ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138604.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138605.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Without guidelines, there is potential for both over‐ and underdiagnosis and mismanagement

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138606.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Australia urgently needs a national database to identify the number of people with IDDM and the distribution of new cases of the disease

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138607.x

出版商:Wiley    

年代:1996

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138608.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo assess the value of performing routine pulmonary function tests by flow‐loop spirometry in young adolescents with asthma.DesignA prospective clinical study comparing clinical assessment and patients' self‐reporting of asthma severity with the results of pulmonary function tests.SettingGeneral practice in a small rural community of about 30000 people.PatientsYoung adolescents with asthma, aged 10‐15 years, were enrolled in the study over a two‐year period from July 1993 to June 1995 when they presented for either elective, interval assessments or with an acute exacerbation of asthma.Main outcome measuresDiscrepancy between (i) the doctor's and the patient's perception of asthma control (six scale measures) and the consequent management plans, and (ii) the results of pulmonary function tests that indicated less than adequate airway function (i.e., forced expiratory volume in one second as a percentage of predicted vital capacity for height and sex [FEVi%] less than 65% or average flow rate over the middle 50% of forced vital capacity as a percentage of predicted normal value [FEF25%‐75%] less than 65%).ResultsTwenty‐seven adolescents with asthma were assessed on a total of 37 occasions. The results of pulmonary function tests did not correlate with asthma symptoms and treatment in 11 of the 37 assessments (30%; 95% confidence interval [Cl], 16%—47%). The 11 assessments were performed on eight patients.ConclusionsThis small community‐based study of adolescents with asthma supports the view that pulmonary function testing by flow‐loop spirometry should be part of the routine assessment of acute and chronic asthmatics. Further study in a larger community is needed to clarify the frequency of over‐ and underestimation of asthma severity in this difficult age group.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138609.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo compare the efficacy of penthienate with that of propantheline and placebo for treatment of primary idiopathic detrusor instability.DesignTwo prospective, randomised, crossover trials (double‐blind for penthienate versus placebo and non‐blinded for penthienate versus propantheline).SettingUrology Clinic of Prince Henry Hospital, Sydney, NSW (an outpatient clinic of a tertiary referral hospital), in 1993‐1994.ParticipantsNeurologically intact patients with urodynamically proven detrusor instability, urgency and urge incontinence, but no stress incontinence (20 participated in the penthienate/placebo trial and 23 in the penthienate/propantheline trial).Outcome measuresCystometrography results before and after treatment; frequency and volumes of urine voided in weeks 1 and 4 of treatment; and patient scores for degree of continence, side effects, efficacy and acceptability of treatment.InterventionsPenthienate (5 mg), propantheline (15 mg) or placebo (all three times a day) for 4 weeks.ResultsPenthienate produced significantly greater improvements than placebo in frequency (daytime,P=0.002; and night‐time, P=0.02), incontinence scores(P=0.002) and amplitude of unstable detrusor contractions, when present (P=0.01), and significantly increased diurnal and nocturnal bladder capacity, both on cystometrography(P=0.003) and by voiding‐diary records(P<0.001). It also increased residual urine volume over the baseline level, but not significantly. Side effects, especially dry mouth, were common with penthienate, and one patient developed urinary retention. Penthienate was significantly better than propantheline in improving cystometric capacity (P=0.03), and reducing the amplitude of unstable detrusor contractions (P=0.01), and was perceived as more effective by patients for frequency, nocturia and incontinence.ConclusionsPenthienate (5 mg three times a day) was objectively and subjectively significantly better than both placebo and propantheline (15 mg three times a day) for treatment of primary idiopathic detrusor instability.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138610.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

ObjectiveTo examine local procedures for assessment of attention deficit hyperactivity disorder (ADHD) and its management with psychostimulant medication and to compare these with published practice guidelines.DesignRetrospective postal survey.ParticipantsParents of children living in the Hunter region of New South Wales first prescribed psychostimulants between 1992 and 1994.Main outcome measuresProcedures for diagnostic assessment, treatment monitoring and continuing management.Results788 parents (60%) responded. Diagnostic assessment procedures complied with published guidelines for about 70%, and detection of comorbid conditions was consistent with community prevalence estimates. There was systematic assessment of treatment response with questionnaires in only a third. Some children with academic or behavioural problems (19%‐24% and 32%, respectively), almost 50% with emotional problems and 63% with motor problems were not receiving treatment for these difficulties. Modal interval for review was six months. Trials off medication were most commonly during school holidays, contrary to recommendations of the New South Wales Health Department. Most parents reported considerable improvement in their children's quality of life with medication.ConclusionsProblems comorbid with ADHD are detected often. Areas of deficiency in management of ADHD include the low rate of contact with schools for diagnostic assessment and determining treatment efficacy, poor support for comorbid problems, infrequent review, and inadequate methods for determining need to continue treatment.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138611.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

The new funding system for Australia's public hospitals has not been shown to be effective and is likely to fragment and undermine services that require cooperation rather than competition.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138612.x

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

This position statement was developed as a consensus view between the two authors and was subsequently reviewed by the Education and Research Sub‐Committee of the Thoracic Society of Australia and New Zealand, whose membership comprises six respiratory physicians with a broad range of interests in research and clinical respiratory medicine. This Committee also sought the opinion of an external reviewer with expertise in the subject. The following conclusions were reached:Physiological changes which occur during pregnancy may affect asthma control.Regular monitoring (monthly or every six weeks) of asthmatic women should occur throughout pregnancy.Regular therapy, including the use of inhaled steroids, is recommended.Well‐controlled asthma should have no adverse effects on pregnancy, labour or breastfeeding.Medicines used to control asthma carry less risk to the mother and baby than a severe attack of asthma.Good asthma management will result in a birth outcome similar to that experienced by women without asthma.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1996.tb138613.x

出版商:Wiley    

年代:1996

数据来源: WILEY