ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01431.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.tb01432.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:Many residents of aged‐care accommodation are chronic users of benzodiazepines. This pattern of use contradicts current guidelines and may adversely affect residents. It was hypothesised that a lasting reduction in benzodiazepine use could be achieved through a programme which involved prescribers, residents and caregivers in the change process.Aim:To demonstrate that an intervention which involved education and relaxation training for patients, and education of prescribers and caregivers, could reduce levels of chronic benzodiazepine use among residents of an aged‐care facility.Methods:Two aged‐care facilities from metropolitan Adelaide were chosen; one received the intervention, the other was a no‐intervention comparison. Pre‐test, post‐test and follow‐up interviews were conducted with 60 residents: 27 from the intervention setting and 33 from the comparison setting. Residents at the intervention setting were provided with relaxation skills training, and their medical practitioners and caregivers were provided with information about alternative strategies for managing sleep disturbance. Outcome measures were: the proportion of residents using benzodiazepines, total medication use, cognitive performance, emotional responsiveness, subjective health and sleep ratings and an index of well‐being.Results:The proportion of participants in the intervention condition who used benzodiazepines declined significantly (from 70% to 35%); the reduction was maintained over the subsequent three months. No adverse consequences were associated with cessation of benzodiazepine use; there was improvement in emotional responsiveness among those who ceased benzodiazepine use. This structured intervention strategy is a useful approach for reducing levels of chronic benzodiazepine use among residents of aged‐c

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01433.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:The role of intravenous aminophylline in acute asthma is unclear despite meta‐analysis of many studies comparing aminophylline with other bronchodilator therapies.Aims:The aim of this study is to determine whether continuous aminophylline infusion confers any benefit in acute severe asthmatics treated with intravenous steroids and inhaled bronchodilators.Methods:The study was randomised, double‐blind and placebo‐controlled. All patients received nebulised salbutamol (1 mL of 0.5%) and ipratropium bromide (1 mL of 0.025%) with glycol diluent (1 mL) at 0, two, four, six, eight and 12 hours, and six‐hourly thereafter. In addition all patients were given intravenous hydrocortisone 250 mg six‐hourly and oxygen to maintain normoxia. Aminophylline infusions were adjusted to maintain therapeutic levels. Peak expiratory flow rate (PEFR) was measured before and after nebulised bronchodilator on a two‐hourly basis in the Emergency Department (ED) and six‐hourly on the inpatient wards.Results:Thirty‐one patients were clinically sufficiently improved within 12 hours to be discharged home from the ED. The remaining 28 patients were admitted to the inpatient ward for a total trial duration of 48 hours.No significant difference was found between the placebo and treatment groups for measurements of PEFR, or for the duration of stay of the patients in hospital. The power of the study was 80% for a 25% to 33% difference at a 5% level of significance. Presentation values of PEFR and arterial blood gases did not predict which patients would require inpatient admission and which could be safely discharged h

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01434.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:The admission of a proportion of disabled people to hostels is inevitably followed by their transfer to nursing homes. Our hypothesis was that such admissions are justified in terms of quality of life and the cost to the community, notwithstanding the necessity of subsequent transfer.Aims:To test this hypothesis by measuring the retention and survival times of residents in hostel and in nursing home; to consider the relevance of these factors to the future policy of the two institutions.Methods:A retrospective study was made of 159 residents admitted over a period of 12 years to a hostel with 32 places. Times spent in the hostel and in the nursing home were recorded. Probabilities of survival in hostel and in nursing home were calculated according to the Kaplan‐Meier method. Comparison with the expected survival of a matched cohort of the total population was determined. Estimation was made, using the SAS software package, of the likely number of places needed in nursing homes for residents following transfer.Results:Although the majority of hostel residents eventually needed nursing home care, a worthwhile proportion of their total institutional time (approximately two‐thirds) was spent in the hostel. Ongoing support from the personnel in a geriatric service is likely to increase retention time in the hostel. Because of the ultimate outcome for the majority of residents, planning for hostel care should include consideration of places needed in nursing ho

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01435.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:Contrast angiography provides a silhouette of the arterial lumen, but does not give information about arterial wall structure. Catheter‐tip ultrasound transducers can now provide a cross‐sectional image of the arterial wall. This study examined the pathological correlation of intravascular ultrasound images and the accuracy of ultrasound measurements of vascular geometry.Methods:Intravascular ultrasound images were obtained with a mechanically rotated catheter‐tip transducer and recorded on videotape. Initial validation studies were performed in fresh, postmortem arterial specimens, which were filled with saline at physiological pressures. Ultrasound images at specific sites were compared with the pathological findings at that site and measurements of luminal diameter were compared with corresponding angiographic measurements. Subsequently, intravascular ultrasound was employed to examine the aorta, ilio‐femoral and coronary arteries in patients undergoing balloon angioplasty.Results:The pathological correlations showed that intravascular ultrasound can detect early initial thickening and mild atherosclerotic lesions that do not result in luminal deformation. Ultrasound images provided definition of calcified, fibrotic and lipid‐filled lesions. Ultrasound measurements of luminal diameter correlated well with pathology measurements (r = 0.93), as did ultrasound measurements of plaque area (r = 0.89). Thein vivostudies demonstrated that intravascular ultrasound can define atheroma lesions not evident on contrast angiography and permits detailed evaluation of the results of interventions such as balloon angioplasty.Conclusions:Intravascular ultrasound provides a unique window upon arterial structure and pathology in humans. Ultrasound images allow accurate measurements of vascular geometry and define early atheromatous lesions that are not evident with an

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01436.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:Although studies have assessed the effect of pregnancy on epilepsy, usually the types of epilepsy are not differentiated and most have not included a control group, despite the natural history of epilepsy including fluctuations in seizure frequency.Aims:To assess the effect of pregnancy on seizure frequency and compare this with changes in seizure frequency in non‐pregnant patients. In addition, the relationship between seizure frequency during pregnancy and epilepsy type, seizure frequency prior to pregnancy and duration of epilepsy will be assessed.Methods:Seizure frequency was assessed retrospectively in 37 pregnancies from 24 women by comparing the seizure number for the nine‐month period prior to pregnancy with the number during the pregnancy. An increase in frequency was defined as a 50% or greater increase in the number of seizures. Twenty‐four non‐pregnant women, matched for age and epilepsy type, were included to assess fluctuations in control.Results:In 41% of pregnant women, there was an increase in seizure frequency, in 51% no change and in 8% improvement. In the control group, 24% had an increase, 65% no change and 11% improvement. There was no correlation between seizure frequency during pregnancy and epilepsy type and seizure frequency prior to pregnancy, but those with longer duration of epilepsy were more likely to deteriorate (p<0.05). Alterations in anticonvulsants to reduce the risk of teratogenicity was a common identifiable cause of deterioration in control.Conclusions:Significant random fluctuations in epileptic control occur, but pregnancy may have a deleterious effect on epilepsy, particularly when appropriate therapy is withdrawn to reduce teratog

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01437.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:Knowledge of the portal pressure may be of value in the assessment of patients with chronic liver disease but its measurement is problematic.Aims:To evaluate the ease and safety of percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins and to determine directly the need for an internal zero.Methods:Sixty‐one patients undergoing liver biopsy for suspected liver disease had pressures in branches of portal and hepatic veins measured using a flexible 22G (Chiba) needle.Results:The procedure was successful in all patients, took less than ten minutes in most, and was associated with minimal discomfort. Post‐procedure morbidity was similar to that of liver biopsy. Portal pressure using an external zero (either puncture site or sternal angle) was inaccurate compared with pressures obtained using the generally accepted gold standard internal zero, hepatic venous pressure, and led to incorrect classification of the presence or absence of portal hypertension in at least 10% of patients. Variations in hepatic venous pressure were not predictable on clinical grounds. The only histopathological feature predictive of portal hypertension was cirrhosis, 20 of 25 patients with and four of 36 patients without cirrhosis having portal hypertension. Of routine biochemical and haematological tests, only plasma albumin and platelet count jointly (and negatively) predicted hepatic venous pressure gradient on multiple regression analysis (R2= 0.40).Conclusions:The use of an internal zero is essential for accurate measurement of portal pressure and this can be achieved safely using the percutaneous, transhepatic route in patients with well compensated liver dise

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01438.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground:Simvastatin and pravastatin are both competitive inhibitors of the rate limiting enzyme for cholesterol biosynthesis (HMG CoA) reductase, but data from individual clinical trials suggest significant differences in potency for cholesterol reduction between the two drugs.Aim:To assess any differences in efficacy and safety between simvastatin and pravastatin in a direct, comparative study.Methods:A double‐blind, double‐dummy, randomised study design was used, involving 48 patients with primary hypercholesterolaemia. Following a 6 week placebo baseline period, patients were randomly allocated to treatment with either simvastatin or pravastatin, commencing at a dose of 10 mg daily. The dose levels were titrated up to the recommended maximum effective dose of 40 mg daily at 6 weekly intervals if LDL cholesterol levels remained 3.4 mmol/L. After 18 weeks of therapy, all patients were transferred to simvastatin therapy for a further 6 weeks, continuing at their week 18 dose level. Patients complied with a standard lipid lowering diet (containing<30% of energy as total fat) throughout the study period.Results:Over the 18 week direct comparison of the two drugs, there was a significant difference (p<0.001) in response between simvastatin and pravastatin for reduction in levels of total cholesterol (32%vs21% respectively), LDL cholesterol (38%vs27%) and apolipoprotein B levels (34%vs23%). No significant difference in drug effect was seen for the small reduction in levels of apolipoprotein AI (5%vs6% respectively), nor for the increased levels of apolipoprotein All (14%vsll%) and HDL cholesterol (1 l%vs7%). Lp(a) levels remained unchanged.When pravastatin was replaced with simvastatin for the final 6 weeks of the study in the 23 patients initially randomised to pravastatin, there were further reductions (p<0.01) in total andLDLcholesterol, and apolipoprotein B.These results establish the advantage of simvastatin over pravastatin in terms of efficacy, for the treatment of primary hypercholesterolae

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01439.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.tb01440.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY