bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for osteoporosis and fracture in patients attending rheumatology outpatient clinics
Authors: Brand C. A. , Jolley D. , Tellus M. , Muirden K. D. , Wark J. D. 
Published: March 2008

AbstractBackground: Bone mineral density (BMD) using dual energy X‐ray absorptiometry (DXA) scanning is the best predictor of osteoporotic fracture but may not be cost effective for all patient groups. Risk factors (RF) other than BMD may be useful for fracture prediction.Aim: To assess the prevalence of RF for osteoporosis (OP) and fracture in patients attending a public hospital rheumatology clinic and to document physician awareness of these RF.Methods: Two hundred and twenty rheumatology outpatients completed a self‐administered questionnaire pertaining to known RF for OP and fracture. Initiatives were documented by the treating rheumatologist.Results: One hundred and fifty‐four females and 66 males completed questionnaires: 57% had an inflammatory disorder and 32% had received significant glucocorticoid therapy. Forty‐five (68%) males and 126 (82%) females had three or more RF for OP and fracture. Diagnosis of rheumatoid arthritis or connective tissue disorder (CTD) was the variable most significantly associated with increasing numbers of RF. Anti‐osteoporotic medication (AOM) use at assessment (64/219, 29.2%) was accounted for primarily by the use of hormone replacement therapy in females between 45–54 years. Prednisolone use predicted intervention in 103 (48%) patients.Conclusion: Many rheumatology outpatients have multiple RF for OP and fracture. Infrequent AOM use could be explained by inadequate awareness of high risk patients and the lack of an ideal long term agent. With restricted outpatient resources, the feasibility of identifying high risk patients for OP and fracture would increase if the hierarchical status of RF was better understood.
Attitudes and information needs of Chinese migrant cancer patients and their relatives
Authors: Huang X. , Butow P. , Meiser B. , Goldstein D. 
Published: March 2008

AbstractBackground: The information needs of ethnic minorities often differ from that of the dominant culture, leading to dissatisfaction among both patients and health professionals.Aims: This research project aims to identify attitudes towards cancer and associated information and communication needs of Chinese patients and their relatives in Sydney, thereby providing a framework for the provision of culturally appropriate cancer care for Chinese‐Australians.Methods: A qualitative data collection strategy was selected as the most appropriate method, because no validated measures are available and no previous research has examined attitudes and needs of Chinese‐Australian cancer patients. Patients were recruited from three major teaching hospitals in Sydney and from a Chinese cancer support organisation. Sampling was discontinued when informational redundancy was achieved. Four focus groups and 26 individual telephone interviews were conducted with a total of 36 cancer patients and 12 relatives born in China, Singapore and Malaysia.Results: While individual differences were observed, a majority view was expressed on a range of issues. Non‐disclosure of a poor prognosis was favoured, and the role of the family in liaising between health professionals and the patient was emphasised. Patients preferred a confident and clear diagnosis and treatment recommendation. Most patients wished to incorporate Chinese culture‐specific treatments into their care. The need for interpreters and psychological and spiritual support was emphasised.Conclusions: Providing information in a culturally sensitive manner will assist doctors in providing optimum care and support for ethnic minority groups in this country.
Uncovering a multitude of sins: medication management in the home post acute hospitalisation among the chronically ill
Authors: Stewart S. , Pearson S. 
Published: March 2008

AbstractBackground: Sub‐optimal use of prescribed medication is often associated with unplanned hospitalisation among the chronically ill.Aims: To examine the extent of sub‐optimal use of prescribed medication in a ‘high risk’ patient cohort recently discharged from acute hospital care.Methods: Chronically ill patients discharged from acute hospital care (n=342) were studied. At one week post discharge a home visit was performed by a nurse and a pharmacist during which medication management (including compliance and medication—related knowledge) was assessed.Results: During the majority of home visits at least one medication‐related problem was detected: approximately half of the cohort subject to a ‘reliable’ pill‐count were found to be mal‐compliant and almost all demonstrated inadequate medication‐related knowledge. Mal‐compliance was correlated with ≥ five prescribed medications (Odds ratio [OR] 2.6: p <0.002). Comparatively, lower medication‐related knowledge was correlated with age >75 years (OR 2.2: p <0.001), exacerbation of a pre‐existing chronic illness (OR 2.7: p=0.044) and six years formal education (OR 1.9: p≥0.004). Neither were modulated by extent of in‐hospital counselling. Other previously unknown problems detected during the home visit included hoarding of previously prescribed medication (35%) and reducing medication intake to minimise costs (21%).Conclusions: Management of prescribed medications among chronically ill patients recently discharged from acute hospital care is often sub‐optimal. Assessment of medication management in the home provides an invaluable opportunity to detect and address problems likely to result in poorer health outcomes.
Anti‐transglutaminase antibodies and coeliac disease
Authors: Miller A. , Paspaliaris W. , Elliott P. R. , D'Apice A. 
Published: March 2008

AbstractBackground: Anti‐endomysial antibodies have high specificity for coeliac disease but measurements are limited by the requirement for monkey oesophagus, a substrate that is expensive, and of limited availability and ethical acceptance. Tissue transglutaminase has recently been identified as the endomysial autoantigen in coeliac disease.Aims: To examine the validity of serum tissue transglutaminase antibody levels in patients with coeliac disease and to assess their sensitivity and specificity against standard serological tests.Methods: Serum IgA anti‐tissue transglutaminase antibody titres (measured by ELISA), IgA anti‐gliadin antibody litres (measured by a commercial ELISA) and anti‐endomysial antibody titres (measured by indirect immunofluorescence) were determined in 46 untreated and 14 treated patients biopsy‐proven coeliac disease and 145 disease and healthy controls.Results: All patients with untreated coeliac disease were positive for anti‐endomysial and anti‐tissue transglutaminase antibodies (sensitivity 100%). Seventy‐one per cent of treated coeliac patients were anti‐tissue transglutaminase antibody negative. Five of 145 disease and healthy controls had low titres of anti‐tissue transglutaminase antibody (specificity 97%); no controls were anti‐endomysial antibody positive.Conclusions: Our results demonstrated the sensitivity and specificity of IgA anti‐tissue transglutaminase antibodies to correlate highly with anti‐endomysial antibodies in the diagnosis of coeliac disease. The ELISA for IgA anti‐tissue transglutaminase antibodies is quantitative and easy to perform and is a valid alternative to indirect immunofluorescence for anti‐endomysial antibodies in screening for suspected coeliac disease.
Impact of an aggressive stenting strategy on initial and one‐year follow‐up costs in patients undergoing coronary angioplasty
Authors: Farshid A. , Leong B. , Pitney M. , McCredie R. M. , Allan R. 
Published: March 2008

AbstractBackground: Although stents have been shown in randomised trials to reduce restenosis rates compared with balloon angioplasty, there are concerns regarding the cost‐effectiveness of an aggressive stenting strategy. Stents were shown to increase medical costs over 12 months in the early trials.Aim: Our aim was to determine the economic impact of an aggressive stenting strategy using current stenting techniques compared with a conservative stenting strategy.Methods: Initial and one year follow‐up costs were determined in all patients who underwent successful revascularisation during June to December 1996 (aggressive stenting, n=401), and compared to all patients treated in the corresponding months in 1995 (conservative stenting, n=347). All patients had clinical follow‐up for one year.Results: The proportion of patients receiving a stent increased from 22.5% in 1995 to 66.1% in 1996 (p<0.0001). Requirement for repeat procedures in the 1995 group compared with 1996 was coronary angiography in 31%vs 16%(p<0.0001), coronary angioplasty in 11%vs 6%(p=0.0044) and bypass surgery in 4.8%vs 2.5%(p=0.054). The mean initial cost of the procedure was higher in the aggressive stenting group ($4319±1276 in 1995 vs$5131±1491 in 1996, p<0.0001), but after 12 months follow‐up, total medical costs were equivalent ($5975±4143 in 1995 vs$5994±3476 in 1996, p=NS).Conclusion: An aggressive coronary stenting strategy is associated with higher initial costs compared with a conservative strategy, but lower costs during follow‐up due to reduced need for repeat procedures, resulting in equivalent one year total medical costs.
Risk factors for development of hepatocellular carcinoma among Australians with hepatitis C: a case‐control study
Authors: Dutta U. , Byth K. , Kench J. , Khan M. H. , Coverdale S. A. , Weltman M. , Lin R. , Liddle C. , Farrell G. C. 
Published: March 2008

Abstract Background: Older patients with cirrhosis due to hepatitis C are at risk of developing hepatocellular carcinoma (HCC), but additional risk factors may vary between countries. Aim: In the present study, we sought to identify additional risk factors for HCC among a cohort of Australian patients with chronic hepatitis C. Methods: Case‐control study of patients with advanced fibrosis stage hepatitis C who developed HCC during five‐year follow up at a referral liver clinic. Cases were compared to twice the number of age‐matched patients with chronic hepatitis C of similar fibrotic severity who did not develop HCC over a similar interval, using conditional logistic regression analysis (CLRA) and multivariate analysis. The main outcome measures were demographic and disease‐related variables at first presentation in relation to the development of HCC. Results: HCC developed in 17 cases, an annual incidence among those considered to be at risk of 2%. The duration of follow up since first assessment was comparable among the cases and 34 selected age‐matched controls (4.1 and 5.2 years respectively, p=0.5). Cases were more often male (p=0.03), born in Asia (p=0.05), and had poorer liver function as indicated by serum albumin concentration (p=0.02). Anti‐hepatitis B core antibody (anti‐HBc) was detected in 59% (ten/17) of cases, compared to 21% (seven/34) of the controls (p=0.01). No patient with a sustained response to interferon developed HCC during follow up. There were no significant differences in the mode of HCV transmission, HCV genotype, alcohol exposure, serum bilirubin level or prothrombin time between the cases and the controls. Although the data set was small, multivariate CLR analysis identified serum albumin 35 g/L and anti‐HBc positivity to be independent risk factors for development of HCC. Conclusions: Among older Australian patients (over the age of 40 years) with advanced fibrosis stage hepatitis C, the annual incidence of HCC is about 2%. Those who have low serum albumin and evidence of previous exposure to hepatitis B virus (anti‐HBc positivity) appear to have the highest risk of developing HCC during follow up, but males and those born in Asia could also be at increased risk.
Platelet adhesion receptors: novel targets for anti‐thrombotic therapy
Authors: Williamson D. , Giuliano S. , Jackson S. P. 
Published: March 2008

AbstractThe critical role of platelets in the development of the acute coronary syndromes is now well recognised, and a great deal of effort has therefore focused on elucidating the key adhesion receptors mediating platelet‐vessel wall and platelet‐platelet interactions. The vascular adhesion protein von Willebrand factor (vWf) plays a key role in supporting platelet adhesion to the damaged vessel wall and binds to two adhesion receptors on the platelet surface, the glycoprotein (GP) lb‐ V‐IX complex and glycoprotein IIb‐IIIa. The GP IIb‐V‐IX complex is a unique adhesion receptor which enables platelets to roll on a vWf matrix under conditions of rapid blood flow as well as transducing signals leading to the activation of GP IIb‐IIIa. This latter receptor binds to a distinct site on vWf and is essential for stabilising platelet adhesion to the site of vessel wall injury. In addition to supporting platelet adhesion, GP IIb‐IIIa plays a key role in a number of other platelet responses including platelet spreading, aggregation, the release of procoagulant‐rich microvesicles, and clot retraction. Given its central role in platelet function GP IIb‐IIIa has become an attractive target for the development of novel anti‐thrombotic agents. In this paper, we consider the advantages of inhibitors of GP IIb‐IIIa compared with other established anti‐platelet drugs including aspirin and ticlopidine, and also discuss some potential problems associated with the inhibition of GP IIb‐IIIa and other platelet adhesion receptors.
The addition of allogeneic peripheral blood‐derived progenitor cells to bone marrow for transplantation: results of a randomised clinical trial
Authors: Szer J. , Curtis D. J. , Bardy P. G. , Grigg A. P. 
Published: March 2008

Abstract Background: The use of cytokine‐mobilised peripheral‐blood‐derived progenitor cells (PBPC) has resulted in a significant improvement in the safety of autologous transplantation. Collections of PBPC contain large numbers of haemopoietic progenitors and T‐lymphocytes when compared with bone marrow (BM). Aims: To assess the clinical effects and safety of filgrastim‐mobilised allogeneic PBPC, in particular whether PBPC would alter the kinetics of engraftment or the incidence and severity of graft‐versus‐host disease (GVHD). Methods: Twenty‐seven patients undergoing allogeneic transplantation were randomised to receive BM or BM supplemented by PBPC. Patients were conditioned with busulphan 16 mg/kg and cyclophosphamide 120 mg/kg. GVHD prophylaxis was with methotrexate and cyclosporin. Ganciclovir prophylaxis was administered to all cytomegalovirus seropositive patients. No haemopoietic growth factor was used after BMT. Donors of PBPC underwent a single, seven litre apheresis after four days of filgrastim, 10 μg/kg/day by subcutaneous injection. Results: Donor toxicity was mild, with the most frequently reported being bone pain in the cytokine‐treated donors. The patients transplanted with BM+PBPC received an eight‐fold increase in CD3+ T‐lymphocytes (1.65X108kg vs 0.22×108/kg, p=0.04) and the cytokine product contained a median of 5×106 CD34+ cells/kg. BM+PBPC patients had more rapid engraftment of neutrophils to 0.5×109/L (17 days vs 19 days, p=0.02) and platelets to 50×109/L (22 days vs 35 days, p=0.04). BM megakaryocyte numbers were significantly enhanced at days 14 and 28 after BMT (both p=0.04), however platelet transfusions were not significantly different. The incidence, organ distribution, severity and time to onset of acute and chronic GVHD were not different between the treatment groups and there was no difference in overall survival or event‐free survival. Conclusions: Allogeneic PBPC from HLA‐identical siblings may speed engraftment of neutrophils and platelets without detrimental effects on GVHD or survival.
Profile of people referred to an emergency department from residential care
Authors: Finucane P. M. , Wundke R. , Whitehead C. , Williamson L. , Baggoley C. J. 
Published: March 2008

Abstract Background: Elderly people in residential care are among the most infirm in society and are at high risk of developing acute medical problems. There are no Australian data on the use of acute hospital emergency services by this group. Aim: To determine patterns of use of a major public hospital's Emergency Department (ED) by elderly people living in residential care, their presenting problems and the outcome of attendance. Methods: Prospective study of 300 consecutive referrals to a teaching hospital's ED involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Case records were examined and residential care staff were interviewed by telephone when information required clarification. This occurred in 25% of referrals. Results: The 300 referrals were seen over a three month period and accounted for 2.43% of the 12,371 ED attendances during this period. During this time, at least 4.9% of people in residential care in the region were referred to the ED. The referrals involved 239 residents, 196 (82%) who were referred once only, 32 (13%) twice and 11 (5%) three or more times. Residents had a mean age of 84 years and 70% were female. A broad range of acute medical problems precipitated referral and 61% of people referred were immediately hospitalised. There was no general practitioner (GP) involvement in the management of the presenting illness in 58% of all referrals and in 45% of those where symptoms had been present for over three days. Conclusions: People living in residential care are frequently referred to an ED service, often bypassing their GP in the process. They present with a wide range of acute medical problems for which most are hospitalised. Strategies that anticipate, prevent and manage health breakdown in residential care and so minimise the need for ED referral should be trialed.
Helicobacter pylori treatment and antibiotic susceptibility: results of a five‐year audit
Authors: Fraser A. G. , Moore L. , Hackett M. , Hollis B. 
Published: March 2008

Abstract Background: Helicobacter pylori eradication treatment has been a rapidly evolving field. Audit of treatment results provides reassurance that trial data can be translated into routine clinical practice. Methods: Data were collected prospectively over five years. Patients were given four different treatment regimens over the audit period ‘standard’ triple therapy, two types of clarithromycin‐based treatment or ranitidine, amoxycillin and metronidazole. Eradication was proven by a urea breath test at least four weeks after completing treatment. Results: Eradication treatment for H. pylori was given to 665 patients; 89% had follow‐up data. H. pylori eradication was significantly associated with treatment type (p<0.0001) and smoking (p=0.04) by univariate analysis, but was not associated with sex, age, alcohol consumption, endoscopic diagnosis, recent treatment with anti‐secretory drugs or NSAIDs. By logistic regression analysis, only treatment type was significant (p=0.0001). H. pylori culture and sensitivities were available for 255 patients. Metronidazole resistance was shown for 84 isolates (32%) and clarithromycin resistance for 18 isolates (6.8%). Metronidazole resistance was significantly associated with younger age (p=0.02), ethnicity (p=0.02), female sex (p=0.02), and year of endoscopy (p=0.04), but was not associated with clarithromycin resistance. Clarithromycin resistance was not associated with age, sex, or ethnicity. Metronidazole resistance significantly affected H. pylori eradication for regimens containing metronidazole without clarithromycin. Eradication with metronidazole without clarithromycin was achieved in 90% of sensitive strains but only 55% of resistant strains (p<0.001). Metronidazole resistance was not significantly associated with treatment failure when metronidazole was combined with clarithromycin. Eradication with metronidazole and clarithromycin was achieved in 86% of sensitive strains and 78% of resistant strains (p=0.42). Conclusion: Treatment type and antibiotic susceptibility are the most important determinants of treatment success.
The effect of parental smoking on presence of wheeze or airway hyper‐responsiveness in New South Wales school children
Authors: Belousova E. G. , Toelle B. G. , Xuan W. , Peat J. K. 
Published: March 2008

Abstract Background and Aims: To assess accurately the effect of parental smoking on the respiratory health of New South Wales (NSW) school children, we obtained a large data set by pooling data from seven cross‐sectional studies conducted in NSW between 1991 and 1993. Methods: A random sample of 6394 children age eight to 11 years was studied. Respiratory symptoms, family history of asthma and parental smoking history were measured by questionnaire, atopy by skin prick test and airway hyper‐responsiveness (AHR) by histamine inhalation test. Results: In total, 58.3% of children had at least one parent who smoked; 38.5% were exposed to maternal smoking. After adjusting for potential confounders, such as atopy, parental history of asthma and bronchitis in the first two years, children who were exposed to maternal smoking had a significantly increased risk of recent wheeze but not of AHR (odds ratios 1.33; 95% CI: 1.2‐1.5 and 1.00; 95% CI: 0.9‐1.2). Conclusions: The positive association with wheeze and the lack of an association with AHR suggests that exposure to parental smoking leads to wheezing, but does not increase airway responsiveness.