bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congestive cardiac failure (CCF) as a cause of fatal stroke and all cause death
Authors: Jelinek M. V. , Ansari M. Z. 
Published: March 2008

Abstract Background: Congestive cardiac failure (CCF) has been found to be a clinical risk factor for stroke in patients with non rheumatic atrial fibrillation. Aims: To study CCF as a risk factor for stroke deaths and all cause deaths in coronary heart disease (CHD). Methods: Case control study from a single cardiologist's practice: 370 deaths, 32 (9%) from stroke; controls of 160 and 370 consecutive patients for stroke deaths and all cause deaths respectively. Multivariate analysis using logistic regression. Results: A‐Stroke deaths. Positive associations for CHD with CCF, hypertension; negative association for CHD without CCF. Patients with CHD and CCF were 7.4 times as likely to die from stroke as patients with CHD without CCF.B—All cause deaths. Positive associations for CHD or cardiomyopathy with CCF, atrial fibrillation, diabetes and hypertension; negative association for CHD without CCF. Patients with CHD and CCF were 6.1 times as likely to die from all causes as patients with CHD without CCF. Conclusions: Many stroke deaths in patients with CHD and CCF may be cardioembolic in origin. A randomised controlled trial in such patients is indicated to see if anticoagulants can reduce the incidence of stroke.
Commercial detailing techniques used by pharmaceutical representatives to influence prescribing
Authors: Roughead E. E. , Harvey K. J. , Gilbert A. L. 
Published: March 2008

Abstract Aim: To determine the use of influence techniques by pharmaceutical representatives in their encounters with medical practitioners. Method: We identified six influence techniques from the marketing literature which are thought to be commonly used by sales people. These have been termed the principles of reciprocity, friendship/liking, commitment/consistency, social validation, authority, and scarcity. We examined the use of these techniques by analysing audio‐recordings of pharmaceutical representatives' presentations to medical practitioners. Results: Sixteen recordings, detailing 64 medicines, were obtained from seven medical practitioners. Reciprocation was the most commonly observed method of influence. Samples, gifts, printed material, patient information leaflets or invitations were offered in all encounters. Appeals to authority figures, where promotional claims were supported by reference to professors or specialists, specialist groups and specialist hospitals, were recorded. Social validation acts, where reference was made to the peer group were also common. Commitment acts were observed to occur in two ways; the first was as a direct request to use the product detailed and the second was as a series of questions or statements which gradually moved from pre‐agreed areas to solicitation of a commitment to prescribe the drug. Conclusion: Influence techniques were found to be commonly used by pharmaceutical representatives when they detailed products to medical practitioners. Medical practitioners may not be aware of the potential effect these techniques can have on their prescribing practices. Knowledge of these techniques must be incorporated into educational programmes designed to provide health professionals with critical appraisal skills.
Comparison of atorvastatin alone versus simvastatin ± cholestyramine in the management of severe primary hypercholesterolemia (The Six Cities Study)
Authors: Simons L. A. 
Published: March 2008

Abstract Background: Atorvastatin is a new member of the class of drugs which inhibit the enzyme Hydroxy‐Methylglutaryl Co‐A reductase, the rate limiting step in cholesterol biosynthesis. Aim: To compare the effects of atorvastatin alone versus simvastatin±low dose resin (i.e. versus standard care) on low density lipoprotein (LDL) cholesterol in severe primary hypercholesterolaemia. Methods: An open, multi‐centre, randomised study in patients previously stabilised on a cholesterol‐lowering diet and simvastatin 40 mg daily, having LDL cholesterol ≥5.0 mmol/L and triglycerides <4.0 mmol/L. After five weeks washout, 92 were randomised to receive atorvastatin 10 mg and 44 to receive simvastatin 10 mg. The dose was doubled every six weeks if LDL cholesterol remained ≥3.5 mmol/L. In accordance with manufacturers' recommendations, maximum dosage was atorvastatin 80 mg daily or simvastatin 40 mg daily (+cholestyramine 4 g daily in 84% of cases). Treatment was continued over 30 weeks. Lipids, lipoproteins, haematological and biochemical safety parameters were measured at regular intervals. Adverse events were monitored. Results: Baseline LDL cholesterol was ∼9 ±2 mmol/L (SD). After 30 weeks treatment serum cholesterol reduction was 42±10% on atorvastatin versus 32±13% on simvas‐tatin±resin (p<0.001), LDL cholesterol reduction 49±12%versus 38±14% (plt;0.001), and triglyceride reduction 33±20%versus 25±22% (p<0.02). High density lipoprotein cholesterol increased by 7–10% on both treatments. The proportion of subjects achieving goal LDL cholesterol <3.5 mmol/L was two to three times greater in those on atorvastatin compared with those on simvastatin± resin at each titration point. Six patients on simvastatin and one on atorvastatin were withdrawn. The drugs were generally well tolerated and the pattern of adverse events was similar with either treatment. Conclusions: Atorvastatin up to 80 mg daily appears to be an effective new treatment for the management of primary hypercholesterolaemia. It shows greater efficacy than simvastatin up to 40 mg daily±resin and has a similar safety profile.
Management of malignant pleural effusion
Authors: Tattersall M. 
Published: March 2008

AbstractMalignant pleural effusion is a frequent cause of morbidity in cancer patients. Pleural aspiration relieves dyspnoea usually only for a matter of days, and if the tumour type is not chemosensitive, some form of pleurodesis is commonly required. Tube thoracostomy is widely used to achieve pleural drainage prior to attempting pleurodesis by instillation of a variety of ‘sclerosants’. Recently thoracoscopic instillation of talc has been advocated and some authors report high rates of fluid control. Randomised trials comparing this approach compared to lube thoracostomy and chemical pleurodesis are required.
Phase II trial of ifosfamide and cisplatinum in advanced ovarian cancer
Authors: Aziz Z. , Zahid M. , Ahmed Z. Vd Din , Arshad T. 
Published: March 2008

AbstractTo evaluate the efficacy of systemic ifosfamide, cisplatin (CDDP) combination as first line treatment followed by intraperitoneal (IP) chemotherapy with carboplatin (CBCDA) and etoposide as consolidation in patients with stage III and IV epithelial ovarian cancer.A total of 40 patients with stage III and IV ovarian cancer were entered into the study. Ifosfamide 1 glm2 plus mesna 1 glm2 was given as six hour infusion daily for six days and CDDP 75 mglm2 was given on day seven. Patients completing six cycles of systemic therapy underwent second look laparotomy followed by four cycles of IP chemotherapy with CBCDA 300 mglm2 and etoposide 200 mglm2.Of the 40 patients entering the protocol 27 patients completed six cycles with a complete remission (CR) of 65% and overall response of 67.5%. Twenty‐two patients underwent second look laparotomy with pathological CR in ten patients, microscopic disease in seven and macroscopic disease in five. Eleven patients completed four cycles of IP chemotherapy. At 52 months the overall survival (OS) was 36%. The disease free survival (DFS) at 45 months was 38%. Factors affecting OS were ascites (p<0.011), stage (p<0.04), weight change (p<0.017), residual disease (p<0.001), number of chemotherapy cycles (p<0.0001) and IP chemotherapy (p<0.006). Presently 35% patients are alive in CR, 15% are alive with disease, one patient has been lost to follow up while 47.5% have died. Of these four patients had progressive disease, seven relapsed, four died due to treatment related complications and two died in CR due to other causes. Subset analysis of 22 patients who had second look laparotomy and completed four cycles of IP chemotherapy revealed a distinct survival advantage.IFOS+CDDP is an effective combination as first time treatment in advanced ovarian cancer. IP chemotherapy is effective as consolidation and seems to provide a significant survival advantage. Further studies with larger number of patients need to be done to confirm these results.
The role of ifosfamide in paediatric cancer
Authors: Advani S. H. 
Published: March 2008

AbstractIfosfamide is an active drug in the therapy of paediatric tumours such as rhabdomyosarcoma, Eivings' sarcoma, Wilms' tumour, neuroblastoma, germ cell tumours and lymphomas. Myelosuppression is the major toxicity along with haemorrhagic cystitis. The latter is largely prevented by the use of concomitant mesna.
Evaluation of a computer based package on electrocardiography
Authors: Devitt P. , Worthley S. , Palmer E. , Cehic D. 
Published: March 2008

Abstract Background: Opportunities for interactive learning in electrocardiography are limited particularly at postgraduate level. In medical education, increasing use is being made of the electronic medium and various materials have been developed to improve clinicians’ skills. Aims: To test and evaluate the learning of electrocardiography among health professionals. Methods: A software package, containing a tutorial on electrocardiography and a self‐assessment programme of 140 electrocardiograms (ECGs) was constructed. Seventy‐two health professionals were recruited into the study and tested before and after the study period. Participants were randomly allocated to one of three groups: control (no study material), tutorial or computer. The tutorial group participated in a series of tutorials and the computer group were provided with a CD‐ROM containing study material for them to use in their own time. The results were assessed for statistical significance between all groups using analysis of variance techniques. Results: Sixty‐one individuals completed the study. Each of the three groups was pre and post tested on their knowledge of electrocardiography and their ability to interpret ECGs. The computer group was the only group to achieve a significant increase in performance in their knowledge on electrocardiography and in their ability to interpret ECGs. Conclusions: Suitably structured computer programmes are effective in helping clinicians understand electrocardiography and interpret ECGs.
Alteplase (r‐TPA) vs streptokinase
Authors: Hunt David 
Published: March 2008

AbstractThe GUSTO trial and an Australian consensus meeting in 1993 led to the recommendation that recombinant tissue plasminogen activator (r‐TPA) was the preferred thrombolytic in patients with acute myocardial infarction (AMI) and ST segment elevation under the age of 75, whose infarction was anterior, who could be treated within four hours of the onset of symptoms and who did not have a contraindication to thrombolysis. Available data suggest that streptokinase (SK) should not be administered in a patient who has received this drug three days or more previously.New data on the risks of stroke confirm that the use of r‐TPA is associated with a higher risk of intracranial haemorrhage than SK, and those with a high risk profile for intracranial haemorrhage (hypertension and advanced age) should receive SK rather than r‐TPA.It may be justified to give r‐TPA to any patient with a large infarct regardless of location, within four hours of the onset of infarction in an attempt to achieve TIMI flow grade 3 (complete) reperfusion, reduce mortality and improve left ventricular function and clinical outcomes. The focus for the future will be on how to treat more patients earlier with thrombolytic agents, rather than the choice of agent.
Thrombolytic eligibility
Authors: Ellis Christopher J. , French John K. , White Harvey D. 
Published: March 2008

AbstractThe Fibrinolytic Therapy Trialists’ Collaborative Group has demonstrated that patients without clear contraindications who present with ischaemic chest pain within 12 hours of the onset of symptoms and who have ST segment elevation or bundle branch block on their electrocardiogram (ECG), will benefit from thrombolytic therapy. Therefore the treatment of patients presenting with ischaemic chest pain is guided by the initial ECG. This paper addresses the question of thrombolytic eligibility in several subsets of patients who may benefit from treatment. It also explores the data which confirm the benefit for patients presenting with an inferior myocardial infarction and for those presenting from six‐12 hours after the onset of symptoms. In conclusion, thrombolytic therapy should not be routinely withheld from diabetic or elderly patients, menstruating women and patients who have had cardiopulmonary resuscitation.
Refining the risk‐benefit equation for thrombolysis: How to identify the low risk patient before administering thrombolytic therapy
Authors: Parsons Richard , Thompson Peter , Nidorf Mark , Hobbs Michael , Jamrozik Konrad 
Published: March 2008

AbstractIn view of the relative risk of intracranial haemorrhage and major bleeding with thrombolytic therapy, it is important to identify as early as possible the low risk patient who may not have a net clinical benefit from thrombolysis in the setting of acute myocardial infarction.An analysis of 5434 hospital‐treated patients with myocardial infarction in the Perth MONICA study showed that age below 60 and absence of previous infarction or diabetes, shock, pulmonary oedema, cardiac arrest and Q‐wave or left bundle branch block on the initial ECG identified a large group of patients with a 28 day mortality of only 1 %, and one year mortality of only 2%. Identification of baseline risk in this way helps refine the risk‐benefit equation for thrombolytic therapy, and may help avoid unnecessary use of thrombolysis in those unlikely to benefit.
Hirudin (desirudin) and Hirulog (bivalirudin) in acute ischaemic syndromes and the rationale for the Hirulog/Early Reperfusion Occlusion (HERO 2) Study
Authors: White Harvey D. , Ellis Christopher J. , French John K. , Aylward Philip 
Published: March 2008

AbstractUnlike unfractionated heparin, direct thrombin inhibitors such as hirudin and Hirulog inhibit clot‐bound as well as fluid‐phase thrombin, escape neutralisation by platelet secretion products, do not require monitoring, and are unassociated with immune thrombocytopenia. They have been shown to have modest advantages over heparin when given after thrombolytic therapy, reducing reinfarction by 14%. In the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO 2b) trial, patients treated with streptokinase and adjunctive hirudin had a reduction in death or myocardial infarction of 40% at 30 days (8.6% with hirudin versus 14.4% with heparin, p = 0.004). In the Hirulog Early Reperfusion/ Occlusion (HERO 1) trial, 48% of patients who received Hirulog as adjunctive therapy with streptokinase had Thrombolysis in Myocardial Infarction (TIMI) trial grade 3 flow in the infarct‐related artery, compared with 35% of patients who received heparin with streptokinase (p <0.05). The HERO 2 study, involving 17,000 patients, will test the hypothesis that Hirulog and aspirin given before streptokinase will reduce mortality compared with aspirin plus heparin. Early administration of direct thrombin inhibitors may potentially improve the outcome of patients treated with thrombolytic therapy.
Low molecular weight heparins in acute ischaemic syndromes
Authors: White Harvey D. , Ellis Christopher J. , French John K. 
Published: March 2008

AbstractThrombus formation and ongoing generation play a major role in the pathogenesis of unstable angina and myocardial infarction (MI). Unfractionated heparin is widely used as an adjunctive therapy in the management of acute ischaemic syndromes, but it has a number of limitations including inter‐patient variability, need for monitoring, and the fact that its use may be associated with thrombocytopenia.Low molecular weight heparins have pharmacological and pharmacokinetic properties that may result in better clinical outcomes and safety. They are easy to administer and do not require monitoring. Low molecular weight heparins have been shown to reduce mortality and the incidence of MI and recurrent ischaemia compared with placebo in patients with unstable angina and non‐Q‐wave MI, and have a more predictable anticoagulant effect than standard unfractionated heparin. They also can be used long term in the outpatient setting, in the form of self‐administered subcutaneous injections.The clinical relevance of these new developments is still being defined in ongoing clinical trials and cost‐effectiveness analyses.
Percutaneous transluminal coronary angioplasty (PTCA) without on‐site surgical facilities
Authors: Cheong Y. M. , Dick R. , Sia B. , Lim Y. L. 
Published: March 2008

Abstract Background: Numerous publications from European and Canadian centres have documented the feasibility of performing percutaneous transluminal coronary angioplasty (PTCA) without on‐site surgical facilities. The absolute need for surgical standby has been changing especially with the introduction of coronary stent for bailout situations. This practice may be applicable in Australian centres especially in the environment of long waiting lists and cost containment. Aim: To review the safety of performing PTCA by experienced operators in two Melbourne hospitals without on‐site surgical facilities. Methods: We reviewed data of all patients who had PTCA electively (with low and moderate risks) between July 1996 and January 1997 and in the setting of acute myocardial infarction (AMI) from January 1996 to January 1997. Surgical standby was available as ‘next available room’ basis in nearby centres. Immediate outcome before discharge was documented and follow up from three to six months in 80% of all surviving patients. Results: There were 46 elective PTCA and 41 PTCA for AMI. PTCA was successful in 82 (94%) patients. Among the elective cases, seven patients were already inpatients with unstable or postinfarct angina. Thirteen patients had stents deployed with three for acute closure. Abciximab (Reopro) was given to eight patients. Two patients had acute closure in the laboratory which could not be reopened, but did not require emergency coronary artery bypass grafting (CABG). There were four inhospital deaths (three related to AMI and one died of a noncoronary cause). Conclusion: PTCA can be performed electively in a selected group of patients with coronary artery disease and as a primary procedure for AMI without on‐site surgical standby. (AustNZJMed 1998; 28: 165–171.)
KRAS codon 12 mutations in Australian non‐small cell lung cancer
Authors: Fong K. M. , Zimmerman P. V. , Smith P. J. 
Published: March 2008

Abstract Background: In certain non‐small cell lung cancer (NSCLC) populations, codon 12 mutations of the KRAS oncogene comprising mostly G‐T transversions have diagnostic and prognostic value. However, it is not known if these findings are applicable to all populations of lung cancer patients. Aims: To examine for KRAS codon 12 mutations in Australian NSCLC patients. Methods: Tumour samples and corresponding normal lung tissue from 108 Australian patients with NSCLC undergoing curative resection were studied for mutations of KRAS codon 12 using a sensitive PCR assay. Mutations were confirmed by DNA sequencing and correlated with histological subtype, tumour stage, the presence of nodal metastases and survival. Results: Eleven KRAS codon 12 mutations were detected in 108 NSCLCs, with most (8/11) occurring in the adenocarcinoma subtype (17% prevalence), but were not associated with adverse outcome or clinico‐pathological features. G‐T transversions were surprisingly infrequent (37% of adenocarcinoma mutations). Conclusions: These data add to the evidence suggesting geographical differences in the spectrum and significance of KRAS codon 12 mutational genotypes in NSCLC. While these may be due to genetic variation and/or differences in carcinogen exposure, there is a need for larger population based studies before this potentially important biomarker can be recommended universally for optimising lung cancer management. (Aust NZ J Med 1998; 28: 184–189.)
Progress in management of acute myeloid leukaemia (AML) in Australia since 1980: a single institution retrospective study
Authors: Thomas D. M. , Seymour J. F. , Szer J. , Grigg A. P. , Basser R. L. , Green M. D. , Fox R. M. 
Published: March 2008

AbstractBackground: Much research has been conducted into the pathobiology, diagnosis, and management of acute myeloid leukaemia (AML) since 1980, with major contributions from Australian studies in this period.Aims: To determine whether advances in basic and clinical research into AML have translated into improved survival for patients in the community.Methods: A retrospective survey of records of all patients with AML presenting to the Royal Melbourne Hospital (RMH) over a 16 year period, analysed according to induction therapy and established prognostic factors. Between 1980 and December 1996 223 (98%) of 227 patients were evaluable.ResuZts: The probability of survival at five years for patients treated since 1990 has improved significantly compared to the cohort treated between 1980‐89 (3455% vs 422%; meankstandard error). This benefit is most evident in patients less than 60 years of age (5057% vs 1124%). Successive induction protocols in the context of clinical trials conducted since 1985 contributed to improved outcomes. The selective application of bone marrow transplantation, and use of retinoic acid as induction therapy for acute promyelocytic leukaemia has also improved survival. Despite increases in dose‐intensity, early death rates for patients undergoing induction therapy fell during the study period.Conclusions: Participation in clinical and basic research with the development of more intense and specific treatments for patients with AML has contributed to better outcomes, underpinned by improvements in supportive care. (Aust NZ J Med 1998; 28: 190‐1 96.)