ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138633.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

The end of lifeWeneed a humane and informed framework, not only a medical model, to deal with death and dying

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138634.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

We must let patients know we are on their side and make every effort to ascertain and deliver what it is they seek from treatment

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138635.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

This new subtype of β‐adrenoceptor may provide a target for antiobesity drugs

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138636.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Science and logic are again being applied to AIDS research

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138637.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo examine factors that influence medical practitioners' treatment decisions for patients with life‐threatening or terminal illnesses.DesignPostal survey, conducted between September and November 1995, of a self‐administered questionnaire, describing four clinical case scenarios, to a random sample of 2172 Australian doctors in all States and Territories. Respondents were asked to prescribe treatment for the patients described in the scenarios. Patients' characteristics varied in terms of mental competence, illness severity, prognosis, the presence of advance directives, request for assisted death, and sociodemographic factors. The respondents' sociodemographic and medical training characteristics were also obtained.SettingRandom national sample of all active medical practitioners.ParticipantsHospital trainees, general practitioners, physicians, palliative care practitioners and surgeons were surveyed. A response rate of 73% was achieved.Main outcome measuresFrequency of prescription of supportive, acute or intensive treatment for patients in the four clinical scenarios based on respondents' sex, religion, medical training and country of medical degree.ResultsThree main findings were: (i) doctors did not make consistent decisions, but their decisions varied systematically by sociodemographic and medical training factors; (ii) doctors generally adhered to patient and family wishes when these were known; (iii) doctors did not generally adhere to a patient's request for assisted death.ConclusionTreatment provided is significantly determined by the individual characteristics of the doctor and not solely by the nature of the medical problem. Participation in the informed‐consent process and in the preparation of advance health care directives would enable practitioners to be familiar with patient and family wishes and could reduce variations of treatment related to sociodemographic and medical training factors. Stronger empirical data on the way that treatment decisions are made could provide the basis for an informed euthanasia policy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138638.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo assess the patterns of alternative medicine use in patients of a public hospital oncology unit, and to compare patients' experience of alternative with conventional medicine.Design and settingSelf‐administered questionnaire survey of cancer patients attending specialist consulting rooms at the Royal North Shore Hospital and the Oncology Outpatient Clinic at Port Macquarie Base Hospital during August 1995.Participants507 patients attended the clinics; 335 (66%) returned questionnaires, of which 319 (62%) were sufficiently complete for analysis.Main outcome measuresExpectations of and satisfaction with both conventional and alternative treatment, use of alternative treatment, and patient characteristics associated with this use.ResultsExpectations of and satisfaction with both conventional and alternative treatment were very high. Alternative treatments (most commonly dietary and psychological methods) were used by 21.9% of patients. Median annual cost of alternative therapy was $530, with most patients reporting “value for money”. Younger age and being married were positively associated, and satisfaction with conventional treatment was negatively associated, with alternative medicine use; 40% of patients did not discuss alternative medicine with their physician.ConclusionsA significant proportion of cancer patients use one or more forms of alternative therapy. The use of alternative therapy may reflect on deficiencies in the current standard of care.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138639.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo report the outcome in our first 100 patients with abdominal aortic aneurysms repaired by the endoluminal method.DesignAnalysis of concurrently collected data of patients undergoing repair of an aortic aneurysm. The technique involves the delivery of an endograft into the abdominal aorta by means of a sheath inserted through the femoral or iliac artery. Clinical examination and contrast‐enhanced computed tomography (CT) were performed within 10 days, at six months and then annually after operation.SettingRoyal Prince Alfred Hospital, Sydney, a tertiary referral teaching hospital.Patients100 patients, seven women and 93 men, with a mean age of 70 years (range, 46‐87), treated between May 1992 and December 1995. Because of comorbidities, 43 of the patients had been considered unsuitable for conventional open repair at other medical centres. Our criteria for inclusion were the presence of a 1,5‐cm or greater segment of thrombus‐free aorta between the lowermost renal artery and the commencement of the aneurysm, and iliac arteries allowing access to the aorta from the groin.Outcome measures(i) Need to convert to open repair; (ii) damage to the arteries from sheath insertion; (iii) communication between the aneurysmal sac and the circulation; (iv) death within 30 days; (v) effect on aneurysmal diameter.ResultsEndografts were successfully deployed in 88 patients. In the remaining 12 patients endoluminal repair was converted to open repair. There were five deaths within 30 days of the operation, including three in the failed group. Damage to the femoral or iliac arteries from sheath insertion occurred in five patients. These were repaired without the need to convert to open repair. No patients were lost to follow‐up (62 patients have been followed up for at least six months). Contrast‐enhanced computed tomography shows progressive diminution in maximal transverse diameter of the aneurysms with time, after successful exclusion of the aneurysmal sac from the general circulation.ConclusionsEndoluminal repair of abdominal aortic aneurysms is feasible and this method of repair is durable in mid‐term follow‐up.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138640.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo examine management of cellulitis in a tertiary teaching hospital, identify inefficiencies and suggest revised management guidelines.DesignRetrospective case survey, based on patient hospital records.SettingHeidelberg Repatriation Hospital, Melbourne, Victoria (a tertiary teaching hospital), in 1991 and 1992.SubjectsAll patients admitted with lower‐limb cellulitis as the primary diagnosis.Results118 patients were included. Underlying disease predisposing to cellulitis was found in 79%, but was adequately investigated in only 20% of these. Blood cultures were performed in 55%, all with negative results. Other microbiological investigations also had poor yields. Combination therapy with intravenous (IV) flucloxacillin and penicillin was given to 76%, with duration varying widely (mean, six days). Where documented (73%), most patients (94%) responded to antibiotics within five days. However, in 40% of patients IV therapy was continued for longer and in 10% for 10 days or more, with no significant difference in outcome. Length of hospital stay averaged 13 days, with prolonged stay often associated with surgical intervention or intercurrent problems. However, 15% of patients remained in hospital longer than 10 days for no clear indication. Outpatient review was common (75%), but persistence or relapse of cellulitis was found in only four patients on review.ConclusionsManagement of inpatients with cellulitis is inefficient, with excessive use of microbiological investigations, inadequate investigation and treatment of underlying disease, prolonged use of intravenous antibiotics, unnecessarily long hospital stays, questionable use of combination antibiotic therapy and excessive outpatient review (rather than review by a local medical practitioner).

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138641.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

The ability of medical technology to prolong life has created unease with current law governing the protection of life. Adopting and advertising standards of approved medical practice in this area may remove the perceived need for euthanasia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138642.x

出版商:Wiley    

年代:1996

数据来源: WILEY