bluuebunny/crossref_metadata_2025 huggingface dataset:
Symptom experience associated with immunosuppressive drugs after liver transplantation in adults: possible relationship with medication non‐compliance?
Authors: Drent G. , Moons P. , De Geest S. , Kleibeuker J.H. , Haagsma E.B.
Published: August 2010

Abstract: Symptom experience (occurrence and perceived distress) associated with side effects of immunosuppressive medications in organ transplant patients may well be associated with poorer quality of life and medication non‐compliance. The aims of this study were: first, to assess symptom experience in clinically stable adult patients during long‐term follow‐up after liver transplantation; and second, to study the relationship between symptom experience and medication non‐compliance. This cross‐sectional study included 123 liver transplant patients. Symptom experience was assessed using the “Modified Transplant Symptom Occurrence and Symptom Distress Scale” (29‐item version) at the annual evaluation. According to the duration of follow‐up, patients were divided into a short‐term (1–4 yr) and a long‐term (5–18 yr) cohort. Medication non‐compliance was measured using electronic monitoring. Results showed that increased hair growth was the most frequent symptom in both sexes. Symptom distress was more serious in women than in men. The most distressing symptom in women was excessive and/or painful periods, while in men this was impotence. Clear differences were revealed at item level between symptom occurrence and symptom distress in relationship with the two time cohorts and between sexes. No relationship was found between symptom experience and prednisolone non‐compliance.
A search for cyclophilin‐A gene variants in cyclosporine A‐treated renal transplanted patients
Authors: Moscoso‐Solorzano Grace Tamara , Ortega Francisco , Rodríguez Isabel , García‐Castro Mónica , Gómez Ernesto , Díaz‐Corte Carmen , Baltar José M. , Alvarez Victoria , Ortiz Alberto , Coto Eliecer
Published: August 2010

Abstract: Background:  The cyclophilin A (CypA) ‐ cyclosporine (CsA) complex promotes immune response. The variation at the CypA gene could explain CsA‐pharmacokinetics and clinical outcomes among CsA‐treated patients.

Methods:  The study included 290 kidney transplanted patients (65% male; mean age 51 ± 15 yr), treated with CsA. The five CypA‐ exons and the promoter region were analysed through single‐strand conformation analysis, denaturing high performance liquid chromatography, and direct sequencing. The effect of a promoter polymorphism (−11 G/C) on gene expression was analysed in cell‐cultures.

Results:  We found two polymorphisms in the promoter (−11 G/C) and exon 1 (+36 G/A). Genotype frequencies did not differ between patients according to their pharmacokinetics status. In vitro studies showed that −11 G/C affected gene expression. The −11 G allele was significantly associated with clinical nephrotoxicity (p = 0.006). The strongest predictors for nephrotoxicity were a donor age ≥55 yr, and the promoter GG + GC genotypes.

Conclusions:  Our work suggests that a CypA‐promoter polymorphism (−11 G/C) could be associated with clinical nephrotoxicity. Replication of this study in other populations is necessary to define the role of CypA‐variants in the main clinical outcomes among CsA‐treated kidney‐transplanted patients.
A pilot study on the immunological effects of oral administration of donor major histocompatibility complex class II peptides in renal transplant recipients
Authors: Womer Karl L , Magee Colm C , Najafian Nader , Vella John P , Milford Edgar L. , Sayegh Mohamed H , Carpenter Charles B.
Published: August 2010

Abstract:  Oral tolerance is an important physiological mechanism of immune hyporesponsiveness to dietary antigens and the commensal flora of the gastrointestinal tract. Feeding of alloantigens, therefore, has the potential to suppress undesirable immune responses after transplantation. To date, there are no published reports on the effects of such an approach in human transplant recipients. In the present pilot study, we demonstrate complete suppression of baseline indirect alloreactivity in patients with chronic renal allograft dysfunction following the oral feeding of low (0.5 mg/d) but not higher (1.0 and 5.0 mg/d) doses of donor major histocompatibility complex (MHC) class II peptides. The regimen was well tolerated with no evidence for sensitization to the donor antigen. Our results indicate that oral feeding of low dose donor MHC peptide may represent a safe and effective therapy to suppress indirect alloreactivity in renal transplant recipients with chronic allograft dysfunction and warrants further clinical investigation.
Laparoscopic gastric banding in a kidney–pancreas transplant recipient with new onset type II diabetes mellitus associated with morbid obesity
Authors: Bonatti H. , Schmitt T. , Northup J. , Schirmer B. , Swenson B.R. , Pruett T.L. , Sawyer R.G. , Brayman K.
Published: August 2010

Abstract: Combined kidney–pancreas transplantation is the treatment of choice for end‐stage diabetic nephropathy. Post‐transplant weight gain increases the risk for post‐transplant complications and death owing to cardiovascular events. Gastric banding is an established treatment for moderate morbid obesity. We report on a patient who experienced significant weight gain and developed type II diabetes mellitus following successful kidney–pancreas transplantation. He underwent laparoscopic gastric banding and initially had good weight loss. However, lack of compliance with dietary guidelines led to transient failure of weight loss therapy. With further adjustment of the gastric band good weight loss was achieved.
CD30, a marker to detect the high‐risk kidney transplant recipients
Authors: Spiridon Camelia , Nikaein Afzal , Lerman Mark , Hunt Judson , Dickerman Richard , Mack Michael
Published: August 2010

Abstract: Background:  Sensitization of potential renal transplant recipients may impact the selection of donors and the outcome of transplant. Another element of the potential kidney transplant recipient immune system that provides useful information regarding the transplant outcome is the immunologic CD30 molecule.

Methods and results:  This study shows a significant correlation between the pre‐transplant high level of soluble CD30 and increased incidence of post‐transplant infection. Only 7/34 (20.6%) of the patients who had a low level of sCD30 (<90 U/mL) developed infection as compared with the 25/58 (43.1%) of the patients who had a high level (>90 U/mL) of sCD30 (p < 0.04). Higher level of sCD30 pre‐transplant was also correlated with the increased level of serum creatinine (p < 0.05) and pre‐transplant malignancy (p < 0.04). A significant higher level of sCD30 was also noted among females (74%), as compared with males (50%) with p < 0.03. In addition, significant effect of 3–6 human leukocyte antigen (HLA) mismatches on rejection was seen.

Conclusions:  These results show that higher pre‐transplant immunologic reactivity measured by sCD30 level was associated with post‐transplant outcome. The high level of sCD30 among females may indicate an active immunologic status, perhaps because of previous pregnancies.
Clinical efficacy of prophylactic strategy of long‐term low‐dose acyclovir for Varicella‐Zoster virus infection after allogeneic peripheral blood stem cell transplantation*
Authors: Kim Dong Hwan , Kumar Deepali , Messner Hans A. , Minden Mark , Gupta Vikas , Kuruvilla John , Chae Yee Soo , Sohn Sang Kyun , Lipton Jeffrey H.
Published: August 2010

Abstract:  Varicella‐Zoster virus infection (VZV) has a high incidence post‐allogeneic peripheral blood stem cell transplant (PBSCT). However, data regarding long‐term acyclovir prophylaxis for VZV prevention are limited. We evaluated the clinical efficacy of long‐term low‐dose acyclovir prophylaxis for VZV infection after allogeneic PBSCT at the Princess Margaret Hospital (PMH), Canada and the Kyungpook National University Hospital (KNUH), Korea. The acyclovir prophylaxis regimen at PMH was acyclovir 400 mg/d orally until engraftment, and at KNUH was acyclovir 800 mg/d orally until immunosuppression discontinuation. Long‐term acyclovir prophylaxis was given to 26/193 (14%) patients in the PMH group and 73/79 (92%) patients in the KNUH group. In the PMH group, 42 cases (22%) developed VZV infection, while six cases (8%) had VZV infection in the KNUH group (p = 0.005). With a median of 26.5 months of follow‐up, the incidences of VZV infection at one and two yr were 15.8% and 20.7% in the PMH group, and 2.5% and 5.8% in the KNUH group, respectively (p = 0.001). By controlling the other potential risk factors for VZV infection in multivariate analysis, the use of long‐term acyclovir was the only protective factor for VZV infection after allogeneic PBSCT (p = 0.04, hazard ratio = 0.296). Long‐term use of acyclovir appears to be protective for VZV infection after allogeneic PBSCT, especially during the period of immunosuppressive therapy.
Tuberculosis in southern Chinese renal‐transplant recipients
Authors: Chen Si‐yang , Wang Chang‐xi , Chen Li‐zhong , Fei Ji‐guang , Deng Su‐xiong , Qiu Jiang , Li Jun , Chen Gu‐odong , Fu Hong‐mei , Xie Can‐mao
Published: August 2010

Abstract: Objectives:  To analyze the characteristics of tuberculosis (TB) in Southern Chinese renal transplant recipients, and summarize the corresponding experiences in diagnosis and management.

Method:  Retrospectively study 41 documented post‐transplant TB cases out of the 2333 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat‐sen University between Jan. 1991 and Apr. 2007.

Results:  TB in the post‐renal‐transplant population in Southern China displayed the following characteristics: (i) high incidence within a short time after transplantation, the median interval between renal transplantation and diagnosis of TB was 8 months (range: 1‐156 months) and 56.1% were diagnosed within the first year post‐transplant; (ii) high prevalence (51.2%) of extra‐pulmonary tuberculosis; (iii) high co‐infection rate (19.5%), pathogens included candida albicans, pseudomonas aeruginosa, staphylococcus aureus, Acinetobacter haemolyticus and cytomegalovirus; (iv) fever (82.9%), cough (56.1%) and sputum (39.0%) are the most common clinical manifestations; (v) purified protein derivative of tuberculin (PPD) skin test had little diagnostic value in this group with a negative result in all 41 cases; (vi) acute rejection (29.3%) and liver function damage (17.1%) were the main adverse effects of anti‐tuberculosis chemotherapy; (vii) mortality of patients with post‐transplant tuberculosis reached up to 22.0%.

Conclusions:  Chinese renal transplant recipients face a high risk of TB because of their immuno‐compromised state and epidemiological prevalence of the disease. Therefore, attention should be given to this differential diagnosis in clinical practice. Balancing the benefits and disadvantages of anti‐tuberculosis chemotherapy is of importance for this specific population.
Coronary flow reserve dysfunction in hemodialysis and kidney transplant patients
Authors: Caliskan Yasar , Oflaz Huseyin , Demirturk Mustafa , Yazici Halil , Turkmen Aydin , Çimen Arif , Elitok Ali , Yildiz Alaattin
Published: August 2010

Abstract: Background:  The assessment of coronary flow reserve (CFR) by trans‐thoracic echocardiography has recently been introduced into clinical studies. Impairment of coronary microvascular functions and decreased CFR detected by trans‐thoracic Doppler harmonic echocardiography (TTDE) has recently been reported in hemodialysis (HD) patients, but there is no comparative study between HD patients and renal transplant recipients.

Methods:  The aim of our study was to evaluate coronary microvascular circulation in chronic HD patients and renal transplant recipients. Forty‐eight chronic HD patients, 27 renal transplant patients and 39 normotensive healthy controls were studied for the assessment of CFR by TTDE. The carotid artery intima media thickness (IMT) and areas of focal plaque formation were also evaluated in all subjects.

Results:  CFR values were significantly lower in both the HD and renal transplant groups than in the control group (p = 0.00). CFR values (1.57 ± 0.32 vs. 1.89 ± 0.50, p = 0.01) were also significantly lower in the HD group than in the renal transplant group. In 43 of 48 (89.6%) HD patients, CFR was <2.0; however, in 16 of 27 (59.3%) renal transplant recipients it was <2.0 (p = 0.00). When the HD and renal transplant groups were divided into two subgroups, according to CFR measurements (CFR < 2 and ≥2), no significant differences were found with respect to coronary risk factors and left ventricular echocardiographic measurements. The IMT of the control group (0.586 ± 0.163 mm) was significantly lower than the HD (0.799 ± 0.218 mm) and renal transplant groups (0.681 ± 0.148 mm; p = 0.00). The IMT of the HD patients (0.799 ± 0.218 mm) was significantly higher than the renal transplant recipients (0.681 ± 0.148 mm; p = 0.01).

Conclusions:  Renal transplant and HD patients had lower CFR values detected by TTDE, which may be regarded as an early finding of an affected cardiovascular system. CFR is more impaired in HD patients than renal transplant recipients. Uremia‐associated microvascular disease may be responsible for CFR impairment in HD patients.
Severe veno‐occlusive disease after autologous peripheral blood stem cell transplantation for high‐grade non‐Hodgkin lymphoma: report of a successfully managed case and a literature review of veno‐occlusive disease
Authors: Palladino Mariangela , Miele Luca , Pompili Maurizio , Forgione Alessandra , Vellone Valerio , Vecchio Fabio M. , Chiusolo Patrizia , Laurenti Luca , Gasbarrini Giovanni , Sica Simona , Grieco Antonio
Published: August 2010

Abstract:  Veno‐occlusive disease (VOD) of the liver is a severe complication of high‐dose chemotherapy and allogeneic or autologous stem cell transplantation with potential fatal outcome. We report a case of severe VOD in a patient with a high‐grade B‐cell lymphoma. Liver‐venule occlusion was confirmed by liver biopsy. Supportive care, fibrinolytic treatment with recombinant tissue plasminogen activator and defibrotide maintenance therapy led to complete resolution of VOD demonstrated at liver biopsy and with a follow‐up of 44 months after autologous peripheral blood stem cell transplantation. The literature on VOD has been reviewed.
Urinary tract reconstruction using the controlateral native ureter and a combined open‐retroperitoneoscopic approach after renal transplantation
Authors: Orlando Giuseppe , Di Clemente Luigi , Gravante Gianpiero , Overton John , Di Cocco Pierpaolo , Rizza Vinicio , D’Angelo Maurizio , Famulari Antonio , Pisani Francesco
Published: August 2010

Abstract:  An alternative technique for urinary tract (UT) reconstruction is described in a renal transplant recipient who developed a severe stenosis of the graft ureter. This approach entails the retroperitoneoscopic preparation of the native ureter contralateral to the graft, followed by an open reconstruction of the UT. The ureter was dissected along its entire length to the level of the iliac vessels, with its associated mesentery still attached in order to preserve the vascular supply. The corresponding native kidney contralateral to the graft was endoscopically removed. A longitudinal sub‐umbilical incision allowed the excision of the stenotic tract and the reconstruction of the UT by means of a manual end‐to‐end anastomosis between the new ureter and the graft pelvis. No post‐operative complications occurred and renal function immediately resumed. The approach described represents an alternative solution for the surgical management of severe ureteric graft stenosis. We believe that the magnification of the anatomy granted by the endoscope during the dissection of the ureter and neighboring structures provides the gentle handling of the tissues and the remote dissection away from the ureter with the highest precision.
Impact of dose reductions on efficacy outcome in heart transplant patients receiving enteric‐coated mycophenolate sodium or mycophenolate mofetil at 12 months post‐transplantation
Authors: Segovia Javier , Gerosa Gino , Almenar Luis , Livi Ugolino , Viganò Mario , Arizón Jose Maria , Yonan Nizar , Di Salvo Thomas G. , Renlund Dale G. , Kobashigawa Jon A. ,   for the ERL 2401 Study Group
Published: August 2010

Abstract:  Mycophenolic acid (MPA) dose reduction is associated with increased risk of rejection and graft loss in renal transplantation. This analysis investigated the impact of MPA dose changes with enteric‐coated mycophenolate sodium (EC‐MPS) or mycophenolate mofetil (MMF) in de novo heart transplant recipients. In a 12‐month, single‐blind trial, 154 patients (EC‐MPS, 78; MMF, 76) were randomized to either EC‐MPS (1080 mg bid) or MMF (1500 mg bid) in combination with cyclosporine and steroids. The primary efficacy variable was the incidence of treatment failure, comprising a composite of biopsy‐proven (BPAR) and treated acute rejection, graft loss or death. Significantly fewer patients receiving EC‐MPS required ≥2 dose reductions than patients on MMF (26.9% vs. 42.1% of patients, p = 0.048). Accordingly, the average daily dose of EC‐MPS as a percentage of the recommended dose was significantly higher than for MMF (88.4% vs. 79.0%, p = 0.016). Among patients requiring ≥1 dose reduction, the incidence of treated BPAR grade ≥3A was significantly lower with EC‐MPS compared with MMF (23.4% vs. 44.0%, p = 0.032). These data suggest that EC‐MPS‐treated heart transplant patients are less likely to require multiple dose reductions than those on MMF which may be associated with a significantly lower risk of treated BPAR ≥3A.
Transfer of ureteral carcinoma in a transplanted kidney presenting by early stenosis of the proximal ureter
Authors: Huurman V.A.L. , Baranski A.G. , Groeneveld J.H.M. , Keizer K.M. , Schaapherder A.F.M.
Published: August 2010

Abstract:  A 71‐yr‐old male kidney transplant recipient suffered from delayed graft function. Eighty days after transplantation complete obstruction of the proximal ureter was observed, complicated by recurrent urinary tract infections. Two months later, the donor kidney was removed because of infectious complications and inadequate arterial perfusion. Histological examination of the removed graft showed signs of rejection as well as a low‐grade papillary urothelial cell carcinoma of donor origin in the ureter. The remaining donor ureter was removed subsequently and showed no further signs of malignancy. Follow‐up of the patient until 12 months after surgery did not reveal recurrence of the tumor. This case report is the first to describe accidental transfer of urothelial cell carcinoma in the ureter by transplantation, highlighting the possibility of malignancy when early stenosis is not related to the anastomosis. It again emphasizes the need for precise and cautious screening of organ donors, especially those of higher age.
THE DESTRUCTION OF SERINE AND THREONINE DURING ACID HYDROLYSIS
Authors: Downs Fred , Pigman Ward
Published: August 2010

Bovine submaxillary mucin (a glycoprotein) was hydrolyzed for varous times (1 to 300 hr) at 110° in 6 N HCl (0.3 mg protein per ml). The kinetics of destruction of serine were found to be first‐order and that of threonine to be zero‐order. The velocity constant for the destruction of serine was k – 4.3 X 10‐3 hr‐1 and of threonine was k – 5.6 X 10‐4 mole hr1. The amounts of serine and threonine destroyed after 22 hours hydrolysis were 10.0 % and 2.7 %, respectively. Since the losses were the same in the absence of carbohydrates and since several prior extensive investigations reported similar corrections for serine, these corrections may be applicable to most proteins and glycoproteins.
HUMAN PITUITARY GROWTH HORMONE. * XXVI
Authors: Danho Waleed , Li Choh Hao
Published: August 2010

Three protected peptides occurring in the carboxyl terminal residues 166‐188 in the HGH molecule have been synthesized and characterized. These peptides are

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STABILITY CONSTANTS OF Cu(II) COMPLEXES OF LANTHIONINE
Authors: Weber O. A.
Published: August 2010

Complex stability constants for the stepwise interaction of meso‐ and L‐lanthionine (3,3′‐thiodialanine) with varying amounts of Cu2‐ ions have been determined potentiometrically in aqueous solution at 20° and μ‐ 0.37 (NaN03). The equilibrium could be best described by postulating six stability constants in addition to copper hydrolysis. The difference obtained between individual copper complex stability constants of meso‐ and L‐forms has been attributed both to the presence of two asymmetric centres in the ligand molecule and to the bridging sulphur atom. Thermodynamic quantities for some equilibria have also been determined from the temperature dependence of respective stability constants at 4, 20, 40, and 70°.
IMPROVEMENT TO THE ESTERIFICATION PROCEDURE USED IN SOLID PHASE PEPTIDE SYNTHESIS
Authors: Loffet A.
Published: August 2010

A new procedure of esterificalion of N‐protected amino acids to chloromethyl polymers using tetramethyl ammonium hydroxide as a base has been developed. Elemental nitrogen and amino acid analysis of the polymers are in good agreement.
SOCIAL CONSTRUCTION OF AN ANGU DISABILITY
Authors: Ariotti Louis
Published: August 2010

ABSTRACT: The usual and common‐sense definition of disability is based on a medical model that sees disability as a limitation or lack of competence on the part of the individual. This definition fails to acknowledge that in some cultures disability as a concept does not exist. This paper, based on research undertaken in 1994/1995, examines how the social construction of disability among the Anangu of the cross border region of Western Australia, South Australia and the Northern Territory, takes into consideration the important factors of history, culture and language. The theoretical underpinning of the research was symbolic interactionism, which led to collaborative ethnography becoming the methodology employed to collect and analyse the data. The findings of the research indicate that the social construction of disability among the Anangu occurs in three historical phases: the impairment, oppression and empowerment phases. The paper's purpose is to offer service providers to Aboriginal people with disabilities, information that will help them understand some of the attitudes, customs, mores and beliefs of their clientele.
A Review Of ‘Traditional’ Aboriginal Health Beliefs
Authors: Maher Patrick
Published: August 2010

ABSTRACT: Western health professionals often experience difficulties in service delivery to Aboriginal people because of the disparity between Aboriginal and Western health belief systems. This article reviews the literature which considers ‘traditional’ Aboriginal health beliefs and medical systems. The traditional Aboriginal model of illness causation emphasises social and spiritual dysfunction as a cause of illness. Supernatural intervention is regarded as the main cause of serious illness. There are gender divisions in Aboriginal society that impact on the delivery of Western healthcare. Management strategies such as preventative care, bush medicine, and the role of traditional healers are discussed. These belief systems are considered with particular reference to their interactions and implications with regard to the Western medical system. This information provides a framework to allow improved understanding by health professionals of the health‐related decisions made by Aboriginal people.
AN OVERVIEW OF DISTAL RADIAL FRACTURES
Authors: Mehta Janak A. , Bain Gregory I.
Published: August 2010

ABSTRACT: Fractures of the distal radius include a wide spectrum of fracture patterns. As well as involving the distal radius, these injuries can involve the wrist, the distal radio‐ulnar joint and the distal ulna. The management of these injuries is consequently diverse, ranging from a plaster cast to advanced surgery. The principles of treatment are to reduce and maintain the reduction by restoring the radial height, volar tilt and intra‐articular step. The acceptable reduction is to have radial height to within 2 mm of the ulnar, volar tilt greater than 0° and intra‐articular step less than 1 mm. The present paper reviews the current concepts in the diagnosis, management and complications of distal radial fractures.
AREA HEALTH SERVICES AS LEARNING ORGANISATIONS: THE RURAL EXPERIENCE
Authors: Hartley Ross
Published: August 2010

ABSTRACT: Staff development units (SDUs) across New South Wales Health are in a state of flux. Traditional models of training may no longer be meeting the continuing professional education needs of staff. This paper outlines how one SDU, the Rural Health Education and Research Centre at Tamworth, with few resources, has successfully negotiated the transformation from delivering ad hoc, face‐to‐face teaching, to a model encompassing competency‐based training, recognition of prior learning, workplace assessment and distance education
IMMIGRANTS AND EQUITABLE HEALTHCARE DELIVERY IN RURAL AREAS
Authors: Fuller Jeff , Ballantyne Alison
Published: August 2010

ABSTRACT: In response to settlement patterns in Australia, most immigrant specialist services and programs have been developed in metropolitan locations and large provincial cities. However, immigrants have also settled in smaller numbers in country locations. It is of concern, therefore, to consider how responsive and equitable health‐care services can be delivered in country regions when immigrants do not reach the critical mass that would warrant the development of specialist services. This paper draws on a consultation conducted in South Australia to propose a way forward in linking country health services with local immigrant communities and immigrant specialist services in cities.
IS AUSTRALIAN RURAL PRACTICE CHANGING? FINDINGS FROM THE NATIONAL RURAL GENERAL PRACTICE STUDY
Authors: Strasser Roger P. , Hays Richard B. , Kamien Max , Carson Dean
Published: August 2010

ABSTRACT: The National Rural General Practice Study (NRGPS) was the first comprehensive national study covering rural and remote general practitioners throughout Australia. It was undertaken in 1996–1997 and drew on data from existing sources such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, together with a postal survey of general practitioners in rural and remote areas. There was a 75% response rate to the survey, which covered professional issues, personal and social issues, personal background, patient issues, recruitment and retention programs and changing health services. Overall, the study findings confirmed those of previous individual State‐based studies in the early 1990s and showed that there had been some changes since those previous studies. In particular, access to continuing medical education has improved, the rural medical workforce appears to be ageing, the proportion of women rural doctors is increasing and the projected length of stay in rural practice is decreasing. Whereas in the early 1990s the projection for rural doctor numbers was continuing decline, the NRGPS projected overall numbers in rural practice as staying approximately the same over the next 5 years. In the light of these trends, the challenge is to implement targeted initiatives that improve the recruitment and retention of rural and remote general practitioners.
INTERPRACTITIONER COMMUNICATION: TELEPHONE CONSULTATIONS BETWEEN RURAL GENERAL PRACTITIONERS AND SPECIALISTS
Authors: Hollins Jane , Veitch Craig , Hays Richard
Published: August 2010

ABSTRACT: The results of a study that sought to investigate the utility of and satisfaction with telephone consultations from the perspective of general practitioners and specialists are reported. Semi‐structured interviews with rural general practitioners and specialists were used to elicit information about their most recent telephone consultations. The telephone was found to be an important means of communication for rural practitioners, primarily in terms of organising referrals. General practitioners tended to called specialists who they knew and appeared to have fairly well‐formed networks of specialists who they called for most of their concerns. Trust is an important element of interpractitioner communication as it increases understanding and confidence in the reliability of the information exchanged. Good working relationships ensure that rural general practitioners have an accessible source of acceptable specialist support.
NON‐GOVERNMENT ORGANISATIONS TO COMBINE FOR WORK ON CHRONIC DISEASE IN ABORIGINAL PEOPLES, TORRES STRAIT ISLANDERS AND RURAL AND REMOTE POPULATIONS
Authors: Field Pat , Gregory Gordon
Published: August 2010

ABSTRACT: As a result of the National Health Priority Area Report on Cardiovascular Health and in particular, its remote and indigenous section, a consortium of five organisations ran a national workshop in Townsville in October 1999 on heart disease in Aboriginal peoples, Torres Strait Islanders and rural and remote populations. One of the priority areas identified at this workshop was the need for a more coordinated approach to chronic diseases and for the formation of an alliance of non‐government organisations (NGOs) to work towards this and to undertake a lobbying and advocacy role. A meeting of a wide range of NGOs working in chronic disease, led by the National Heart Foundation of Australia, was held in Sydney in May 2000. At the Sydney meeting it was agreed that an alliance of NGOs could be formed for the development of a chronic disease strategy for Aboriginal peoples, Torres Strait Islanders and rural and remote populations. The NGOs drafted a ‘Statement of Intent’, which would inform their work on both heart disease and on broader work to address chronic preventable disease in the target populations. There is a considerable amount of procedural work to be done before the proposed alliance becomes a reality but the prospect of closer collaboration between the NGOs working in chronic disease has much to offer, especially for the population groups that were the focus of the Townsville workshop. This ‘alliance’ initiative comes at a time when there are national and State/Territory moves on broader aspects of what could become a ‘national chronic disease prevention and management strategy’.
SELECTED DEMOGRAPHIC, SOCIAL AND WORK CHARACTERISTICS OF THE AUSTRALIAN GENERAL MEDICAL PRACTITIONER WORKFORCE: COMPARING CAPITAL CITIES WITH REGIONAL AREAS
Authors: Wilkinson David
Published: August 2010

ABSTRACT: The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full‐ or part‐time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26 359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part‐time work, 42% of females also reported part‐time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues.
SELF‐REPORTED HEART HEALTH BEHAVIOUR PATTERNS IN A RURAL CONTEXT
Authors: Ray Robin
Published: August 2010

ABSTRACT: Does health behaviour change after people receive the results of screening tests? A cohort from rural central Queensland were contacted through telephone interview at 6‐month intervals following heart risk screening. Participants self‐reported their health behaviour and identified aspects of their lifestyles that supported or inhibited positive health behaviour. Qualitative analysis revealed the types of changes made and the contextual issues that affected health behaviour. The majority of participants did change their behaviour or maintained existing positive behaviours. Some participants were unsuccessful in making health changes. Health enablers included physical ability to undertake activities, appearance and support. The cost and availability of nutritious food in rural areas and the need for more socially supportive environments at a community level were issues raised by participants. Resources need to be made available so that mobile health services can augment local health initiatives, supporting positive health behaviour in rural areas.
RURAL PRACTICE EVALUATION: HOW DO RURAL PHYSICIANS EVALUATE THEIR WORKING CONDITIONS?
Authors: Matsumoto Masatoshi , Inoue Kazuo , Kajii Eiji
Published: August 2010

ABSTRACT: Evaluating the quality of rural doctors' working conditions is essential for retaining physicians in rural areas. We carried out a trial to investigate those aspects of working conditions that are important to rural physicians and with which aspects they are satisfied or dissatisfied. Questionnaires were mailed to 204 doctors who were working in rural clinics in Japan. The professional conditions of rural clinic practices were classified into 17 items. The doctors were then asked to evaluate the importance of and degree of satisfaction with each item. Among the 17 items, the clinic's equipment, the municipal government's attitude and the base hospital were evaluated to be more important than the overall average. With regard to satisfaction, the distance to major cities, the municipal government's attitude and locum availability were rated significantly lower than that overall. There were some items where there was a discrepancy between the importance and the degree of satisfaction. Identifying these discrepancies may contribute to creating an environment that will raise the level of rural physicians' satisfaction.
EFFECTIVENESS OF CHANGES IN THE DELIVERY OF DIABETES CARE IN A RURAL COMMUNITY
Authors: O'Grady Andrew , Simmons David , Tupe Stan , Hewlett Gailene
Published: August 2010

ABSTRACT: Diabetes has a significant impact upon health in rural Maori communities. A diabetes club was established to support self‐care and improve diabetes management in a rural community in Northland, New Zealand. A structured approach to care and an associated audit were also introduced. Patient involvement and ownership of the condition were considered important issues. Monitoring of care processes increased by 79%. The first year of audit was associated with a reduction in mean fructosamine from 369 ± 85 μmol L‐1 to 321 ± 65 μmol L‐1 and this was sustained for a further 3 years. The number of people using insulin increased from 15 to 22%. The audit process facilitated the implementation of changes in the delivery of care. We conclude that the data indicate that the enthusiastic delivery of care in general practice, with a devolution of power to the patient, linked to an audit service can result in improved management among patients with Type 2 diabetes.
IMPROVING ACCESS FOR RURAL AUSTRALIANS TO TREATMENT FOR ANXIETY AND DEPRESSION: THE UNIVERSITY OF MELBOURNE DEPRESSION AND ANXIETY RESEARCH AND TREATMENT GROUP–BENDIGO HEALTH CARE GROUP INITIATIVE
Authors: Judd Fiona K. , Jackson Henry , Davis Julian , Cockram Alexandra , Komiti Angela , Allen Nicholas , Murray Greg , Kyrios Michael , Hodgins Gene
Published: August 2010

ABSTRACT: Rural Australians have limited access to care for mental health problems. We describe a collaboration between the University of Melbourne Departments of Psychology and Psychiatry and a rural Area Mental Health Service to provide a specialist anxiety and depression treatment service in rural Victoria. The clinical service and the education and training approach are described.
COSTS OF MOBILE SCREENING FOR DIABETIC RETINOPATHY: A PRACTICAL FRAMEWORK FOR RURAL POPULATIONS
Authors: Lee Sue J. , McCarty Catherine A. , Taylor Hugh R. , Keeffe Jill E.
Published: August 2010

ABSTRACT: Australia's rural and remote residents experience considerably higher hospitalisation and death rates due to diabetes than their metropolitan counterparts. There is clearly a need for improved diabetes care services in these areas and interventions that target conditions associated with diabetes will yield beneficial results for the community. All people with diabetes are at risk for diabetic retinopathy, which can cause vision loss and blindness. Although vision loss and blindness due to diabetes is nearly 100% preventable through regular eye examinations, 35% of Victoria's rural population with diabetes do not have their eyes examined on a regular basis. A pilot, mobile screening program for the early detection of diabetic eye disease was conducted in rural Victoria and proved to be a successful model of adjunct eye care for people with diabetes. Actual costs from the pilot screening were applied to a permanent model for rural eye care. At A$41 per participant, costs for mobile screening were competitive with Medicare rebate costs for eye examinations. The model addresses barriers of accessibility and availability, targets a portion of the rural population with diabetes that is not otherwise having eye examinations, and is cost‐saving to the Government.
USE OF MEDICARE SERVICES RELATED TO DIABETES CARE: THE IMPACT OF RURAL ISOLATION
Authors: Overland Jane , Yue Dennis K. , Mira Michael
Published: August 2010

ABSTRACT: This study used Medicare data for people living in New South Wales (NSW) (1993–1997) to examine the impact of rural isolation on the utilisation of diabetes health care services. The relative odds of attending a specialist was slightly higher for people in urban areas when compared to their rural counterparts but reached as high as 1.85 in regard to attendance to consultant physicians. Surveillance of diabetes parameters over the 5 year period showed greatest improvement in rural areas. The proportion of patients each year with glycaemic control assessed by quantification of glycosylated haemoglobin (HbA1c) or renal function and vascular risk by micro‐albuminuria estimation rose to 57.4% and 12.3%, respectively, in rural areas compared to 55.2% and 11.3% in major urban areas. This study has shown that the level of monitoring in rural areas is equal to urban areas, despite decreased access to medical care, highlighting the vital role GPs play in diabetes management in rural NSW.
DEVELOPING A CARDIAC REHABILITATION EDUCATION RESOURCE FOR RURAL HEALTH WORKERS IN QUEENSLAND: REVIEWING THE PROCESS AND OUTCOMES
Authors: Parker Elizabeth , O'Connor‐Fleming M. , Tooth L. , Humphries R. J.
Published: August 2010

ABSTRACT:The provision of cardiac rehabilitation services to people living in rural and remote areas is often limited to the nearest large hospital situated in urban coastal centres, leaving a gap in the rehabilitation of cardiac patients. This paper discusses the development, composition and the results of a process evaluation of a cardiac rehabilitation education resource for rural health workers. The development of the structure and content of the manual were informed by a review of current rehabilitation literature, the results of focus groups with 60 rural health workers in five Queensland rural centres, and survey results of 135 rural cardiac patients admitted to five Queensland hospitals. The draft manual was trialled by health workers in seven rural centres throughout Queensland by the National Heart Foundation (Queensland Division). The results of the process evaluation provided valuable feedback on the efficacy of the manual as an educational resource for rural health workers in the cardiac rehabilitation of their patients. Specific content in the educational resource was strengthened as a result of this evaluation. The limitations of the evaluation and suggestions for its improvement are also discussed. The paper highlights the importance of this level of evaluation in the development of health promotion education resources.
MEDICATION COMPLIANCE PROBLEMS IN GENERAL PRACTICE: DETECTION AND INTERVENTION BY PHARMACISTS AND DOCTORS
Authors: Bonner Chris J. , Carr Bruce
Published: August 2010

ABSTRACT: Medication compliance; the role of a portable Medical Summary Card as a compliance aid; and the role of a medical practice‐based clinical pharmacist in identifying medication‐related problems in a rural general practice setting is evaluated. A clinical pharmacist checked the medications of 50 predominantly aged patients against their medical summary and noted inconsistencies and potential medication problems. From this information the general practitioner (GP) assessed patient compliance with prescribed medications and transcribed the correct medication regimen and medical problems onto a Medical Summary Card for the patient to carry. Forty per cent of the patients were non‐compliant. A Medical Summary Card alone was unable to improve compliance. Issues noted by the clinical pharmacist warranted a change in therapy for 8% of patients. Eighteen per cent of patients provided medical information to the clinical pharmacist of which the GP was unaware. Non‐compliance with prescribed medications is common. A portable Medical Summary Card may not rectify this problem. Patients' withholding medical information from their medical practitioner is of particular concern.
CAPACITY BUILDING IN RURAL MENTAL HEALTH IN WESTERN AUSTRALIA
Authors: Aoun Samar , Johnson Lyn
Published: August 2010

ABSTRACT: A regional success story in capacity building in terms of workforce development in rural Western Australia is described. A rural and remote distance education program in mental health was delivered in 1999 across 10 rural sites to 31 health professionals (26 general nurses, four allied health and one Aboriginal health worker) who are in contact with mentally ill patients at the primary level in country areas. Evaluation on completion of the program and at 4 months postprogram was extremely positive, with participants reporting that they have gained knowledge of mental health management regimens, developed mental health assessment skills and enhanced their clinical practice. Both participants and their line managers identified that the program had greatest impact on improving relationships with the mental health team. The program has also been an example of capacity building in terms of innovative resourcing to address a statewide need in mental health education for those at the forefront of rural practice.
RURAL URGENT CARE MODELS: WHAT ARE THEY MADE OF?
Authors: O'Meara Peter , Burley Mollie , Kelly Heather
Published: August 2010

ABSTRACT: The study aimed to identify the elements that constitute rural urgent care systems. Participation in the study was sought from health professionals, welfare and emergency services sectors, and community members. Primary data were collected from informants through interviews and focus groups in five rural communities of different sizes. Twelve common elements to rural urgent care systems were identified and divided into two categories: (i) infrastructure; and (ii) personnel. Infrastructure included organisational support, community support, transport, communication and coordination processes, facilities and equipment, and community knowledge and information. Personnel included nurses, doctors, community leaders, health and welfare professionals, emergency service workers and ambulance officers. The study's major outcome was the recognition that rural urgent care systems consist of a balance of interrelated elements. These elements are context driven, with geographical, social and economic environments having a substantial impact on the ability of rural communities to develop and sustain their urgent care systems.
AMALGAMATION OF HEALTH SERVICES IN SOUTH‐WEST VICTORIA: REINVENTION OR SURVIVAL?
Authors: O'Toole Kevin , Nesbitt Pat , Macgarvey Anna
Published: August 2010

ABSTRACT: In Australia ‘the hospital’ has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic‐related groups that promote a rationalised output‐based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi‐purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged‐care facilities). These changes are about survival. This paper analyses one such case in south‐west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.
FAECAL OCCULT BLOOD TEST: CURRENT PRACTICE IN A RURAL QUEENSLAND COMMUNITY
Authors: Janda Monika , Hughes Karen , Tong Shilu , Stanton Warren R. , Aitken Joanne , Clavarino Alexandra , Short Leonie , Mar Christopher Del , Leggett Barbara , Newman Beth
Published: August 2010

ABSTRACT: The findings of a recent telephone survey of 604 residents (50–74 years of age) in a rural community in Queensland are presented. The survey focused on the participants' knowledge concerning the faecal occult blood test (FOBT) and their previous testing history. Responses were analysed in terms of gender, age and education differences. More than half of all participants were aware of the FOBT, and 109 (18%) had undergone FOBT in the past. Fewer understood the importance of ‘health checks without symptoms’ than the ‘advantage of early treatment’. The most common reasons to use FOBT were: ‘prevention’ and ‘I want to know if I have cancer’. A person's gender, age and education were shown to be associated with their knowledge and beliefs. These results suggest an increase in the use of the FOBT with time (in relation to previous surveys), but a poor understanding of its place in promoting health.
CHALLENGES TO RURAL MEDICAL EDUCATION: A STUDENT PERSPECTIVE
Authors: Delaney Gabrielle , Lim Siv Eing , Sar Lee , Yang Shu Ching , Sturmberg Joachim P. , Khadra Mohammed H.
Published: August 2010

ABSTRACT: The key feature of the Greater Murray Clinical School model is the attachment of students to patients. Students follow their patients through the health care system, in contrast to the standard approach where students are attached to doctors or speciality based clinical units. The patient/student coupling occurs at the primary care level, which mostly but not exclusively will occur in the GP's office. Students anchor their knowledge by seeing the natural progression of common illnesses, the impact of behavioural aspects on health and disease, and by experiencing continuity of care. Along their path they develop good problem solving skills and learn to understand the health care system they will become part of. The main obstacle in teaching a medical undergraduate curriculum in a rural setting is that large geographical distances separate students, teachers and resources. Consequently, information technology will play an important role in terms of delivery of the GMCS curriculum. Moreover, there is potential for flow‐on benefits to the community following integration of new information technology into the local health infrastructure.