bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of Emergency Department thrombolytic therapy and changes in inpatient mortality of acute myocardial infarction on the NSW Central Coast 1986 to 1994–96
Authors: Hooi H. 
Published: March 2008

Abstract Aims: To examine changes in inpatient mortality of acute myocardial infarction (AMI) from 1986 to 1994–96 and to review the Emergency Department (ED) use of thrombolytic therapy (TT) for AMI on the NSW Central Coast. Method: A retrospective review of medical records of patients presenting to the EDs of Gosford and Wyong Hospitals with a discharge diagnosis of AMI (ICD9 code 410.x) from 1 January 1986 to 31 December 1986 and 1 January 1994 to 31 December 1996. Data were collected on patients' age, sex, duration of symptoms on arrival at the ED, ECG changes and presence of positive ECG criteria for thrombolysis, agent used, contraindications to TT, and inpatient mortality. The main measure of outcome was inpatient mortality. Results: There were 423 admissions for AMI in 1986 and 1220 admissions in 1994–96. The overall inpatient mortality has declined from 18.9% in 1986 to 9% in 1994–96 (p<0.0001). The mean age of patients has increased from 67.5 years to 68.1 years (p=0.35). The proportion of patients over age 75 years has increased significantly from 24.6% to 30.3% (p<0.0001). Presentation times from onset of symptoms have not changed significantly from a median time of two hours in 1986 to 2.5 hours in 1994 to 1996 (p=0.52). The overall proportion of patients with ECG criteria for TT was 53.2% in 1994–96. TT was administered to 42.9% of patients with a mean door to needle time of 67 minutes (median 45 minutes). The Australasian College for Emergency Medicine benchmark door to needle time of 60 minutes was achieved in 71.3% of patients. Streptokinase was the predominant agent given in 78%, while recombinant tissue plasminogen activator accounted for 15.7% of patients. Patients not receiving TT due to negative ECG criteria showed a decline in mortality from 18.6% to 6.7% (p<0.0001). Patients who underwent mechanical revascularisation (by bypass graft or angioplasty) increased from 8.7% to 17.4% (p<0.0001). Inpatient mortality has declined for all age groups, for both sexes, and for all sites of AMI. Conclusion: There have been significant declines in inpatient mortality of patients with AMI on the Central Coast. TT has had a significant impact on this decline but has an eligibility rate of less than half. Significant declines in mortality have also been seen in patients ineligible for thrombolysis. These patients have benefited from other therapies introduced or more widely used in the last decade. The results achieved on the Central Coast compare favourably with published reviews in Australia and overseas despite the lack of facilities for coronary angiography, coronary angioplasty and cardiothoracic surgery.
Use of cytokeratin fragments 19.1 and 19.21 (Cyfra 21‐1) in the differentiation of malignant and benign pleural effusions
Authors: Lee Y. C. (Gary) , Knox B. S. , Garrett J. E. 
Published: March 2008

Abstract Background: Differentiation between malignant and benign pleural effusions is often difficult. Serum level of Cyfra 21‐1, a marker of cytokeratin 19 fragments, has been used in the diagnosis and monitoring of epithelial tumours, especially bronchogenic carcinomas. Aim: This study is designed to establish the usefulness of effusion Cyfra 21‐1 level in differentiating malignant from benign effusions. Methods: Forty‐eight malignant effusion aspirates (proven by cytology or pleural biopsy) and 34 benign samples were compared. Cyfra 21‐1 concentration was measured by a solid phase sandwich radioimmunoassay (Centocur®, USA). Results: Cyfra 21‐1 level was significantly higher in malignant effusions (geometric mean 123.6 ng/mL, 95% confidence interval [CI] 76.6‐199.4) than in benign ones (geometric mean 14.3 ng/mL, 95% CI 8.5‐23.9), p<0.00005. By Receiver Operating Characteristics curve analysis, the sensitivity is 77% for a specificity of 79% if the cut‐off is set at 32 ng/mL. No significant difference was observed (p=0.1) in Cyfra 21‐1 concentration between adenocarcinoma and mesothelioma effusions. Cyfra 21‐1 level was not influenced by the effusion protein concentration (r=0.29), or by renal function as measured by serum creatinine (r=0.1). There was no significant difference between Cyfra 21‐1 levels in benign exudate and transudate effusions, p=0.28. Conclusions: Cyfra 21‐1 is a useful adjunct in the workup of effusions but should not replace conventional investigations as there is considerable overlap in levels between benign and malignant groups. It is unable to differentiate between subgroups of malignancies.
Renal sarcoidosis in Christchurch, New Zealand 1970–1998
Authors: Jose M. D. , McGregor D. O. , Lynn K. L. 
Published: March 2008

Abstract Aim: To identify patients presenting to a nephrologist in whom a diagnosis of sarcoidosis could be made, to assess the relevant causes of renal involvement and to review treatment and long‐term follow‐up of this group. Method: A retrospective review of the computer database PROTONTM for patients given the diagnosis of sarcoidosis, followed by a case note review of identified patients with respect to the mode of presentation, clinical and laboratory features, treatment and subsequent follow‐up. Results: Nineteen patients (15 males) were identified, mean age 45 years, all were Caucasian, and follow‐up was four months to 26 years (mean 9.3 years). Most common mode of presentation was acute renal failure (11) during spring/summer (14). Evidence for systemic disease was present in all patients. Mean plasma creatinine on presentation was 0.52 mmol/L and calcium 3.01 mmol/L. Hypercalcaemia was present in 60%. Kidney biopsy was performed in seven patients with the predominant findings of tubular atrophy and interstitial fibrosis; significant granulomata were present in only two. Treatment in all patients was with corticosteroids with good result. Mean long term plasma creatinine was 0.17 mmol/L at 9.3 years. Steroid withdrawal was attempted in all patients, successful in five, with the mean time to relapse of five months in the remaining 14. Mean steroid dose in this group was 7.6 mg on long term follow‐up. Conclusions: Sarcoidosis causes renal dysfunction mainly through altered calcium metabolism. Treatment with corticosteroids is successful in improving renal function, but relapse is common on steroid withdrawal and prolonged treatment is necessary for disease control.
Cardiac surgery in octogenarians – The Green Lane Hospital Experience 1995–1998
Authors: Wong S. P. , Dixon S. R. , Ruygrok P. R. , Legget M. E. 
Published: March 2008

Abstract Background: An increasing number of patients aged 80 years and over are being considered and accepted for cardiac surgery. Aim: To review the experience of surgery in this elderly group of patients at our institution. Methods: Hospital records of octogenarians undergoing surgery between January 1995 and September 1998 were reviewed and follow‐up was obtained by general practitioner (GP) and patient questionnaires. Results: Thirty‐seven patients underwent cardiac surgery. The mean age was 82.8±1.4 years (range 80.8 to 86.2 years). Twenty‐three (62%) were male. All were independent pre‐operatively with severe symptoms and minor co‐existing morbidity.All operations were urgent except two (emergency). Twenty patients (54%) had isolated coronary surgery, six (16%) aortic valve replacement alone, and 11 (30%) combined surgery. There were four (11%) early deaths and five (14%) peri‐operative neurological events. The mean duration of post‐operative intensive care stay was 2.4±3.9 days (range 0.05 to 16, median 1.0) and post‐operative hospital stay 14.0±13.9 days (range 0 to 79, median 11).At the time of follow‐up (mean duration 20.0±11.2 months) two further patients had died (non‐cardiac). Twenty‐six of the 31 survivors were living at home (23 independently), one with relatives, and four in residential care. Their cardiac symptoms were well controlled. The GPs of all hospital survivors, and all surviving patients themselves, felt that cardiac surgery had been beneficial. Conclusions: Cardiac surgery in the very elderly has been reserved for those with severe disease or symptoms and little co‐morbidity. Early mortality is higher than for the general population undergoing cardiac surgery, but post‐operative resource use is acceptable and the intermediate‐term outcome for survivors is good.
Are antipseudomonal antibiotics really beneficial in acute respiratory exacerbations of cystic fibrosis?
Authors: Wolter J. M. , Bowler S. D. , McCormack J. G. 
Published: March 2008

Abstract Background: Although anti‐pseudomonal antibiotics are routinely used in the treatment of acute respiratory exacerbations of adult cystic fibrosis (CF), the specific efficacy of such treatment remains uncertain, the mechanism of action of these agents is not fully understood, and the role of sputum susceptibility testing in clinical decision making is controversial. Aims: We investigated the relationship between susceptibility testing and clinical outcome in adult CF patients colonised with Pseudomonas aeruginosa. Methods: Sputum samples were collected before, during and after respiratory exacerbations from 31 admissions (17 patients). Sputum colony counts and MIC of P. aeruginosa were performed. Results: Sputum colony counts did not change significantly during or after intravenous (IV) antibiotic therapy. Clinical outcome parameters (lung function, 12‐minute walking distance, sputum weight and quality of life) were compared with susceptibility of P. aeruginosa colonies isolated at admission to the antibiotics used, and no correlation was evident. There was no evidence for the development of cross‐resistance and there was no change in the proportion of mucoid colonies with therapy. Conclusions: While this study has a small patient sample size, it highlights the inconsistency of the role of antipseudomonal drugs also shown in other similar studies. The presence of P. aeruginosa in sputum of acutely ill CF patients prompts us to prescribe IV antipseudomonal drugs. If this approach was valid, we would expect to find a reduction in sputum colony counts and improvement in clinical parameters with the use of antibiotics to which the organisms were sensitive. The fact that such a relationship cannot be consistently demonstrated in this and other studies suggests that the use of antipseudomonal therapy in these patients requires more critical bacteriological and clinical evaluation.
Improvements in outcomes for chronic obstructive pulmonary disease (COPD) attributable to a hospital‐based respiratory rehabilitation programme
Authors: Young P. , Dewse M. , Fergusson W. , Kolbe J. 
Published: March 2008

Abstract Aim: To determine whether the benefits of pulmonary rehabilitation, demonstrated in selected subjects in randomised controlled studies, can be achieved by a hospital‐based respiratory rehabilitation programme conducted as part of routine clinical management. Methods: Design: A prospective longitudinal study of patients with severe chronic obstructive pulmonary disease (COPD) enrolled in a hospital based, non‐medically supervised, outpatient, respiratory rehabilitation programme was undertaken.The rehabilitation programme was of pragmatic design and content, supervised by respiratory physiotherapists and comprised seven two hour sessions over one month for groups of six to eight patients. It included education on disease management, practical instruction in coping skills, as well as a progressive aerobic exercise programme for specific muscle training related to functional activities.Subjects were assessed prior to the programme but after optimisation of pharmacologic therapy, at the completion of the programme and at three months and six months post‐programme. Principal outcome parameters were exercise capacity (as assessed by a six minute walk distance [MWD] test), degree of perceived breathlessness and quality of life (QOL) (assessed by the Chronic Respiratory Disease Questionnaire [CRDQ]). Results: Fifty‐one subjects with severe COPD (Fev1=0.9±0.4 1) completed the programme. There was a significant improvement in exercise capacity (a six MWD test improved from 375±126 m at baseline to 440±109 m at three months, p<0.005). There were significant improvements in QOL (in the total CRDQ score as well as in the domains of dyspnoea, fatigue and mastery). There was a reduction in the level of perceived dyspnoea (modified Borg Scale). Most improvements were maintained for three and six months following completion of the programme. Compared with the six months preceding the programme there was a reduction in hospital admissions and reduction in courses of oral steroids. Conclusions: An outpatient, hospital‐based respiratory rehabilitation programme pragmatically adapted for clinical utility produces substantial and clinically significant improvements in exercise tolerance and QOL, similar in type and magnitude to those obtained in controlled clinical trials. There was an associated reduction in COPD‐related morbidity. Such gains were mostly maintained for six months after completion of the programme. Thus respiratory rehabilitation must be regarded as an essential component of a comprehensive clinical programme for the management of COPD.
Is health‐related quality of life among older, chronically ill patients associated with unplanned readmission to hospital?
Authors: Pearson S. , Stewart S. , Rubenach S. 
Published: March 2008

Abstract Background: Assessment of health‐related quality of life (HRQL) is being used increasingly to assess the impact of treatment. Aims: To determine if HRQL, assessed shortly after acute hospitalisation, is associated with readmission to hospital. Methods: In a prospective, longitudinal study, 163 chronically ill, medical and surgical patients (mean age 67.0±16.3 years) discharged to home following acute hospitalisation were studied. HRQL was assessed at one month post‐hospital discharge using the MOS 36‐Item Short‐Form Health Survey (SF‐36). Patients were followed‐up for six months thereafter to determine subsequent incidence of unplanned readmission. Results: HRQL as measured by the eight health dimensions of the SF‐36, for the entire cohort, was lower relative to age and gender matched norms for the local population (p<0.01). During study follow‐up, 47 (35%) patients had an unplanned readmission and one patient died. Patients who had an unplanned readmission demonstrated both significantly lower physical (32.2±9.8 vs 38.6±10.1: p<0.001) and mental (45.1±12.7 vs 49.9±12.3: p=0.03) health component scores in comparison to the remainder of the cohort. On multivariate analysis, independent correlates of unplanned readmission were: 1) presence of formal home assistance (OR 6.4: p<0.01), 2) ≥five prescribed medications (OR 2.4: p=0.04), 3)≥two admissions in the six months before follow‐up (OR 4.3: p<0.01) and 4) an SF‐36 physical component score of ≤40 (OR 2.2: p=0.05). Conclusions: In this cohort of predominantly older and chronically ill patients recently discharged from acute hospital care, relatively lower SF‐36 physical health component scores were independently associated with an increased risk of subsequent unplanned readmission.
Correlation of cytogenetics, BCR‐ABL PCR studies and fluorescence in situ hybridisation (FISH) in adult acute lymphoblastic leukaemia
Authors: Campbell L. J. , Martinow A. , Michael P. M. , White J. S. , Rayeroux K. C. , Januszewicz E. H. 
Published: March 2008

Abstract Background: Philadelphia positive (Ph+) acute lymphoblastic leukaemia (ALL) accounts for 11–29% of adult ALL. Reverse transcriptase polymerase chain reaction (RT‐PCR) for the BCR‐ABL fusion mRNA has identified patients with the fusion mRNA without cytogenetic evidence of the 9;22 translocation. The reason for discrepancies between cytogenetic and molecular diagnoses is unclear. Aim: Our aim was to study cases of ALL with discordant cytogenetic and RT‐PCR results and identify any reasons for such discrepancies. Methods: Laboratory records were scanned for cases of ALL tested by both RT‐PCR and cytogenetics and positive by either for the 9;22 translocation. Fluorescence in situ hybridisation (FISH) was used to study discordant results where a specimen was available. Results: We identified 15 patients with ALL who had both cytogenetic and RT‐PCR studies for BCR‐ABL. Seven had discordant results; five patients had positive RT‐PCR studies with normal (four/five) or abnormal but Ph negative cytogenetics (one/five), and two were Ph+ but RT‐PCR negative. FISH, using Vysis LSI bcr/abl translocation probes, showed fused signals in 12% interphase cells but not in metaphase cells in one specimen with normal cytogenetics, and 6% interphase cells in the Ph negative patient with abnormal cytogenetics. This second patient subsequently relapsed with a minor Ph+ cell line derived from the Ph negative line. Conclusions: These results confirmed the need for both cytogenetics and RT‐PCR to identify Ph+ ALL. FISH did not show sub‐microscopic rearrangements of BCR‐ABL in normal metaphases. Failure to identify the Philadelphia chromosome cytogenetically appeared due rather to Ph+ cells failing to divide.
The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD)
Authors: Smith B. J. , Appleton S. L. , Bennett P. W. , Roberts G. C. , Fante P. Del , Adam R. , Trott C. M. , Allan D. P. , Southcott A. M. , Ruffin R. E. 
Published: March 2008

Abstract Background: Chronic obstructive pulmomary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services, for conditions such as COPD. Aim: To determine the effectiveness of an outreach respiratory nurse in a shared care approach, with collaboration between general practitioners and hospital services, in the management of patients with severe COPD. Methods: Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nursing intervention (HBNI) over 12 months with outcome measures including mortality rate, hospital service utilisation, FEV1 and health related quality of life (HRQL) using a modified Dartmouth Primary Care Co‐operative Quality of Life questionnaire. Results: There were 48 subjects in each study arm, with no differences in mortality rate (eight deaths in the HBNI group and seven in the control group), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow‐up of FEV1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL (in three of ten indices measured) was demonstrated, despite a deterioration in FEV1 (11% reduction, p=0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change. Conclusion: An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation.
Comparison of an age adjusted warfarin loading protocol with empirical dosing and Fennerty's protocol
Authors: Roberts G. W. , Druskeit T. , Jorgensen L. E. , Wing L. M. H. , Gallus A. S. , Miller C. , Cosh D. , Eaton V. S. 
Published: March 2008

Abstract Aim: A warfarin loading protocol adjusting doses for age was compared to both Fennerty's protocol (Fenn) and empirical dosing (Emp). Methods: Patients beginning warfarin were randomised to receive doses according to either the age adjusted (Age) protocol or Fenn. Data were retrospectively collected for patients who had begun warfarin in the previous six months to represent empirical dosing. The study was performed on inpatients being commenced on warfarin for the first time at two teaching hospitals. Main outcome measures: Endpoints were time to reach a stable, therapeutic International Normalised Ratio (INR) between 2–3, the number of patients experiencing an INR ≥4 in the first week and the number of patients who had a dose held in the first week. Results: Thirty‐five patients were assessed in the Age group, 28 in the Fenn group, and 123 patients for the Emp group. Patients using the Age protocol achieved a stable, therapeutic INR more rapidly than either the Fenn (p=0.003, log rank test) or Emp (p<0.001) group. The Age group had a lower proportion of patients experiencing an INR ≥4 in the first week (p<0.05) as well as a lower proportion having doses held in the first week (p<0.01). There were no differences between Emp and Fenn for any of the endpoints. Conclusion: Adjustment of warfarin loading doses for age exhibits clear superiority over the use of Fenn or Emp. This becomes increasingly important as the average age of patients being warfarinised increases, with the recognition that atrial fibrillation requires anticoagulation. Fenn consistently overdosed elderly patients, especially those aged 80 years and older.
Male systemic sclerosis and occupational silica exposure—a population‐based study
Authors: Englert H. , Small‐McMahon J. , Davis K. , O'Connor H. , Chambers P. , Brooks P. 
Published: March 2008

Abstract Background: The continuing uncertainty about the silica‐systemic sclerosis relationship led to the investigation of its role as a disease determinant in a large population‐based study of systemic sclerosis. Aims: To compare the frequency, socioeconomic and educational status, age‐specific prevalence and duration of occupational silica exposure in males with and without systemic sclerosis. To assess the temporal relationship between exposure and disease onset. To estimate disease latency. To compare disease characteristics between silica‐exposed and non‐silica‐exposed male cases. Methods: The study was case‐control in design. The exposure variable was occupational silica exposure as assessed by an occupational health officer blinded to case/control status and the outcome variable was systemic sclerosis. The employed instrument comprised either a standardised telephone questionnaire (interviewed cases and controls) or medical records (deceased or living‐status‐unknown cases). Results: Sixty of 160 cases (37.5%) and 11 of 83 (13.3%) controls had occupational silica exposure (OR=3.93; 1.84‐8.54). Comparison of data between 64 interviewed cases and all controls demonstrated initial occupational silica exposure occurring before age 40, comparable educational status but significantly different cumulative socioeconomic status with cases being over‐represented in semi‐skilled and unskilled occupations. Cross‐sectional ‘current’ occupational data underestimated cumulative silica exposure by more than 50%. Silica exposure uniformly preceded onset of second disease symptoms and disease diagnosis. In most, it also preceded onset of first disease symptoms. Disease latency approximated two decades. No disease features distinguished silica‐associated systemic sclerosis from idiopathic systemic sclerosis. The duration of silica exposure in the interviewed silica‐exposed cases did not significantly exceed that of silica‐exposed controls. Conclusions: Male systemic sclerosis displays socioeconomic dependence. Silica is a disease determinant in male systemic sclerosis, with disease features including a long latency and clinical characteristics indistinguishable from idiopathic disease. Cross‐sectional ‘current’ occupational data underestimate cumulative occupational silica exposure.