban teaching hospital.Outcome measureSuccess or failure of the algorithm, with failure defined as an abnormal FT4level missed because the TSH level was normal.ResultsThe algorithm failure rate both overall and in the patients not in the HIC clinical categories was 2.7%, and there was no significant difference in algorithm failure rate in the patients in the various HIC clinical categories. The categories and failure rates were: patients being monitored for thyroid disease, 3.4%; patients with the “sick euthyroid” syndrome, nil; patients with psychosis or dementia, 1.1%; patients taking drugs affecting thyroid function, 2.1%; and patients with pituitary dysfunction, one of six cases. The range of FT4values in patients in whom the algorithm failed was 6.4–29.5 pmol/L in those without thyroid disease and 3.4–27.4pmol/L in those with thyroid disease. In patients being monitored for thyroid disease, the proportion of abnormal values of TSH alone was significant (P<0.001).ConclusionWe have shown that the HIC's imposition of a TSH‐based algorithm by financial fiat is also scientifically acceptable. Use of this algorithm in hospitals (including psychiatric hospitals) will result in substantial savings.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122046.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo assess the effectiveness of the flashlamp‐pumped pulsed dye laser in the treatment of port‐wine stains.DesignA retrospective review of medical records and patients.SettingRoyal Perth Hospital (a tertiary referral hospital), August 1989 to December 1992.Subjects186 consecutive patients with port‐wine stains treated with a flashlamp‐pumped pulsed dye laser.Outcome measuresDegree of lesion fading; adverse reactions.ResultsOf 131 patients who completed treatment, 78% had better than 50% fading of the lesion and only 9% had less than 25% fading. An average 3.4 treatments were needed to achieve more than 50% fading. The response was better in children than in adults, although the difference was not significant. Anaesthesia was needed for 44% of patients. Pigmentary change (usually transient) occurred in 6.1% of patients and permanent and significant adverse effects in only 4.6%.ConclusionThis study confirms the efficacy of the flashlamp‐pumped pulsed dye laser in the treatment of port‐wine stains in children and adults. Early treatment of port‐wine stains should be encouraged to reduce the physical and psychological morbidity of disfiguring lesions.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122047.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Objectives(i) To assess the efficacy and tolerability of tropisetron when used for acute and delayed cisplatin‐induced emesis. (ii) To investigate whether dexamethasone added to tropisetron improves the control of emesis for patients who do not achieve a complete response to tropisetron alone. (iii) To assess sex of the patient and alcohol intake as prognostic factors for nausea and vomiting.DesignA prospective open label phase II trial over one or two cycles of chemotherapy. Data collection was based on observed response and patients’ self‐reporting.SettingTwenty Australian tertiary care hospitals in 1994.Patients102 male and female patients from 18 to 75 years with histologically confirmed malignancy receiving their first chemotherapy containing ≥50 mg/m2cisplatin.InterventionIn Cycle 1 tropisetron 5 mg was given intravenously before chemotherapy on Day 1, then 5 mg orally before breakfast on Days 2 to 6. In Cycle 2, dexamethasone 20 mg intravenously on Day 1, then 8 mg orally on Days 2 to 6 could be added to tropisetron if a complete antiemetic response had not been achieved in Cycle 1.Main outcome measuresNumber of vomiting episodes and severity of nausea for 6 days after chemotherapy; severity of side effects; patient satisfaction with chemotherapy treatment; oestradiol levels in women; and past alcohol consumption in men and women.Results(i) The complete response rate (CR) for acute emesis in Cycle 1 was 64% (95% confidence interval [CI], 54%–72%), with 84% (95% CI, 76%–90%) having ≤2 vomits. The CR for delayed emesis was 24% (95% CI, 17%–32%). The CR for acute nausea was 56% (95% CI, 47%–66%), with 97% (95% CI, 91%–99%) having ≤2 nausea episodes. The CR for delayed nausea was 21% (95% CI, 14%–30%). Seventy‐one patients received Cycle 2. The main side effects were headache (20 patients) and constipation (16 patients). The control of acute emesis was rated as “good” or “very good” by 68% of investigators; 85% rated the tolerability of treatment as “good” or “very good”. Treatment was rated as “very satisfactory” or “satisfactory” by 52% of patients. (ii) The CR for acute emesis with dexamethasone added was 78% (95% CI, 64%–88%). (iii) Women with lower oestradiol levels had better control of emesis, although this difference was not statistically significant. Chronic alcohol intake and binge drinking were strongly associated with a complete acute antiemetic response.ConclusionsTropisetron was effective for acute cisplatin‐induced emesis; adding dexamethasone enhanced this response. Both single and combined therapy had less effect on delayed emesis. The impact of alcohol on control of emesis is a chronic rather than acute phenomenon which requires prospective testing.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122048.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo investigate general practitioners’ (GPs') examination and referral practices for diabetic retinopathy.MethodsA questionnaire survey of a random stratified sample of 500 Victorian GPs.ResultsThe response rate was 88%. 53% of GPs examined none or less than half of their patients with diabetes for diabetic retinopathy. Those who did examine for retinopathy rarely performed funduscopy through a dilated pupil and 65% reported that they never did. Only 37% had dilating drops in their surgery. Only 45% often or always tested visual acuity. 88% often or always referred patients at the recommended frequency to an ophthalmologist.ConclusionsAlthough most GPs do not perform dilated fundus examinations, they report referring their patients with diabetes for assessment by an ophthalmologist at an early stage to prevent vision loss. Referral chain breakdown may explain the discrepancy between GPs’ reported referral rates and the lower rates of ophthalmic examination reported in the Melbourne Visual Impairment Project.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122049.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122050.x

出版商:Wiley    

年代:1996

数据来源: WILEY