Showing papers in "The Medical Journal of Australia in 1995"
TL;DR: A review of the medical records of over 14 000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an “adverse event”, which resulted in disability or a longer hospital stay for the patient and was caused by health care management.
Abstract: A review of the medical records of over 14,000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an "adverse event", which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.
2,197 citations
TL;DR: The clinical and epidemiological features of an outbreak of a viral infection affecting humans and horses are described.
Abstract: OBJECTIVE To describe the clinical and epidemiological features of an outbreak of a viral infection affecting humans and horses SETTING Stables in Hendra, a suburb of Brisbane SUBJECTS Affected horses and humans, and at-risk human contacts RESULTS A pregnant mare died two days after arrival from a paddock elsewhere in Brisbane Eight to 11 days later, illness (depression, anorexia, fever, dyspnoea, ataxia, tachycardia, tachypnoea and nasal discharge) was reported among 17 other horses from the same or an adjoining stable Fourteen horses died or were put down Five and six days after the index mare's death, a stable-hand and then a horse-trainer, both of whom had had close contact with the sick mare's mucous secretions, developed influenza-like illnesses The stable-hand recovered but the trainer developed pneumonitis, respiratory failure, renal failure and arterial thrombosis, and died from a cardiac arrest seven days after admission to hospital A morbillivirus cultured from his kidney was identical to one isolated from the lungs of five affected horses The two affected humans and eight other horses were seropositive for the infection, which was reproduced in healthy horses following challenge by spleen/lung homogenates from infected horses There was no serological evidence of infection in 157 humans who had had contact with the stables or the sick horses or humans CONCLUSIONS A previously undescribed morbillivirus infected a probable 21 horses and two humans; one human and 14 horses died That no further cases were detected among humans suggests that the virus was of low infectivity The source of infection remains undetermined
333 citations
TL;DR: To compare continuity of care from a midwife team with routine Care from a variety of doctors and midwives, a comparison of 12 midwife teams in Northern Ireland over a 25-year period is suggested.
Abstract: OBJECTIVE To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives. DESIGN A stratified, randomised controlled trial. PARTICIPANTS AND SETTING 814 women attending the antenatal clinic of a tertiary referral, university hospital. INTERVENTION Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives. MAIN OUTCOME MEASURES Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. RESULTS 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% CI, 0.41-0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%. CONCLUSION Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.
192 citations
TL;DR: To test the hypothesis that administration of activated charcoal is as efficacious and safe as the combination regimen of gastric emptying plus charcoal in adults after acute oral overdose, a large number of patients receive treatment with activated charcoal.
Abstract: Objective: To test the hypothesis that administration of activated charcoal is as efficacious and safe as the combination regimen of gastric emptying plus charcoal in adults after acute oral overdose. Design: Prospective randomised controlled trial, with subjects presenting on odd-numbered dates allocated to the emptied group (E), and those on even-numbered dates to the not-emptied group (NE). Setting: Princess Alexandra Hospital, Brisbane (a tertiary referral hospital), which serves an adult urban community, between 4 January 1988 and 11 June 1990. Subjects: Consecutive patients (13 years or older ) who presented to the Emergency Department after ingesting an overdose of one or more compounds able to be adsorbed by actived charcoal. Interventions: All patients received charcoal by the oral or nasogastric route. Those in the E group also had gastric emptying by ipecac-induced emesis or gastric lavage. Outcome measures: Clinical course during the first six hours after treatment began, length of hospital stay, complications. Results: 876 patients were eligible for the study. There were no significant differences between the E and NE groups in age and sex distribution, severity of the overdose or other characteristics, except the mean interval between presentation and administration of charcoal (91 min [SD, 52] for E group and 55 [SD, 41] for NE group; P = 0.0001). There were no significant differences between the E and NE groups in outcome, even when the groups were stratified for severity of the overdose or into subgroups that presented sooner or later than one hour after ingestion. Conclusions: Gastric emptying can be omitted from the treatment protocol for adults after acute oral overdose.
171 citations
TL;DR: To compare the prevalence and severity of asthma and of allergic sensitisation in children in different regions, it is hypothesized that regions with different standardised hospital admission rates would have different prevalences of childhood asthma and that diverse climates would result in a range of sensitisations to different allergens.
Abstract: OBJECTIVE To compare the prevalence and severity of asthma and of allergic sensitisation in children in different regions. We hypothesised that regions with different standardised hospital admission rates would have different prevalences of childhood asthma and that diverse climates would result in a range of sensitisations to different allergens. DESIGN AND SETTING We studied large random population samples of children in seven regions in New South Wales (NSW) in 1991-1993. Hospitalisation rates were obtained from NSW Department of Health data. PARTICIPANTS 6394 children aged 8-11 years. OUTCOME MEASURES History of respiratory symptoms by self-administered questionnaire; airway hyperresponsiveness by histamine inhalation test; and sensitisation to allergens by skin-prick tests. RESULTS Children in all regions had a high prevalence of recent wheeze (22%-27%), of diagnosed asthma (24%-38%) and of use of asthma medications (22%-30%), but no region was consistently higher or lower for all measurements. The prevalence of current asthma in children living in three coastal regions (where sensitisation to house-dust mites was high) and in the far west (where sensitisation to alternaria was high) was 12%-13%, which was significantly higher than the prevalence of 7%-10% in children living in three inland regions (where sensitisation to these allergens was lower) (P < 0.01). CONCLUSIONS We found significant variations in the prevalence and severity of childhood asthma in NSW. The prevalence of hospitalisations, diagnosed asthma, recent symptoms and medication use may relate to different regional diagnostic patterns, whereas current asthma prevalence may relate to different levels of allergic sensitisation.
135 citations
TL;DR: To outline the spectrum of eye injuries in the Victorian population, the colours of the rainbow are selected to highlight the most common types of injuries.
Abstract: Objective To outline the spectrum of eye injuries in the Victorian population Design and setting Prospective survey of all eye injuries treated at the Royal Victorian Eye and Ear Hospital; and a review of morbidity data from all Victorian hospitals to estimate the incidence of ocular trauma across the State Results During a 12-month period, 6308 patients were treated at the hospital Most had superficial injuries, but 401 (6%) were admitted for severe trauma Most were male and young; children aged under 15 years comprised 25% of hospitalisations (severe injuries) The workplace accounted for 44% of all injuries and 19% of severe trauma, including ruptured globes and internal bleeding Sports injuries accounted for 5% of all injuries, but 19% of severe injuries The incidence estimate for penetrating eye injuries was 36 per 100,000 population The incidence of eye injuries requiring hospitalisation was 152 per 100,000 Annual medical costs were estimated conservatively at $158 million a year for this hospital alone and projected at $39 million a year for 29,000 eye injuries in Victoria and $155 million a year for 116,000 cases nationwide Conclusions Most ocular trauma occurs in young people and could be prevented by proper use of safety eyewear
127 citations
TL;DR: To document the incidence, case fatality, clinical and demographic features of invasive pneumococcal disease in central Australia.
Abstract: OBJECTIVES To document the incidence, case fatality, clinical and demographic features of invasive pneumococcal disease in central Australia. DESIGN Invasive isolates from the regional central laboratory were prospectively recorded over five years and case notes retrospectively reviewed. Population denominators were calculated from national Census data from 1986 and 1991. RESULTS The population estimates for the region were 14,568 for Aboriginals and 28,680 for non-Aboriginals. There were 185 episodes of invasive pneumococcal disease over the five years, 162 (87.5%) in Aboriginals and 23 (12.5%), in non-Aboriginals. The incidence in Aboriginal children under two years of age was 2052.7 per 100,000 and for those 20-59 years was 178.2 per 100,000. The relative risk in Aboriginals compared with non-Aboriginals was 10.8 (95% CI, 5.6-20.7; P < 0.0001) for those aged 0-4 years and 20.4 (95% CI, 9.7-42.5; P < 0.0001) for those 15-59 years. Forty-one Aboriginal adults aged over 14 (62%) had at least one conventional risk factor for pneumococcal disease; alcohol abuse was present in 27 (41%). There were 13 Aboriginal deaths and the case fatality rose from 2% in those under four years to 40% for those over 59 years. CONCLUSIONS Central Australian Aboriginals have the highest incidence of invasive pneumococcal disease reported. The rate for children under two years is 59 to 80 times the rates for children in the United States and Sweden. These data have implications for improving vaccine use, health service delivery and environmental health in Aboriginal communities.
120 citations
TL;DR: To determine whether plasma glutamine levels can be used as an indicator of exercise‐induced stress, and to consider the possible effects of low plasma glutamines concentrations on the immune system, a large number of animals were studied.
Abstract: OBJECTIVE: To determine whether plasma glutamine levels can be used as an indicator of exercise-induced stress, and to consider the possible effects of low plasma glutamine concentrations on the immune system. METHODS: We used two exercise regimens: in Trial 1 seven male subjects were randomly stressed on a treadmill at 0, 30%, 60%, 90% and 120% of their maximal oxygen uptake (VO2max); in Trial 2 five highly trained male subjects underwent intensive interval training sessions twice daily for ten days, followed by a six-day recovery period. RESULTS: Plasma glutamine concentrations decreased significantly from an average of 1244 +/- 121 mumol/L to 702 +/- 101 mumol/L after acute exercise at 90% VO2max (P < 0.05) and to 560 +/- 79 mumol/L at 120% VO2max (P < 0.001). Four of the five subjects showed reduced plasma glutamine concentrations by Day 6 of the overload training trial, with all subjects displaying significantly lower glutamine levels by Day 11. However, glutamine levels showed a variable rate of recovery over the six-day recovery period, with two subjects' levels remaining low by Day 16. CONCLUSIONS: Reduced plasma glutamine concentrations may provide a good indication of severe exercise stress.
111 citations
TL;DR: To examine the morbidity and mortality associated with self‐poisoning with different drug classes, a large number of patients were diagnosed with at least some form of psychotic illness or substance abuse.
Abstract: OBJECTIVE: To examine the morbidity and mortality associated with self-poisoning with different drug classes. DESIGN: Prospective cohort study with limited follow-up. Retrospective analysis of coronial data. SETTING: Primary and tertiary referral toxicology centre covering Newcastle and Lake Macquarie, Australia, 1987-1992. RESULTS: There were 1969 admissions after ingestion of 3724 substances (2424 prescription drugs and 1300 non-prescription items). The coroner investigated 83 drug-related deaths. Only 12 of these people presented to hospital and, for most of these, death was inevitable at presentation. The most frequently ingested substances were benzodiazepines, alcohol, paracetamol, antidepressants, neuroleptics and anticonvulsants. Since 1980, the percentage of self-poisonings involving benzodiazepines has fallen, while it has risen for those involving antidepressants. Over 50% of deaths were due to tricyclic antidepressants or opioid analgesics. CONCLUSIONS: As death usually occurs out of hospital, interventions to decrease mortality from self-poisoning must focus on prevention, and targeting drugs that are frequently taken or frequently lethal in overdose. Consideration should be given to the use of antidepressants that are safer in overdose. The use of antidepressants, barbiturates or chloral hydrate as sedatives should be discouraged. Language: en
107 citations
TL;DR: An attempt is made to assess the practicality, safety, cost effectiveness and outcome of receiving intravenous antibiotics at home for patients at risk of infection.
Abstract: OBJECTIVE To assess the practicality, safety, cost effectiveness and outcome of receiving intravenous antibiotics at home. METHODS Patients with serious bacterial infections requiring parenteral antibiotic therapy were enrolled in a pilot program to receive treatment at home. Antibiotics were premixed in the hospital pharmacy and administered by the Royal District Nursing Service, and medical back-up was provided. RESULTS Twenty patients (mean age, 58 years; range, 19-84 years) received 21 courses of intravenous antibiotics at home (mean duration +/- SD, 26 +/- 9 days; range, 11-44 days). Conditions treated included osteomyelitis (10 patients), endocarditis (5), vascular graft and pacemaker sepsis (4), and chronic cellulitis (1). Treatment at home was well tolerated with no significant complications, and cure was achieved in 18 of the 20 patients. It was both efficient and cost effective, with a mean benefit in treatment costs between home and the equivalent inpatient therapy of at least $112 per day for the 538 days that home therapy was provided. Moreover, the reduced bed use could allow an additional hospital throughput of between 86 and 107 patients annually. CONCLUSIONS Home intravenous antibiotic therapy is safe, effective and well tolerated. It allows more efficient inpatient care and reduces total treatment costs in an important subpopulation of patients.
107 citations
TL;DR: To examine the pattern and incidence of sepsis occurring in neonatal units in Australia, a large number of patients diagnosed with the disease are referred to neonatal intensive care units.
Abstract: Objective: To examine the pattern and incidence of sepsis occurring in neonatal units in Australia
TL;DR: This newly established body will work to focus the national effort to control breast cancer.
Abstract: This newly established body will work to focus the national effort to control breast cancer
TL;DR: The risk of an Australian dying while travelling overseas is probably little different from that while staying home, and the low level of fatal infections may result from preventive measures.
Abstract: To determine the number and causes of deaths of Australian citizens who died overseas in a 12-month period. Retrospective survey of deaths reported to the Australian Department of Foreign Affairs and Trade by Australian embassies, high commissions and consulates for the period July 1992 to June 1993. Data on Australians travelling overseas were obtained from the Australian Bureau of Statistics. During the year 1992-1993, 2,299,500 Australians travelled overseas for less than 12 months (short term travellers), with an estimated mean trip duration of 6.3 weeks. Another 65,450 left for more than 12 months (long term travellers), and 27,910 left permanently (residents). Of the 421 recorded deaths, 289 were in short term travellers, 108 in long term travellers/residents and 24 in members of work parties. The annual crude mortality rate for short term travellers and work party members was estimated at about 0.1%. Men outnumbered women almost 4:1. Death rates increased with age, reflecting underlying medical problems in older travellers, with heart disease being the leading cause (146 deaths, 35%). Fatal trauma predominated in younger people. Accidents, mainly in traffic, accounted for 77 deaths (18%) and infections for 10 (2.4%), including two cases of malaria. Death rates varied between geographical regions, with New Zealand being the safest destination. The risk of an Australian dying while travelling overseas is probably little different from that while staying home. The low level of fatal infections may result from preventive measures. Travellers should be aware of the danger of accidents, particularly traffic accidents, while overseas.
TL;DR: Doctors' attitudes towards their own medical care are described to describe doctors' attitudes to patients' medical care.
Abstract: AIM To describe doctors' attitudes towards their own medical care. METHODS Postal survey asking 2564 doctors about their access to, and use of, medical services. The sample, 14% of all New South Wales doctors, was randomly selected from the NSW Register of Medical Practitioners. To ensure anonymity, non-respondents were not followed up. RESULTS The response rate was 44%. Only 42% of respondents had a general practitioner and most had self-prescribed medication. Nineteen per cent reported marital disturbances, 18% emotional disorders, 3% alcohol problems and 1% drug abuse, but not many had discussed these problems with their doctor. Twenty-six per cent had a condition warranting a medical consultation but felt inhibited about consulting a doctor. CONCLUSION Many doctors lack adequate medical care. RECOMMENDATIONS We recommend that doctors have their own general practitioner, avoid "corridor consultations" and not self-prescribe drugs that affect mental function. Teaching of appropriate help-seeking responses should be part of medical education.
TL;DR: This study aims to identify patient populations at risk of Pneumocystis carinii pneumonia and assess the potential role of chemoprophylaxis in these populations.
Abstract: OBJECTIVES To identify patient populations at risk of Pneumocystis carinii pneumonia (PCP) and assess the potential role of chemoprophylaxis. METHODS Review of cases of PCP among patients admitted to a tertiary referral hospital in Sydney between January 1990 and April 1993. Cases were identified by indirect immunofluorescent antibody microscopy performed on respiratory tract specimens. RESULTS Ninety-two episodes of PCP were diagnosed in 64 HIV-positive patients and 28 others. All HIV-negative patients had received corticosteroids combined with other immunosuppressive agents before the onset of PCP symptoms, which occurred within six months of immunosuppression. The group included nine of 150 kidney transplant recipients (6%) six of 138 liver transplant recipients (4.3%) and three of 25 patients with Wegener's granulomatosis (12%). Mortality associated with PCP in HIV-negative patients was significantly higher than in those who were HIV-positive (32% v. 8%, P < 0.005). CONCLUSION Solid organ transplant recipients and individuals receiving treatment for Wegener's granulomatosis have a significant risk of developing PCP. Given the high mortality associated with this disease in HIV-negative patients, primary PCP chemoprophylaxis should be considered during the first six months of immunosuppression.
TL;DR: To determine the extent and patterns of benzodiazepine use among heroin users, and whether preferences for different Benzodiazepines exist among this group, a survey of heroin users in England and Wales revealed a preference for the former and a dislike of the latter.
Abstract: Objectives: To determine the extent and patterns of benzodiazepine use among heroin users; and whether preferences for different benzodiazepines exist among this group.
TL;DR: To assess the epidemiology of methicillin‐resistant Staphylococcus aureus (MRSA) in Western Australia, a large number of patients with confirmed or suspected MRSA infections are diagnosed with at least one type of infection.
Abstract: OBJECTIVE To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Western Australia. DESIGN Retrospective review of statutory notification data. SETTING Western Australia (WA), 1993. OUTCOME MEASURES Notification rates, antibiotic resistance patterns and classification of isolates as imported or WA MRSA strains on the basis of antibiotic susceptibility. RESULTS There were 204 notifications of MRSA, 78% of which were classified as WA MRSA. Three outbreaks of MRSA infection and colonisation occurred in separate WA hospitals. Notification rates per 100,000 were highest in the rural regions: the Kimberley (86.32), Goldfields (62.47), Mid West (37.21) and Pilbara (27.38) regions; and lowest in the metropolitan regions (5.52). All MRSA isolates were susceptible to vancomycin. Most imported strains were susceptible to amikacin, bacitracin, chloramphenicol, framycetin, fusidic acid and novobiocin, but only 23% to gentamicin. WA MRSA strains remained predominantly susceptible to all antibiotics tested, except beta-lactams, erythromycin and tetracycline, but a few strains resistant to rifampicin (1%) and fusidic acid (3%) appeared in the second half of 1993. CONCLUSIONS The epidemiology of MRSA in WA is changing rapidly, with increases in both the numbers of notifications and the proportion from country regions. A new strain of MRSA (WA MRSA) that is less resistant to antibiotics than imported MRSA has emerged and is threatening the State's success in preventing establishment of MRSA in its hospitals.
TL;DR: To assess general practitioners' (GPs') views of adole cents as a discrete patient group with specific developmental health c are needs, and to document GPs' perceived knowledge of and competence in adolescent health care, is presented.
Abstract: OBJECTIVES: To assess general practitioners' (GPs') views of adolescents as a discrete patient group with specific developmental health care needs; to document GPs' perceived knowledge of and competence in adolescent health care; and to clarify the barriers GPs perceive to effective delivery of such care. DESIGN: Qualitative research. METHODS: Stratified sampling generated a sample of 57 GPs from rural and urban divisions of general practice. Focus group discussions and individual interviews were recorded and transcripts were analysed. RESULTS: Thirty-three GPs (62%) reported that adolescents made up 10% or more of their weekly consultations. Although 10 GPs defined adolescents by developmental criteria, 47 had an incomplete understanding of the developmental aspects of adolescence. Most GPs (43) had some concerns about their knowledge of and competence in delivering adolescent health care and 52 stated that they had had little or no formal training in adolescent health. The participants perceived a range of barriers to effective health care provision, including issues of confidentiality, communication and cost. CONCLUSIONS: Changes are needed in the Medicare card and rebate systems to ensure improved access to affordable, confidential care for adolescents. Our results also support the incorporation of important adolescent health care issues in undergraduate and postgraduate medical training.
TL;DR: To examine the effect of specific firearm control legislation on firearm and overall suicide rates, six states and the District of Columbia are examined.
Abstract: OBJECTIVE To examine the effect of specific firearm control legislation on firearm and overall suicide rates. DESIGN Retrospective survey of data from the Register of the Suicide Research and Prevention Program, Queensland Department of Health. The hypothesis was tested that the legislation would reduce firearm and overall suicides more in metropolitan and provincial city areas than in rural areas, where firearm ownership is higher. SETTING State of Queensland 1990-1993. OUTCOME MEASURES Suicide rates by age, sex and method for metropolitan, provincial city and rural areas in the two years before (1990-1991) and after (1992-1993) legislation. RESULTS Mean annual firearm suicide rates declined significantly (P < 0.05) in metropolitan and provincial city areas after legislation (from 3.6 to 2.3 per 100,000 and from 5.2 to 3.1 per 100,000, respectively), with significant declines among men and in the 15-29 years age group. Rates increased slightly in rural areas (from 7.2 to 8.2 per 100,000). Overall suicide rates declined in provincial areas only, with minimal change in metropolitan areas and a slight rise in rural areas. CONCLUSION These results provide preliminary evidence that firearm control legislation, including a 28-day "cooling-off" period before firearm purchase, reduces suicide rates, especially among younger adult men.
TL;DR: To estimate the prevalence of persistent insomnia and its correlates in samples of people living in the community and in institutional settings, data are collected on adults in the Netherlands over a 10-year period in order to establish a baseline for this study.
Abstract: OBJECTIVE To estimate the prevalence of persistent insomnia and its correlates in samples of people living in the community and in institutional settings. METHODS Respondents were interviewed in their place of residence by trained interviewers using the Canberra Interview for the Elderly, a structured psychiatric examination. RESULTS Information about sleeping habits was obtained from 874 community and 59 institutional residents. Insomnia was persistent in 16% of the community-dwelling population and 12% of the institutional residents, with 15% and 40%, respectively, regularly taking a hypnotic. Of those without insomnia, 10% in the community but over a third in institutions were using a hypnotic. Insomnia was associated with depression, pain and poor physical health. CONCLUSIONS Persistent insomnia in the elderly, as in other age groups, is strongly associated with depressed mood, as well as with physical disease. Because of this, insomnia should not be dismissed as a normal part of ageing, and therefore ignored as a significant symptom. Continued surveillance is needed in general practice, geriatric services and nursing homes of the routine use of hypnotics by the elderly.
TL;DR: To determine blood products used, clinical outcomes and frequency of haemostatic complications of massive blood transfusion, data is collected on patients treated with these products over a 12-month period.
Abstract: OBJECTIVE To determine blood products used, clinical outcomes and frequency of haemostatic complications of massive blood transfusion. DESIGN AND SETTING Retrospective review of the medical records of patients receiving more than 10 units of blood in 24 hours at a tertiary referral hospital in 1993. PATIENTS Forty-three patients fulfilled this criterion. The major reasons for massive transfusion were trauma (46%; 20 patients), gastrointestinal bleeding (21%; nine patients) and leaking abdominal aortic aneurysm (14%; six patients). MAIN OUTCOME MEASURES Blood products used, platelet count ( < 50 x 10(9)/L in first 48 h), prothrombin time (PT) and activated partial thromboplastin time (APTT) (twice normal in first 48 h), microvascular bleeding, and survival. RESULTS The 43 patients used 824 units of packed cells 15.2% of the total used in 1993), 457 units of fresh frozen plasma (FFP) (17.1% of the 1993 total) and 370 units of platelets (14.8% of the 1993 total). Overall, these patients consumed 16% of the total number of units of blood product used in 1993 for 1478 transfusion episodes. The overall survival rate was 60%. Severe coagulopathy occurred in 19 patients (44%) (mortality rate, 74%), and 13 (31%) had severe thrombocytopenia ( < 50 x 10(9)/L). There was no significant correlation between the severity of coagulopathy/thrombocytopenia and total units transfused, or between the age of the units of blood and development of coagulopathy or microvascular bleeding. CONCLUSIONS Severe coagulopathy is common after massive transfusions. In the absence of clear correlation with the number of units transfused, "formula" replacement with plasma and platelets is unlikely to avoid the problem. Duration of tissue hypoperfusion and platelet consumption are likely to be more important than simple haemodilution of coagulation factors.
TL;DR: To determine how current hospital practice for transfusions of red cells, platelets and fresh frozen plasma conformed with published criteria, a large number of patients were randomly selected to receive transfusions.
Abstract: Objective To determine how current hospital practice for transfusions of red cells, platelets and fresh frozen plasma conformed with published criteria. Design Elaboration of criteria for transfusion from a review of the current literature; and analysis of the medical records of patients receiving transfusions of red cells (200), platelets (215), and fresh frozen plasma (260) during defined time periods in 1993. Setting A large tertiary care teaching hospital. Outcome measures Inappropriateness rates for transfusion episodes and numbers of individual units of blood products administered. Results Inappropriateness rates for transfusion episodes and numbers of individual units administered were 16% and 10% for red cells, 13% and 11% for platelets, and 24% and 16% for fresh frozen plasma (31% and 21% when transfusions for thrombotic thrombocytopenic purpura were excluded). Red cells and fresh frozen plasma were used inappropriately most frequently in association with a surgical procedure; for platelets, it was their use for bleeding. In many of the transfusions deemed inappropriate, deficiencies of red cells, platelets and/or coagulation factors were documented, but the degree of deficiency did not meet the stringent appropriateness criteria. Twenty-six transfusions were deemed inappropriate because the indication was not documented in the medical record. Conclusions Specific problem areas in which blood product use was inappropriate were identified. Guidelines for transfusion appropriateness, education of hospital staff, and a monitoring system to ensure adherence to the guidelines, are required.
TL;DR: To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to e timate the toxi and to recommend management trategies.
Abstract: Objective To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to estimate the toxic dose and to recommend management strategies. Design and setting Retrospective analysis of case histories of children admitted to the Royal Children's Hospital, Melbourne, between 1 January 1981 and 31 December 1992 with a diagnosis of eucalyptus oil poisoning. Main outcome measures Demographic data, circumstances of ingestion, doses, clinical effects, management, complications and duration of hospital stay. Results 109 children (mean age, 23.5 months; range, 0.5-107) were admitted; clinical effects were observed in 59%. Thirty-one (28%) had depression of conscious state; 27 were drowsy, three were unconscious after ingesting known or estimated volumes of between 5 mL and 10 mL, and one was unconscious with hypoventilation after ingesting an estimated 75 mL. Vomiting occurred in 37%, ataxia in 15% and pulmonary disease in 11%. No treatment was given for 12%. Ipecac or oral activated charcoal was given for 21%, nasogastric charcoal for 57%, and gastric lavage without anaesthesia for 4% and under anaesthesia for 6%. All patients recovered. Hazardous treatment and overtreatment were common. For 105 children, mean hospital stay was 22 hours (range, 4-72 h) and for 13 patients mean intensive care unit stay was 18 hours (range, 4-29 h). In 27 patients who ingested known doses of eucalyptus oil, 10 had nil effects after a mean of 1.7 mL, 11 had minor poisoning after a mean of 2.0 mL, five had moderate poisoning after a mean of 2.5 mL and one had major poisoning after 7.5 mL (P = 0.0198). Conclusions Ingestion of eucalyptus oil caused significant morbidity in infants and young children. Significant depression of conscious state should be anticipated after ingestion of 5 mL or more of 100% oil. Minor depression of consciousness may occur after 2-3 mL. Airway protection should precede gastric lavage.
TL;DR: The importance of appropriate first aid is emphasised and an update on management presented, and the role of brown snakes in deaths is presented.
Abstract: Twelve deaths attributed to snakebite were reported in 1992-1994. Eight of the victims were males, and brown snakes (genus Pseudonaja) were involved in six of the deaths. Deaths caused by brown snakes were often sudden and unexpected, and autopsy findings were usually unremarkable. In no case was prompt effective first aid applied. The importance of appropriate first aid is emphasised and an update on management presented.
TL;DR: To investigate whether exposure to Murray River and allied water sources during a period of raised cyanobacterial cell counts was associated with gastrointestinal and dermatological symptoms, a study of cyanobacteria cell counts in the Murray River area was conducted.
Abstract: Objective To investigate whether exposure to Murray River and allied water sources during a period of raised cyanobacterial cell counts was associated with gastrointestinal and dermatological symptoms. Design A case-control study selecting gastrointestinal and dermatological cases and controls from subjects attending 21 general practitioners in eight Murray River towns. The association between the proportion of consultations for such symptoms and mean log cyanobacterial count was also examined. Subjects 102 gastrointestinal cases, 86 dermatological cases and 132 controls. Main outcome measure The relative odds of gastrointestinal and dermatological symptoms, respectively, as opposed to no such symptoms, according to water-contact history during the week preceding the medical consultation. Results After adjusting for concurrent risk factors, subjects drinking chlorinated river water rather than rain water had a raised risk of gastrointestinal symptoms (P = 0.008), and those using untreated river water for domestic purposes rather than rain water had a raised risk of gastrointestinal (P = 0.034) and of dermatological (P = 0.048) symptoms. The proportion of consultations for gastrointestinal and dermatological symptoms correlated on a weekly basis with the mean log cyanobacterial cell count, although statistical significance was not achieved for the correlation with dermatological consultations or for separate reaches of the river. Conclusions The raised risks of gastrointestinal and dermatological symptoms in those using Murray River water for drinking and other domestic purposes are consistent with causal relationships. However, the evidence for adverse health effects is, at best, only suggestive. Further research is indicated.
TL;DR: To assess the long term effect of a nutrition program in a remote Aboriginal community (Min jilang) in Australia, a large number of children in this study are enrolled in a school-based feeding program.
Abstract: Objective: To assess the long term effect of a nutrition program in a remote Aboriginal community (Minjilang). Design: Evaluation of nutritional outcomes over the three years before and the three years after a health and nutrition program that ran from June 1989 to June 1990. Turnover of food items at the community store was used as a measure of dietary intake at Minjilang and a comparison community. Setting: A community of about 150 Aboriginal people live at Minjilang on Croker Island, 240 km north-east of Darwin. A similar community of about 300 people on another island was used as the comparison. Results: The program produced lasting improvements in dietary intake of most target foods (including fruit, vegetables and wholegrain bread) and nutrients (including folate, ascorbic acid and thiamine). Sugar intake fell in both communities before the program, but the additional decrease in sugar consumption during the program at Minjilang 'rebounded' in the next year. Dietary improvements in the comparison community were delayed and smaller than at Minjilang. Conclusions: The success of the program at Minjilang was linked to an ongoing process of social change, which in turn provided a stimulus for dietary improvement in the comparison community. When Aboriginal people themselves control and maintain ownership of community-based intervention programs, nutritional improvements can be initiated and sustained.
TL;DR: To compare prescription data for Australia with drugs ingested in self‐poisoning and suicide, to determine which drugs are over‐represented.
Abstract: OBJECTIVE: To compare prescription data for Australia with drugs ingested in self-poisoning and suicide, to determine which drugs are over-represented. DESIGN: Comparison of data on drugs taken in self-poisoning admissions and suicides with Australian prescription drug dispensing data from the Drug Utilization SubCommittee (DUSC). SETTING: Newcastle and Lake Macquarie, Australia, 1989-1992. SUBJECTS: Between July 1989 and June 1992, 1159 prescription drugs were taken in overdose. Eighty-three drug-related deaths were investigated by the coroner between 1987 and 1992. On 48 occasions a prescription drug was the primary cause of death. RESULTS: Drugs over-represented in self-poisoning (relative to Australian prescriptions) included not only those prescribed for psychiatric conditions (antidepressants, neuroleptics and lithium), but also benzodiazepines, barbiturates and other anticonvulsants. The highest odds ratios for death when adjusted for prescription numbers were for short-acting barbiturates (523.7; 95% confidence interval [CI], 207-1322), chloral hydrate (58.1; 95% CI, 18.1-187), colchicine (27.9; 95% CI, 3.8-202), dextropropoxyphene (20.8; 95% CI, 8.8-48.9), tricyclic antidepressants (13.3; 95% CI, 7.2-24.5) and anticonvulsants (11.6; 95% CI, 4.1-32.2). CONCLUSIONS: Short-acting barbiturates, chloral hydrate and dextropropoxyphene have little or no clinical advantage over alternatives and excessive toxicity in overdose. They should be removed from the market. The toxicity of anticonvulsants and colchicine should be considered when they are prescribed, and smaller amounts per prescription may be advisable for high risk patients using these and other toxic drugs. Language: en
TL;DR: To determine the pattern of use of psychotropic drugs in Sydney nursing homes, a large number of patients were diagnosed with dementia and the use of these drugs was known to be a major cause of death.
Abstract: OBJECTIVE To determine the pattern of use of psychotropic drugs in Sydney nursing homes. DESIGN Survey of data from medical records of residents and interviews with residents and staff. SETTING Central Sydney Health Area, June to December 1993. PARTICIPANTS All residents of 46 of the 47 nursing homes in the western sector of the health area. MAIN OUTCOME MEASURES Psychotropic drugs used regularly or as required. Degree of cognitive impairment and depression rated on interview with residents, using Mini-Mental State Examination and Geriatric Depression Scale. Behavioural disturbances reported by staff. RESULTS Most residents (58.9%) were taking one or more psychotropic drugs regularly and another 7% were prescribed these drugs as required. Neuroleptics were taken regularly by 27.4% and as required by a further 1.4% (at least one dose in the previous four weeks), but doses were equivalent to more than 100 mg/day of chlorpromazine for only 8.8%. Neuroleptics were more likely to be given to residents with greater cognitive impairment and more disturbed behaviour. Other psychotropic drugs in regular use were: benzodiazepines (32.3%); hypnotics (26.6%); antidepressants (15.6%); and anxiolytics (8.6%). At least half of antidepressant doses were subtherapeutic. Of 874 residents who responded to a depression questionnaire, 30% scored as significantly depressed; one-third of these were taking antidepressants. CONCLUSIONS The percentage of residents in Central Sydney nursing homes who were taking neuroleptics, hypnotics or anxiolytics is among the highest reported from geriatric institutions around the world. Prescribing practices in Australian nursing homes need to be reviewed.
TL;DR: To carry out a systematic quality review and meta‐analysis of all randomised trials ofammographic screening that included women aged under 50 years and to investigate the role of adverse events in the selection of women for mammographic screening.
Abstract: Objective: To carry out a systemic quality review and meta-analysis of all randomised trials of mammographic screening that included women aged under 50 years. Data sources: Reports of randomised trials of mammographic screening were identified via MEDLINE and checks of the bibliographies of retrieved articles and reviews. Data synthesis: Identified trials were assessed for: (i) method of randomisation; (ii) documented comparability of baseline data; (iii) standardised criteria for breast cancer death; (iv) use of an 'intention-to-treat analysis'. Seven randomised trials including almost 160 000 women aged under 50 were studied. The combined estimate of relative risk was 0.95 (95% confidence interval, 0.77-1.18), a statistically non-significant reduction of 5%. Adjustment for the cluster randomisation of two trials, and for degree of compliance, did not substantially change this result. Conclusions: These analyses suggest little, if any, benefit for women under 50 years of age. The results are not explained by the quality of the trials or the radiology. We recommend that women in this age group intending to be screened should be fully informed of these results.
TL;DR: To identify characteristics of women seeking termination of pregnancy, their reasons for having a termination, and whether they intended to submit a Medicare claim for the procedure, a survey is conducted.
Abstract: Objectives To identify characteristics of women seeking termination of pregnancy, their reasons for having a termination, and whether they intended to submit a Medicare claim for the procedure. Design Survey by self-administered questionnaire. Subjects and setting All women who attended 11 private clinics in New South Wales (NSW) over a six-week period in 1992. Results 2249 completed questionnaires were received (94% response rate). Terminations were frequent at all ages, but women in their 20s accounted for more than half the terminations (54%) and teenagers accounted for only 17%. Respondents were generally well educated and from various ethnic and religious backgrounds; 56% were single and 41% had had one or more previous terminations. Fifteen per cent of respondents could not or did not intend to make a Medicare claim. The most frequently cited factors contributing to the decision to seek a termination were concerns about finances, change in lifestyle, single parenthood and being too young. Conclusions Private clinics, where most terminations are performed, clearly meet a major demand, but it is likely that terminations in NSW as recorded by Health Insurance Commission claims are under-reported by at least 15%.