ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121777.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121778.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121779.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo review cases of fatal child abuse, looking for any characteristic features of these cases.Design and settingA case review of all childhood deaths at The Children's Hospital, Camperdown, between January 1976 and December 1990. Cases with a definite diagnosis of child abuse were extracted. Cases where there was only a suspicion of child abuse as the cause of death were not included.SubjectsSeventeen cases of fatal child abuse were reviewed with emphasis on autopsy findings and sociological data.ResultsAll children who died were less than three years of age; nine were under one year. Seventy‐six per cent died from head injury and 24% from asphyxia or strangulation. In addition to their fatal injuries, 41% had multiple bruises on the trunk and limbs. Thirty‐five per cent had evidence of previous physical abuse.ConclusionsThe commonest age for fatal child abuse is the first year of life. When physical abuse occurs in children under three years, and particularly under one year, a thorough assessment, follow‐up and institution of appropriate supportive services are essential, as the abuse may be an early warning of a subsequent fatal episode of abuse. The introduction of a process of review of child deaths may increase awareness of and help prevent fatal child abuse.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121780.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo evaluate the safety and efficacy of a preoperative autologous blood donation (PABD) program with liberal patient exclusion criteria.DesignProspective patient accrual from September 1990 to May 1992.SettingA PABD program in a public tertiary care hospital linked with a specialist orthopaedic practice in a private hospital.PatientsOne hundred and twenty patients consecutively scheduled for orthopaedic surgery were referred for PABD. There were 77 women (median age, 63 years) and 43 men (median age, 62 years). One‐third of patients were 70 or more years old. Coexistent medical disease, mainly cardiovascular, was present in 46% of patients and 3% were excluded because of coexisting morbidity. Total hip or total knee replacement was performed in a private hospital with intraoperative or postoperative blood salvage in 37% of the patients.Outcome measuresAdverse effects of PABD, autologous blood collected and used and homologous blood transfused.ResultsOne hundred and sixteen patients donated 267 units of autologous blood. In 70 patients undergoing total hip replacement, 78% donated three and 20% donated two units, with 95% of autologous blood being used. In 38 patients undergoing total knee replacement, 42% donated two units and 55% donated one unit, with 87% of autologous blood being transfused. Seventy‐eight per cent of all patients only received autologous blood. In the remaining patients, homologous blood use was confined to two units or less in 80%. Hypotensive episodes associated with phlebotomy occurred in 3% of patients, and 13% of patients had preoperative haemoglobin levels ranging from 85–100 g/L without adverse clinical effects.ConclusionA hospital‐based PABD program with less strict patient exclusion criteria does not prejudice the clinical status of the donors. Its linkage to private hospitals can significantly reduce the use of homologous blood in selected elective surgery.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121781.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo discover what measures have been taken in urban Australian hospitals to involve general practitioners (GPs) in public hospital services.DesignA descriptive study. Data were collected by postal survey.SettingHospitals in urban areas.Main outcome measuresAppointment of GP affiliates or associates, existence of departments or divisions of general practice, appointed GP liaison positions and formal arrangements for GP shared care and discharge planning.ResultsNinety‐five of 102 hospitals (93%) responded to a postal survey. Sixty‐five per cent of respondent hospitals had appointed GP affiliates or associates, 32% had a division or department of general practice and 41% had a designated GP liaison position. Forty per cent had formal GP shared care programs and 14% had formal GP involvement in discharge planning.ConclusionThere was a high level of adoption of measures to involve GPs in urban hospitals. However, only a minority of hospitals had comprehensive measures in place and sufficient support for this to occur.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121782.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo describe methods used for adult patient assessment and selection for day case surgery at a major Australian teaching hospital.DesignA prospective analysis of assessment data and information from the unit's computerised database.Patients and settingFive thousand day patients consecutively admitted to the Day Surgical Unit, Royal Adelaide Hospital.Main outcome measuresThe proportion of patients assessed only by trained nursing assessment staff was determined and compared with that for patients requiring additional anaesthetic assessment before surgery. The percentage of patients requiring preoperative Investigations was established. Unanticipated hospital admission rates were calculated for surgical, anaesthesia‐related and social reasons.ResultsAfter initial screening by a trained assessment nurse, 46% of patients required additional review by an anaesthetist before the day of surgery. The remaining 54% were assessed by an anaesthetist on the day of surgery. Preoperative investigations were ordered by anaesthetists in 8.5% of all day patients. The assessment methods outlined resulted in a 1.28% rate of unanticipated hospital admissions. This admission rate was mostly caused by complications of surgery (0.94%). Only 0.12% of patients were admitted for anaesthesia‐related reasons and 0.14% were admitted for social reasons.ConclusionsThis cost‐effective system allows suitable patients and procedures to be identified, with a satisfactory unanticipated hospital admission rate. Satisfactory assessment also results in short preoperative waiting periods, fewer cancellations, reduced postoperative problems and more satisfied patients. The development of an efficient assessment system is aided by the use of a dedicated day surgery area with experienced nursing staff, the use of a comprehensive patient questionnaire and coordination by experienced day surgery anaesthetists.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121783.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo assess the efficacy and tolerance of fluconazole (150 mg oral dose, once a week) in the prevention of recurrent oropharyngeal candidiasis in patients with moderate to severe human immunodeficiency virus (HIV) infection.DesignA randomised, double‐blind, placebo‐controlled trial.PatientsEighty‐four patients with moderate to severe HIV infection who had successfully completed two to four weeks treatment with fluconazole for oropharyngeal candidiasis were randomly allocated to receive either placebo or fluconazole. Pre‐treatment clinical and laboratory characteristics were similar in the two groups.Outcome measuresSuccess was classified as absence throughout the course of treatment of clinical evidence of oropharyngeal candidiasis, and failure as recurrence or relapse of symptomatic oropharyngeal candidiasis.ResultsOf 73 evaluable patients the median time to relapse was ≥ 168 days in the fluconazole group and 37 days in the placebo group (P<0.0001). One patient in the placebo group and 18 patients in the fluconazole group completed six months’ treatment without clinical relapse (P<0.001).ConclusionFluconazole was well tolerated and prevented clinical relapse of oropharyngeal candidiasis In 71% of patients who completed three months of treatment (95% confidence interval [CI], 55–86) and 58% (95% CI, 41–75) who completed six months of treatment.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121784.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo establish a program for the prevention of rheumatic fever and rheumatic heart disease In a semi‐Isolated Aboriginal community in far north Queensland and to test its efficacy.DesignA prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted In the community in 1985 and subjects with possible acute rheumatic fever were assessed. A prophylactic antibiotic program was instituted. Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey. A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever.SettingThe Yarrabah Aboriginal community in north Queensland (latitude 17°S). The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division.ParticipantsThe whole Yarrabah community (population 1250) was invited to participate. In 1985, after the completion of an educational program, 89% of the community cooperated in the survey. There was no educational program before the 1991 survey and the compliance rate was much lower. Importantly, however, 87% of the vulnerable group (4–16 year olds) were examined.InterventionsAfter the 1985 survey, all community members aged 4–16 years had throat swabs taken three times each year. Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found. Results: Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community. In the six years after the program was introduced only one case of acute rheumatic fever occurred. This was at a time when swabbing had temporarily lapsed for a three‐month period.ConclusionsThese results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever. The cooperation of the community is an integral part of Its success and this can be obtained by community education.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121785.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb121786.x

出版商:Wiley    

年代:1993

数据来源: WILEY