ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122228.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

An effective system is the key to quality outcomes, and is the responsibility of hospital management

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122229.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Safe and effective methods are now available

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122230.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Education, vaccination and penicillin prophylaxis are the mainstays of prevention

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122231.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Despite exemplary scientific process and approval by community‐based scientific and parliamentary committees, the ACT heroin trial still awaits approval to proceed

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122232.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo determine the incidence of deep venous thrombosis (DVT) after laparoscopic cholecystectomy.DesignProspective cross‐sectional analysis, with a one‐month follow‐up, conducted in 1994.SettingUniversity teaching hospital.Subjects20 patients undergoing elective or urgent laparoscopic cholecystectomy, consecutively recruited.InterventionsPatients received thromboprophylaxis according to the normal practice of the attending surgeon and underwent laparoscopic cholecystectomy. A venous duplex scan was performed before the operation and on Day 1, 7 and 30 after the operation.Main outcome measureThe presence of postoperative DVT.ResultsAll patients were given graduated compression stockings to wear and 16 received electrical stimulation of the calf during the operation. Only 16 patients received pharmacological thromboprophylaxis before the operation, but all patients received this after the operation. The median duration of pneumoperitoneum was 80 minutes (40–160 minutes). Eleven of 19 patients completing all the required scans developed venous thrombosis (incidence, 55%); in three the thromboses involved major axial veins. In one patient the Day 7 and Day 30 scans were not performed, but the Day 1 scan was negative. Seven of the 11 thromboses were detected on the Day 1 scan. None of the DVTs were suspected clinically.ConclusionsThis extremely high incidence of venous thrombosis correlates with the haemodynamic changes which occur in the venous system during pneumoperitoneum. Laparoscopic cholecystectomy should not be considered a procedure with a low risk of DVT, and further studies are needed to determine optimal DVT prophylaxis for laparoscopic surgery.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122233.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectivesTo assess method of acquisition, presence of liver disease, potential infectivity and the effect on work practices in health care workers with hepatitis C virus (HCV) infection referred to a hepatitis clinic.Patients and methodsAll 33 health care workers referred to a hepatitis clinic for management of HCV infection because of a positive test for HCV (enzyme‐linked immunosorbent assay) between 1 January 1990 and 31 December 1994 (comprising six medical practitioners, 18 nurses, two scientists and seven others) were retrospectively assessed for most likely method of infection, alanine aminotransferase levels, results of liver biopsy and measurement of HCV‐RNA.Results30 health care workers (12 men and 18 women; age range, 27–68 years) had HCV infection confirmed on further testing. Only seven were believed to have acquired their infection occupationally (one with documented needlestick injury), Twenty‐eight patients had elevated alanine aminotransferase levels and, of 23 patients who underwent liver biopsy, one had cirrhosis and 12 had chronic hepatitis and fibrosis. Of the 24 health care workers with direct patient contact, four had retired, eight had stopped or modified their work practices and 12 continued to practise normally.ConclusionsFew health care workers with chronic HCV infection have acquired it occupationally. We recommend that guidelines be set up for institutional expert committees to advise health care workers with HCV infection about modifying their work practice.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122234.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectivesTo determine the incidence of hospital admissions for adverse events related to drug therapy, and to assess whether these drug‐related admissions (DRAs) could have been reasonably prevented.SettingA tertiary teaching hospital.Design and patientsProspective assessment of all admissions through the emergency department and resulting in a stay of more than 24 hours during 30 consecutive days in November and December 1994 to determine if the admission was related to drug therapy. Cases of intentional overdose were excluded.Main outcome measuresThe number, type, causality and avoidability of drug‐related admissions.ResultsOf 965 admissions, 55 (5.7%) were assessed as being drug‐related. Drug‐related admissions (DRAs) were designated possibly (38%), probably (46%) or definitely (16%) drug‐related; caused by prescribing factors (26%), patient noncompliance (27%) and adverse drug reactions (47%); and classified as definitely (5.5%), possibly (60.0%) and not (34.5%) avoidable. The estimated annual cost to the hospital for all DRAs was $3496956 and for unavoidable DRAs was $1629494.ConclusionThe DRA rate we found lies around the middle of the range of other published rates. Few DRAs were judged definitely avoidable and over one‐third were unavoidable. Nevertheless, the largest proportion were judged possibly avoidable. As the drugs identified in this study are clearly needed in the community, efforts to reduce DRAs must concentrate on education, counselling and monitoring of drug therapy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122235.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

A three‐week‐old boy had life‐threatening renal failure which was successfully treated by salbutamol and sodium bicarbonate infusion, rectal resonium and a left percutaneous nephrostomy. Ultrasonography of this child at 19 weeks’ gestation had shown a treatable renal tract abnormality (bilateral hydronephrosis). No arrangements had been made for follow‐up.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122236.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

The medical management of the HIV‐infected man is covered throughoutManaging HIV.Understanding the sexuality of men is a crucial factor in understanding the HI V pandemic.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb122237.x

出版商:Wiley    

年代:1996

数据来源: WILEY