ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04716.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04717.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04718.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: The value of the radionuclide blood pool venogram in detecting deep venous thrombosis (DVT) has to date been inadequately evaluated. This is despite its lower complication rate than the gold standard of contrast X‐ray venography.Aims: To compare the relative accuracy and inter observer variability of radionuclide blood pool and X‐ray contrast venography as well as evaluate previous literature on radionuclide venography.Methods: Prospective comparison of radionuclide and contrast venography was performed in 39 patients. Sensitivity and specificity of radionuclide venography were compared to contrast venography and confidence intervals were measured using standard error calculations. A meta‐analysis of previous studies was also performed.Results: Significant inter observer variation in reports was present in both radionuclide (37%) and contrast (22%) venograms. Using consensus reports sensitivity of radionuclide venography was 87% compared to contrast venography and specificity was 83%. These results are similar to those obtained in previous studies. Furthermore, sensitivity in specificity in the proximal veins were 90% and 92% respectively which were superior to sensitivity and specificity in the distal veins where it was 74% and 90% respectively.Conclusion: The radionuclide venogram appears accurate in the proximal veins and in excluding but not diagnosing distal venous thrombosis. (Aust NZ J Med 1993; 23: 641

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04719.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: Racial differences occur in the incidence of systemic lupus erythematosus (SLE). It has been suggested that SLE occurs at a higher prevalence and with greater severity in Aboriginal Australians, but because of the small, widely distributed population base, this has not been well documented.Aims: To confirm and document the clinical impression of an increased prevalence and severity of systemic lupus erythematosus (SLE) in Aboriginal Australians, and to identify prognostic indicators.Methods: Top End Northern Territory (NT) Aborigines with SLE on 1 January 1984 or diagnosed thereafter were followed until 1 January 1991. Epidemiological, clinical and serological data were collected.Results: Prevalence on 1 January 1991 estimated at 1:1900, at least twice the estimated prevalence in non‐Aboriginal Australians. High frequencies of renal disease (62% with proteinuria>0.5 g/day) and autoantibodies to the Sm antigen (29%) were identified, contributing to the high mortality. Five year survival rate was 60%, with 67% of deaths resulting from infection.Conclusions: There is a high prevalence of SLE in NT Aborigines. In view of probable under‐recognition of mild cases the true prevalence is likely to be even higher. Although morbidity and mortality may have been overestimated for the same reason, both were found to be high. Improved living conditions and health care delivery may improve prognosis. (Aust NZ J Med 1993; 23: 646

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04720.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: Captopril has been shown to improve insulin sensitivity in insulin resistant hypertensive individuals and enalapril has been shown to improve insulin sensitivity in a small group of healthy volunteers, but there has been no direct comparison of the effects of the different angiotensin converting enzyme inhibitors (ACEIs) on insulin sensitivity in either insulin sensitive or insulin insensitive populations.Aim: To compare the impact of two different ACEIs (captopril and enalapril) on insulin mediated glucose uptake in normotensive, non‐obese, insulin sensitive subjects.Method: A single blind cross‐over study comparing captopril (6.25 mg twice daily) and enalapril (5 mg once daily) for 28 days with a 28 day washout period between drugs. Insulin mediated glucose uptake was measured by means of the euglycaemic hyperinsulinaemic clamp at the start and completion of each period of drug therapy.Results: Both drugs resulted in elevations of fasting insulin levels (mean difference ± SEM for combined data, 2.7 ± 1.8;p<0.05) and a reduction in insulin mediated glucose uptake (mean difference for combined data, ‐ 0.72 ± 0.37 mg/kg1minute‐1;p= 0.056). Results were similar for both agents and suggest a class effect.Conclusions: The increase in fasting insulin levels, and reduction in insulin mediated glucose uptake in this study are in contrast to findings in obese and hypertensive subjects, and indicate that studies of insulin sensitivity of ACEIs in non‐obese, normotensive subjects are inappropriate for predicting likely effects in clinical practice. (Aust NZ J Med 1993;

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04721.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: Cardiac siderosis from transfused iron remains the major cause of death in thalassaemia major, despite iron chelation therapy with desferrioxamine.Aims: Our aim was to determine the nature and extent of cardiac involvement and its relationship to desferrioxamine use in a group with thalassaemia major.Methods: We reviewed 76 patients with thalassaemia major and performed multiple logistic regression to analyse factors affecting cardiac involvement. Factors studied included: patient sex, age, haemoglobin, serum ferritin, total transfusions, liver iron, duration of desferrioxamine use, electrocardiograms, echocardiograms and compliance to desferrioxamine treatment.Results:Thirty‐seven patients developed heart disease. They were older (p<0.001), began desferrioxamine later (p<0.001), had more liver iron (p= 0.014), higher serum ferritin levels (p= 0.023) and received more blood (p = 0.018). Compared to those with optimal compliance the odds of developing heart disease were increased 10.7 times in fair compilers (p<0.001) and 5.1 times in poor compilers (p= 0.016). However, there was no significant difference between those with fair and poor compliance. After multivariate analysis only compliance (p= 0.02) and age at desferrioxamine onset (p= 0.004) remained significant. Compliance was inversely related to liver iron (p<0.001), serum ferritin (p<0.001) and age at desferrioxamine commencement (p<0.001).Conclusions: We conclude that late commencement of desferrioxamine and noncompliance are associated with greater iron loading and an increased riskof heart disease. (Aust NZ J Med 1993; 23: 656–6

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04722.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: Vancomycin serum concentrations have been monitored over the last 30 years in an attempt to avoid dose‐dependent toxicity and enhance efficacy. Current literature recommendations for peak and trough concentrations are usually in the range of 20–40 mg/L and 5–10 mg/L, respectively. Literature recommendations regarding the time at which peak concentrations are measured are highly variable, ranging from immediately after the end of the infusion to three hours post‐dose.Aims: To identify how vancomycin dosing is being monitored and assess variability in the current practice.Methods: A survey of microbiology departments and infectious disease physicians in major Australasian hospitals was undertaken. The variability in the current practice was assessed by fitting mean recommendations to a two compartment Bayesian model.Results: Of the 83 (70%) who replied 71 (86%) monitored vancomycin concentrations. Fifty‐four percent targeted peak concentrations within the range of 20–40 mg/L, and 73% targeted trough concentrations ≤ 10 mg/L. The time of sampling of peak concentrations varied considerably ranging from immediately (12%) to 120 minutes (12%) post‐infusion (median 30 minutes [40%]). The concentration‐time curves resulting from three sets of mean recommendations (“peaks' drawn at: 0, 30 and 120 minutes aiming for a concentration of 35 mg/L with a trough concentration of 10 mg/L) were modelled using a two compartment Bayesian programme. The predicted true peak (maximum) concentrations ranged from 30 to 86 mg/L, despite aiming for identical target concentrations, indicating marked variation in the actual dosing practice.Conclusions: There is thus considerable variation in the practice of vancomycin therapeutic monitoring which has a major effect on dosing. The main contributing factor is the variable timing of sampling peak concentrations. (Aust NZ J Med

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04723.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: The use of portable glucose meters by nursing staff to perform bedside capillary blood glucose measurements is standard practice in the management of diabetic hospital inpatients. Few studies, however, have examined the practical limitations or the cost of this technology.Aim: To investigate the performance and cost of capillary blood glucose measurements using portable glucose meters in a hospital inpatient population being managed for diabetes mellitus.Methods: The setting was a 500 bed metropolitan University Teaching hospital, with 22 meters (Glucometer‐M) in routine use by about 450 accredited nursing staff. The Glucometer‐M was also compared with an operator‐independent meter (Hemocue) to assess the effect of operator bias on the overall efficacy and cost of the programme.Results: Retrospective analysis of Glucometer‐M reagent strips and comparison of measurements (n = 72) with the Hemocue revealed a marked operator bias which diminished accuracy and increased costs. The significant proportion of low haematocrits (<30%) in the hospital population limited the applicability of the Glucometer‐M which only operates reliably over the haematocrit range 35–50%. The excess of blood glucose measurements was highlighted by both a hospital ward audit and the frequency which exceeded that of routine electrolyte assays.Conclusions: Reliable bedside estimation of capillary blood glucose levels in hospitals requires a meter which is accurate, has negligible operator bias, is largely unaffected by haematocrit, and has insignificant risk of cross‐contamination. At present only the Hemocue fulfils these specifications. Irrespective of meter choice, it is necessary to develop criteria for glucose measurements and monitor adherence. (Aust NZ J Med 1993;

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04724.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground: The management and follow‐up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals.Aims: To study the adequacy of assessment, treatment and follow‐up of patients presenting at A&E departments in non‐teaching hospitals.Methods: A twenty‐five per cent sample of presentations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demographics, assessment, management and referral was extracted from the A&E case notes and medical records of cases with documentation of a final diagnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals.Results: Of 359 presentations with a final diagnosis of asthma, 88% were self referred and only 5% were first presentations. Objective measures of airways obstruction was not documented in 34% of admissions and 48% of nonadmissions. There was no documented follow‐up in 28% of cases. The assessment and management of asthma in A&E was significantly poorer in smaller hospitals.Conclusion: Evidence of high use of A&E as a primary care facility by asthma patients was found in the study. There is a need to implement protocols to optimise assessment and treatment of asthma in smaller hospitals. (Aust NZ J Med 1993; 23:

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb04725.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY