ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01751.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Asthma control may be assisted by educating patients to use peak expiratory flow meters (PEFMs).Aims:To find out the sociodemographic and clinical characteristics of asthmatics attending an Emergency Room (ER) who owned PEFMs.Methods:We undertook a study of 352 asthmatics aged seven to 55 years who attended an ER. The following were analysed: their pattern of peak flow monitoring (PFM), the factors associated with ‘appropriate’ or daily PFM on entry to the study and then prospectively; whether asthma education influenced utilisation and whether there was a reduction in ER use or admissions in those who acquired a PEFM.Results:Those owning a PEFM at entry to the study (54%) had more asthma morbidity(p= 0.0001), had had asthma for longer(p =0.0001), had seen their medical practitioners more often in the previous nine months (p = 0.0001), were on more asthma medications(p= 0.0001) and were more likely to have been to an Asthma Clinic (p = 0.0001). Those not owning a PEFM were more likely to be of lower social class (p = 0.016) and of Pacific Island origin(p= 0.0001) suggesting that distribution is not ideal and is influenced by disease severity, amount of health care use and sociodemographics. Patients with a self‐management plan (35% of PEFM owners) and those receiving ‘good care’ or management, were more likely to use PFM ‘appropriately’ and to mention PFM in a scenario evaluating their response to worsening asthma control and argues for PEFMs to be distributed only in conjunction with a self‐management plan, and therefore in close association with the patients' medical practitioners.Most patients (75%) appeared to prefer making management decisions based on symptoms rather than on their peak expiratory flow (PEF) and few (16%) performed daily PFM at entry to the study and fewer (6%) nine months later. There was an improvement in the pattern of PFM after education, but the acquisition of a PEFM made no difference to the frequency of ER use or admission,Conclusion:More realistic goals need to be defined in relationship to PFM which may improve patients' acceptance of the strategy, and therefore, hopefully their compliance. Such strategies need to be consistently reinforced over time for them to have an impact on asthma morbidity. (Aust NZ J Med 199

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01752.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:The incidence of acute rheumatic fever in New Zealand remains relatively high. Reliable early diagnosis of carditis is difficult and important in management.Aim:To determine if Doppler echocardiography contributed to the early diagnosis of carditis in acute rheumatic fever.Methods:Forty‐seven patients admitted to hospital with suspected acute rheumatic fever and 19 control patients, with a febrile illness due to a documented non‐cardiac bacterial infection, were assessed two days and two weeks following admission. Presence or absence of clinical carditis was determined by a cardiologist unaware of the suspected diagnosis, from clinical examination, chest radiograph, electrocardiogram (ECG) and two dimensional echocardiogram. Doppler echocardiography was then performed and interpreted by a second cardiologist unaware of the diagnosis. After completion of the study the Jones criteria were applied, to categorise the patients with suspected acute rheumatic fever into four groups for the final diagnosis: no acute rheumatic fever, possible acute rheumatic fever, definite acute rheumatic fever without carditis, and definite acute rheumatic fever with carditis.Results:In 19 patients with a final diagnosis of acute rheumatic fever and carditis at the baseline assessment carditis was detected by clinical assessment in 15 patients, compared with 19 patients with evidence of significant valve regurgitation by Doppler echocardiography. Following the two week assessment, all 19 patients had both clinical and Doppler evidence of carditis. Five patients with a final clinical diagnosis of possible acute rheumatic fever or definite acute rheumatic fever without carditis, had a Doppler abnormality detected. There was no clinical or Doppler abnormality in the febrile controls.Conclusions:Doppler echocardiography is more sensitive than clinical assessment in the detection of carditis in acute rheumatic fever, and can contribute to earlier diagnosis. (Aust NZ J Med 1994; 24: 530

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01753.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Selection of patients for a clinical trial is affected by awareness of the existence of the trial, interest in the study question and clinical practices and views of the clinicians.Aims:To investigate the selectivity that may have occurred at Peter MacCallum Cancer Institute (PMCI) during the ANZ Lymphoma Group trial of MACOP‐B vs CHOP in non‐Hodgkin's lymphoma (NHL).Methods:NHL patients at PMCI in the study period were assessed against the trial's eligibility criteria. Comparisons were made between eligible (except for consent) non‐trial patients and all patients actually randomised into the trial.Results:Of 497 patients presenting during the trial period, 320 (64%) did not meet the specified eligibility criteria, 102 (21%) were unsuitable on other grounds (age and medical) and 75 (15%) were eligible. Of those eligible, 43 (57%) were entered into the trial and 32 (43%) were not. Four non‐trial patients had inappropriate application of eligibility criteria and 13 unknown reason. Eligible non‐trial patients were similar to trial patients in most patient and tumour characteristics and overall survival. Significantly more non‐trial patients had higher stage disease (p = 0.02). More non‐trial patients had lower grade histology, but this was not significant.Conclusions:Physician selectivity occurred with respect to patient entry, but trial and non‐trial patients were similar in most characteristics. Eligibility criteria should specify that patients can withstand all trial drugs and patient availability for treatment and follow‐up. PMCI trial accural could have been up to 33% greater. These results suggest the trial accrual period could have been 25% shorter. Patient entry into this trial by PMCI clinicians compared favourably with other centres. (Aust NZ J Med 1

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01754.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:The lengthy period of neutropenia which follows allogeneic bone marrow transplantation (BMT) results in significant morbidity and some mortality. Recombinant human granulocyte colony‐stimulating factor (rhuG‐CSF) effectively reduces neutropenia and morbidity when given after autologous BMT, but has not been adequately investigated in allografts.Aims:To assess the tolerability, safety and efficacy of rhuG‐CSF after allogeneic BMT.Methods:rhuG‐CSF was administered to 13 adult patients with haematological malignancies after HLA‐identical sibling BMT. Five μg/kg of rhuG‐CSF was given daily by subcutaneous bolus injection, commencing four hours after marrow infusion and continuing until the neutrophil count was ≥ 1.0 × 109/L on three consecutive days. Graft‐versus‐host disease (GVHD) prophylaxis was cyclosporin and short‐course methotrexate (days 1, 3, 6 and 11). Prophylactic intravenous (IV) antibiotics were administered from the onset of neutropenia. The control group consisted of patients with comparable diagnoses, transplanted before and after the current study using identical supportive care and GVHD prophylaxis policies.Results:Although time to recovery of the neutrophil count to>0.1 × 109/L was similar, the rhuG‐CSF‐treated patients experienced accelerated recovery to>0.5 × 109/L, which occurred at a median of 15 days (range 11–21) after marrow infusion in study patients compared to 18.5 days (range 14–41) in the controls (p =0.04). No significant differences were detected in any of the indices of transplant‐related morbidity examined, including the number of days of fever, the incidence of culture‐positive infections, the usage of antibiotics, the requirement for parenteral nutrition and IV morphine, the maximum severity of mucositis and GVHD, and the day of discharge.Conclusion:Within the context of this study, rhuG‐CSF had limited impact on the clinical outcome of HLA‐identical sibling

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01755.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Alzheimer's disease is the commonest cause of dementia. Clinical diagnosis of Alzheimer's disease may be difficult. Magnetic resonance imaging has a role to play in diagnosis.Aim:To assess whether volumetric and/or visual assessment of the mesial temporal structures is useful in separating patients with Alzheimer's disease from age matched controls.Methods:Twenty‐four patients with Alzheimer's disease diagnosed by NINCDS/ADRDA criteria and 15 age matched controls were studied with magnetic resonance imaging (MRI) and volumetric techniques. Segmented volumes of the mesial temporal structures were assessed visually and volumetrically.Results:Volumetric analysis demonstrated significant (p<.001) differences between the two groups, but showed overlap in individual cases. Discriminant function analysis predicted correct group membership (patient or control) in 85% of cases. Visual assessment alone demonstrated a sensitivity of 92% and a specificity of 93% in distinguishing the Alzheimer patients from controls.Conclusion:Volumetric and visual assessment of the mesial temporal structures is useful in separating Alzheimer patients from controls. Overlap is present in individual cases. Visual assessment was as useful in separating the two groups as the volumetric analysis. (Aust NZ J Med 1994; 24: 547–5

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01756.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Multiple organ transplants have become frequent. Combined heart‐and‐kidney grafting has been reported recently and we have pursued this in selected cases.Aims: To devise a protocol for simultaneous heart‐and‐kidney transplantation, review our clinical experience with the procedure and the causes of cardiac and renal disease in this group.Methods: Seven patients with advanced cardiac failure (LV ejection fraction375 μmol/L) due to a variety of causes, were accepted for combined heart‐and‐kidney transplantation. Four males, of mean age 33 years, underwent the procedure. Each received his organs from a single cadaveric donor with ABO blood group compatibility and a negative ‘current’ lymphocytotoxic cross‐match, but without regard to HLA‐antigen matching. Cardiac ischaemic time averaged 3 hours 40 minutes, the renal first warm time was 0 minutes in all cases, and renal cold and second warm ischaemic times averaged 5 hours 17 minutes and 52 minutes respectively. The heart was grafted first and the kidney second in a procedure which averaged seven hours. Immunosuppression was achieved by induction with antithymocyte globulin, thence steroids, azathioprine and cyclosporin A.Results: No patient required post‐operative dialysis. One patient had early urological complications requiring operative correction, but no serious opportunistic infections were observed. Early cardiac rejection on biopsy (ISHT grade 3a) was seen in three patients at four‐ten weeks and responded promptly to increased steroids, but severe steroid‐resistant rejection of both heart and kidney contemporaneously occurred in one of these three at 19 months and required a course of muromonab‐CD3. All four patients developed hypertension. Mean creatinine clearance was 1.23 ± 0.22 mL/second (74±13 mL/minute) at last follow‐up. All four recipients were alive, well and rehabilitated 5, 20, 28 and 35 months after grafting. Two patients died while waiting for the double procedure and another patient eventually died after being taken off the dual waiting list and receiving a renal transplant only.Conclusions: In experienced hands, combined heart‐and‐kidney transplantation is feasible and offers a compelling therapeutic solution in the treatment of advanced cardiac and renal failure. IDCM is a frequent cause of the heart failure in this grou

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01757.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground:Low serum cholesterol may contribute to depressive symptoms in the elderly.Aims:To test the relationship between depressive symptoms and low serum cholesterol in an elderly cohort.Methods:This was an examination of cross‐sectional data in a community study of 1237 men and 1568 women aged 60 + years in Dubbo, NSW. Quintiles of serum cholesterol were defined for men and women. The Center for Epidemiological Studies Depression Scale was used as a continuous, dependent variable in multiple regression analyses.Results:Low serum cholesterol was not associated with depressive symptoms in older men or women. Health status, measured by poorer self‐ratings, recent hospitalisation, higher disability levels and higher consumption of prescribed and self‐prescribed drugs, predicted depressive symptoms. As well, the significance in the statistical model of financial difficulties, low self esteem, low feelings of self efficacy, the adequacy of practical help and emotional support, and recent widowhood, confirmed the importance of social origins of depressive symptoms. (Aust NZ J Med 1994; 24: 561

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01758.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Everyone in the western world has a clear idea of what a hospital is. People think of a series of large multi‐storeyed buildings filled with highly skilled and professional people (the ‘ologists’) offering sophisticated services amid an impressive array of high technology equipment. Over the past century the development of the hospital has involved cramming more and more services, staff and resources into the one location. Many large hospitals today have a staff of several thousand and are like a small city. But will hospital development continue in this direction? We think not. We believe the hospital has reached an evolutionary branch. The fundamental nature of hospitals is about to change because of the application of information and clinical technology, changing medical practices and economic rationalism. To understand why requires an excursion into a number of disciplines including the history of the hospital, organisation behaviour, medical practice, management and health care policy. And this is no mere epistemological exploration: it is vital for society generally and those who work in health care particularly to understand that the existing structure of the principal organisation which delivers health care is coming to an end. Our principal focus is the teaching hospital, but the analysis applies to a substantial degree to the many kinds of hospitals found throughout the industrialised

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01759.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb01760.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY