ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121122.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121123.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121124.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveThe purpose of this study was to estimate the rate of recurrence of pregnancy‐induced hypertension in an Australian population.DesignCase records of women with hypertension during pregnancy who were delivered at our hospital during a two‐year period were examined retrospectively. Those who had pregnancy‐induced hypertension and records of subsequent pregnancies at our hospital were examined for recurrence of proteinuric or non‐proteinuric pregnancy‐induced hypertension in their second pregnancy.SettingA Sydney teaching hospital with approximately 2500 obstetric deliveries per year.ParticipantsPregnancy‐induced hypertension was defined as diastolic blood pressure above 90 mmHg after 20 weeks' gestation in a nullipara who had normal blood pressure before 16 weeks' gestation, with no known history of hypertension or renal disease and whose blood pressure returned to normal postpartum. Case records of 610 women were examined; 236 had records of a second pregnancy at our hospital and of these 140 had pregnancy‐induced hypertension.Measurement and main resultsOf these 140 women 50% had a normotensive second pregnancy (95% CI, 42%‐58%), 47% again developed pregnancy‐induced hypertension (95% CI, 39%‐55%) and 3% (95% CI, 0%‐6%) had developed chronic, probably essential, hypertension before their second pregnancy. Proteinuric pregnancy‐induced hypertension occurred in 14% of first but only 4.5% of second pregnancies (xt=4.711, df = 1, P<0.05).ConclusionsAlthough these data are limited by retrospective gathering, it is clear that there is a high recurrence rate of pregnancy‐induced hypertension in Australia. However,. the risk of having proteinuric pregnancy‐induced hypertension, a more severe form of this disorder, diminishes in a second pregnancy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121125.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective and designThe aim of this study was to evaluate treatment of mild to moderate hYPertension (less than 170/110 mmHg) in pregnancy in a prospective, randomised, double‐blind trial.Setting and patientsPregnancy outcome was studied for 52 primigravid women, managed in hospital from early in the third trimester.InterventionsPatients were randomly allocated either to placebo or to active treatment (clonidine plus hydralazine).Main outcome measures and resultsMaternal deterioration dictated withdrawal from trial therapy for eight patients receiving placebo, but for only one receiving active treatment. Maternal proteinuria occurred only in the placebo group. Intention‐to‐treat analysis showed a significant increase in premature delivery for complications in the placebo group (P<0.05), despite active blood pressure treatment for those withdrawn from the group because of severe hypertension (170/110 mmHg or higher). Neonatal respiratory distress' requiring intensive care occurred only in babies born to women in the placebo group. There were no perinatal deaths and no adverse effects of treatment in the neonates.ConclusionsThe study indicates that early control of mild hypertension in pregnancy can prevent progression to emergency premature delivery.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121126.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Cytomegalovirus (CMV) is an important pathogen in persons who are immunocompromised or who have received organ transplants. The rate of symptomatic CMV infection is relatively higher after liver transplantation, and CMV hepatitis may be difficult to differentiate from rejection or cholangitis without recourse to liver biopsy and tissue culture. In this study we have used the polymerase chain reaction (PCR) to amplify and detect CMV‐DNAsequences directly from the saliva and urine of liver transplant recipients. The procedure is simple, rapid and specific, and was found to be as sensitive as tissue culture for the diagnosis of CMV.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121127.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Although cardiovascular disease (CVD) mortality has been declining, CVD is still the major cause of death in Australia and an elevated blood cholesterol level is considered a major contributor. Large‐scale communitybased screening programmes in other countries have demonstrated that a population approach can be effective in reducing cholesterol levels and the risk of CVD. The North Coast Cholesterol Check Campaign is the largest community‐based cholesterol intervention programme in Australia. Since its inception in 1987, 13% of the Region's adult population (over 29 000 persons) have been screened. About half had elevated blood cholesterol levels (~5.5 mmol/L) and were given dietary counselling to reduce fat intake. Mean blood cholesterol levels were significantly reduced between initial screening and follow‐up in all three years. Reductions, after correction for regression, were 8%, 6% and 10%, respectively, in 1987, 1988 and 1989. There was also a consistent and significant 1.5% to 2% reduction in weight. All age/sex cohorts above age 35 were well represented each year although self‐referral did bias both initial and follow‐up samples towards women and the aged. Nevertheless, the proportion of men and men in their middle age increased during the three years. The proportion of participants with elevated cholesterol levels increased in each successive year while the proportion of participants who complied with referrals to visit their general practitioner and with requests to return for follow‐up decreased. Over half of the North Coast adult population has now had a cholesterol test. The rate of increase in testing since the inception of the Campaign has been approximately four times the national rate. North Coast general practitioners have played a major role by catering for the increased community demand for cholesterol testing and by providing an effective referral service for the Campaign. Community‐based screening programmes in Australia can detect and beneficially influence large numbers of persons with elevated cholesterol levels. Interventions like the North Coast Cholesterol Check Campaign, when conducted over a number of years, do attract higher risk and less compliant people. The changing profile of participants is consistent with diffusion of acceptability through the community from the “worried well” to persons at higher risk who may be less likely to attend short‐term interventions.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121128.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objectiveto determine if there have been improvements in the manner in which endoscopes are being cleaned and disinfected since our previous study in 1987. In that study of 123 hospitals, in only 45% of institutions did cleaning and disinfection appear to be satisfactory.DesignOne hundred and twenty‐two quesitionnaires were sent to the endoscopy charge nurse of the hospitals identifiable from our previous study. To ensure the collection of complete information from these hospitals, in those from whom a written reply was not received, the information was obtained by persistent telephone contact. The criteria used to assess adequate cleaning and disinfection were the same as in our previous study. These were based on recommendations of learned bodies and the literature.SettingA complete cross section of hospitals from all States and Territories in Australia was surveyed. These were both public and private, primary care to tertiary referral, teaching and non‐teaching, city and country.Main outcomeOne hundred and twentythree replies were obtained from the 122 hospitals surveyed. In 75% cleaning and disinfection of endoscopes appeared to be inforsatisfactory. Adequate cleaning procedures were noted in 77% compared with 60%.in the 1987 survey. The use of appropriate disinfection increased to 94% frolT) 62% previously.ConclusionWe found that sin~ 1987 there had been a considerable improvement in the cleaning and disinfection of endoscopes in the hospitals surveyed.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121129.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

This paper reports on a survey of the current state of academic general practice in the ten Australian medical schools. Despite its lack of resources, low profile and ambivalent acceptance in Australian medical schools, academic general pr actice has survived. Its problems and potential contribution for producing better doctors are outlined and discussed .

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121130.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Approximately 20% of the Australian population will develop gallstones. On current evidence, patients with asymptomatic gallstones should be treated expectantly. Cholecystectomy remains the therapy of choice for patients with symptomatic or complicated gallstones. In recent years a number of non‐surgical treatments have become available for the management of gallstones, the most exciting of which is extracorporeal shock wave lithotripsy (ESWL), which is now available in Australia. Approximately 20% of patients with symptomatic gallstones are suitable for ESWL. Dissolution of gallstones with long‐term oral bile acid therapy may be appropriate for a small group of patients. Gallstones may also be dissolved by the direct application, via a percutaneously placed

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121131.x

出版商:Wiley    

年代:1991

数据来源: WILEY