ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02896.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02897.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02898.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02899.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02900.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02901.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:Coronary angioplasty (PTCA) offers improved symptom control over medical treatment in patients with stable angina and single‐vessel disease. However, it is uncertain if PTCA is more cost‐effective. Cost‐shifting could also influence the provision of PTCA.Methods:Data from the only randomised trial comparing PTCA to medical therapy (ACME study) were used with costs from an Australian teaching hospital to estimate the costs and freedom from angina in 100 patients over three years. The incremental cost‐effectiveness of PTCA, and the potential for cost‐shifting were also examined.Results:Although the total cost of treating 100 patients over three years with PTCA ($678,978) was higher than a medical strategy ($631,078), PTCA was more cost‐effective ($10,930versus$12,682 per patient free of angina). The incremental cost‐effectiveness of PTCA ($3875 per extra patient free of angina) was also substantially less than the cost of the medical strategy. These should be considered crude estimates as they were based on limited data on resource use. The hospital could reduce costs by pursuing a medical strategy, but 54% of the savings would result from shifting the cost of treating patients to the Federal Government and patients. By performing PTCA on privately insured rather than Medicare patients, die hospital could shift $29,876 per 100 patients to the Federal government and private insurance funds.Conclusions:From society's perspective, PTCA may be more cost‐effective than a medical strategy. However, the financial interests of the hospital are best served by limiting PTCA or restricting PTCA to privately insured patients. Cost‐shifting may have a major impact on the provision of PTCA. The costs of providing medical services need to be weighed against the cost of n

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02902.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Background:Multiple endocrine neoplasia type 1 (MEN 1) is a tumour predisposition syndrome that usually manifests in the first four decades of life. It has an autosomal dominant mode of inheritance which means that any new member of a MEN1 kindred has roughly a 50% chance of developing the disorder during their lifetime. The localisation of theMEN1gene to a small region of chromosome band llql3 has led to the development of DNA‐based predictive diagnosis for this disease.Aims:To establish a polymerase chain reaction (PCR)‐based system, using simple tandem repeat polymorphisms (STRPs), to predict gene carriers in four Australian MEN 1 kindreds.Funding:This work was supported by the National Health and Medical Research Council of Australia and the Princess Alexandra Hospital Foundation.Methods:Six STRP markers flanking theMEN1region of chromosome band 11q13 were used to screen individuals for a common haplotype in order to determine carrier status.Results:The accuracy of prediction was calculated to be>95% in informative individuals.Conclusions:DNA‐based presymptomatic detection of affected members of MEN 1 kindreds could facilitate their care and reduce the inconvenience and expense of repeated testing of unaffected members. However, due to occasional recombination events or uninformativeness of markers in certain individuals, carrier status cannot always be pred

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02903.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:Semipermanent tunnelled silicone rubber Hickman catheters are widely used to provide durable central venous access for patients with cancer or haematological disease.Aims:To document the frequency and severity of Hickman catheter related adverse events and to identify predisposing factors.Methods:A retrospective review was undertaken of 153 sequential Hickman catheters inserted into patients receiving treatment for cancer or haematological disease. All Hickman catheters were inserted percutaneously in a radiology department under local anaesthesia and fluoroscopic control. The exact position of the catheter tip was determined by reviewing post‐insertion radiographs.Results:The median duration of catheter use was 55 days (range one‐650). Complications led to the removal of 32% of catheters. Exit site infection complicated 22% of catheters, septicaemia 7%, migration or dislodgment 7%, and venous thrombosis 8%. Complications were more common in male patients (exit site infection and catheter loss), in patients with acute leukaemia (septicaemia) and in obese patients (catheter migration). Left sided catheters caused more venous thrombosis and were more likely to malfunction or block. Left sided catheters required removal more frequently than right sided catheters. Termination of the Hickman catheter within the high superior vena cava (SVC) resulted in loss of function earlier when compared to termination with the low SVC or right atrium (RA).Conclusions:Right‐sided Hickman catheters terminating in the low SVC/RA offer the best chance of durable function. The use of subcutaneously tunnelled catheters in obese patients poses unique problems with catheter migration. Vigilance in the placement and care of Hickman catheters remains esse

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02904.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Background: Aprospective study in non‐institutionalised Australian elderly 60 years and over commenced in Dubbo, NSW in 1988.Aim:To examine clinical and socio‐demographic predictors of all‐causes mortalityMethods:The data were derived from a community‐based sample comprising 1236 men and 1569 women followed for a median period of 62 months.Results:Two hundred and thirty five men (19%) and 184 women (12%) died, 46% of male and 53% of female deaths respectively related to cardiovascular disease. In a proportional hazards model, the significant predictors of mortality were: older age, being married (relative risk [RR]=0.71 for men, 0.74 for women), current smoking for men (RR=3.11), taking more than three alcoholic drinks per day for men (RR=0.37), prior coronary heart disease for men (RR=1.36), severe hypertension for women (RR=1.99), use of anti‐hypertensive medication for men (RR=1.74), diabetes for men (RR=1.62), poor‐fair self‐rated health for women (RR=1.74) and physical disability for men (RR=1.72). Serum cholesterol was associated with mortality in a ‘J‐shaped’ relationship in men and in a reciprocal relationship in women. Blood pressure predicted mortality in an incremental fashion below 75 years, but in older subjects lower pressure was associated with excess mortality.Conclusion:Some predictors of mortality in the well elderly have been identified and a more extended period of follow‐up will possibly resolve contradictory f

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02905.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY