ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137903.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137904.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137905.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137906.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine the prevalence of tuberculosis (TB) infection and to determine the rate of conversion to a positive Mantoux test result after BCG vaccination in a subgroup of the Australian population.DesignA descriptive and retrospective study.SettingThe Police Academy, Goulburn, New South Wales.Participants4704 recruits to the New South Wales Police Service between 1987 and 1990.Main outcome measuresRates of positive Mantoux test results before and after administration of BCG.ResultsEleven per cent of Police Cadets were Mantoux positive. Of those who had never been vaccinated with BCG, 7% were positive. Statistically significant differences in Mantoux positivity were found in relation to age, sex and country of birth. There was also a significant difference in the frequency of positive Mantoux reactions between the group vaccinated with BCG at the Academy and those who were vaccinated earlier in life.ConclusionsRoutine Mantoux testing of population subgroups provides a useful source of information on the prevalence of TB infection. However, without testing for the "booster phenomenon" only a minimum estimation of the infection rate can be determined. The National Health and Medical Research Council recommendation that a Mantoux reaction of 5‐9 mm be considered positive in the southern States of Australia Is supported. The low rate of conversion to a positive Mantoux test result after administration of BCG vaccine at the Police Academy indicates that Mantoux testing after vaccination is not useful. (Med J Aust 1993; 159: 369‐372)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137907.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo establish the extent to which participants in the WA methadone treatment program used opiates, cannabinoids, benzodiazepines, cocaine and amphetamines, and to define the pattern of such use over time. In addition, the relationships between methadone daily dose and the use of the various drug groups was examined.DesignA retrospective analysis of data from 1678 samples from urinalysis screening over 13 separate surveys between 1984 and 1991. A mean of 35.9% of patients in the program was sampled on each occasion with each patient contributing only one sample in any one survey. Analytical techniques used included enzyme‐multiplied Immunoassay, thin‐layer chromatography and gas chromatography‐mass spectrometry.ResultsMethadone and/or its major metabolite were detected in most urine samples, indicating satisfactory compliance by patients. The detection of opiates increased from a mean of 27.1% of samples in 1984‐1989 to a mean of 44.2% of samples In 1990‐1991. Codeine or morphine were most frequently detected (94% of all opiate‐positive samples) and were found together in 38.2% of opiate‐positive samples. Detection of cannabinoids also increased from a mean of 45.2% of all samples during 1984‐1987 to a mean of 56.4% of samples during 1990‐1991. Benzodiazepines were found in a mean of 26.7% of samples but use was not time‐related. Detection of amphetamine‐class drugs doubled from a mean of 8.3% of all samples (mid 1989 to mid 1990) to 16.8% of samples (mid 1990 to mid 1991). The major representatives of the latter group were methylamphetamine (47.3% of amphetamine‐positive urines), amphetamine (15.7%) and ephedrine/pseudoephedrine (44.6%). Opiate use was significantly lower (P<0.05) in those patients taking more than 80 mg methadone/day. In addition, benzodiazepine use increased significantly (P<0.05) with increasing methadone daily dose. There was no relationship between methadone daily dose and use of cannabinoids or amphetamines.ConclusionsThe increase in the use of opiates, cannablnoids and amphetamines over the period 1984‐1991 occurred about four years after the adoption of a harm minimisation treatment philosophy by the WA methadone program. The high prevalence of codeine and morphine in opiate‐positive urine samples strongly suggested the use of "home‐bake" heroin. In addition, the data showed that methylamphetamine and ephedrine/pseudoephedrine were the most frequently used psychostimulants. Suppression of opiate use in those clients receiving more than 80 mg methadone/day was consistent with earlier studies. However, the significant increase in use of benzodiazepines with Increasing methadone daily dose requires further study. (Med J Aust 1993; 159: 373‐376)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137908.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine whether slow‐release enteric coated aspirin (100 mg daily), commenced before operation, improves the patency of saphenous vein (SV) coronary artery bypass grafts at six months.Design and settingDouble‐blind, randomised, placebo‐controlled study at a teaching hospital.ResultsOne hundred and forty patients were randomly allocated to receive enteric coated aspirin or matching placebo. Similar groups of 50 (aspirin) and 52 (placebo) subjects completed the six months follow‐up and had an angiogram to assess patency. Five patients treated with aspirin and nine who received placebo had at least one occluded SV graft; the distal ends of 6 of 128 SV grafts in aspirin‐treated patients (4.7%) and 13 of 145 SV grafts in patients in the placebo group (9.0%) were occluded — the difference was not significant. An arterial graft was occluded in one other patient in each group (3% of arterial grafts). There was more postoperative blood loss, on average, in patients treated with aspirin, but the difference was not significant. Only one patient was withdrawn from long‐term therapy because of possible gastrointestinal symptoms; most withdrawals from the trial were necessitated by commencement of aspirin or non‐steroidal anti‐inflammatory therapy for musculoskeletal disorders.ConclusionsThe coronary bypass graft occlusion rate six months after surgery was low, and was lower on average in aspirin treated subjects but not significantly so. Long‐term treatment with low‐dose aspirin is recommended unless contraindicated. (Med J Aust 1993; 159: 376‐378)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137909.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine medical student response to the set objectives for a one‐week nursing attachment, completed before their major clinical training, in a teaching hospital.DesignLinear ordinal scale assessments of the objectives, encompassing familiarisation with ward and hospital practice, appreciation of the roles of nurses in patient care, the interaction between nursing and medical professions, and the acquisition of basic skills related to patient care and focus group discussions with students and with their nurse supervisors.ParticipantsOne hundred and sixty‐four medical students at Flinders University who completed their nursing attachments in 1986 and 1990‐1992.ResultsStudents thought there had been a uniformly high level of achievement of objectives. A number of suggestions were made by both students and supervisors to improve the program.ConclusionsA period of nursing attachment for medical students, before their major clinical training, helps them to fit into usual ward routine, provides them with some basic patient care skills, and helps them gain greater understanding of and respect for the roles and responsibilities of nurses. (Med J Aust 1993; 159: 379‐381)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137910.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

Objectives(i) To describe the prevalence of self‐reported hearing impairment and level of hearing aid use in women aged 65 years and over living in the community; (ii) to provide comparison findings from the National Health Survey and the Survey of Disability and Ageing undertaken by the Australian Bureau of Statistics.DesignCross‐sectional study of a large community population.SettingConducted as part of the Randwick Falls and Fractures Study, in Randwick, a suburban area in eastern Sydney.ParticipantsFour hundred and ninety‐six women aged between 65 and 99 years (mean age, 74.6 years) took part in the study. The sample was representative of the population from which it was drawn.ResultsWe found a higher level of hearing difficulty than the levels reported in the Australian Bureau of Statistics surveys for women of comparative ages, which may reflect differences in the questions posed. The proportions with a hearing aid in the Randwick study and the Survey of Disability and Ageing were very similar (7.1% and 7.3% respectively). Of the one‐third of the Randwick sample who reported a hearing difficulty, only half had been referred for audiometry and a quarter had been prescribed an aid. Only slightly more than a third of those who received an aid were regularly wearing it. Among the women with hearing difficulties, not using an aid was not associated with age, cognitive status or subjective health. There was a trend suggesting that those who did not use an aid had increased use of community support services. Women who had not received assistance with their hearing impairment had more difficulty shopping and relied more on family members.ConclusionAlmost two‐thirds of people prescribed a hearing aid were not wearing it regularly, denying themselves proven benefits in communication, social involvement and life satisfaction. The prescribing of these unused aids represents a huge waste of health resources. A program to increase hearing aid use by hearing impaired people may reduce the waste of health resources and the need for community support services. Such a program may greatly increase the life satisfaction for this very large group of disabled older people. (Med J Aust 1993; 159: 382‐384)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137911.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo describe the categories of people being approved for admission to nursing homes; to consider whether any alternatives would have been more appropriate; and to outline the care needed for each category.Participants and settingPatients in acute‐care facilities in metropolitan Perth for whom a request had been made for nursing home admission.DesignPatients were interviewed (by R B L and M D) and records in the acute hospital were examined. A second interview of those patients still available was conducted after their transfer to the nursing home.ResultsNursing care was considered necessary for 123 of the 201 people seen in the acute hospitals; domestic care in a standard hostel for 24 people; care in a special dementia unit (SDU) hostel for 26 people; and care in a psychiatric institution for 16 people. Twelve others had various specific needs. Several different categories were identified in the group needing nursing care.ConclusionsApplicants for nursing home admission do not form a homogeneous group; there are several categories with different needs. SDU hostels should be added to the available facilities. In addition to undertaking the assessment of nursing home applicants, personnel from geriatric services should be encouraged to become involved in their continuing care. (Med J Aust 1993; 159: 385‐388)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137912.x

出版商:Wiley    

年代:1993

数据来源: WILEY