bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of treating people with reversible ischaemic attacks of the brain and eye on the incidence of stroke in Australia
Authors: Hankey G. J. 
Published: March 2008

Abstract Background: Reversible ischaemic attacks of the brain or eye (RIA) are a risk factor for stroke. Strategies of stroke prevention include vascular risk factor control, antithrombotic therapy, and carotid surgery. Aims: To determine the effectiveness, risks and costs of each stroke prevention strategy for patients with RIA and the Australian community, and the effect of treating people with RIA on the incidence of stroke in Australia. Methods: Review of data from prospective community‐based studies to determine the prevalence of RIA, the incidence of stroke, and the proportion of stroke patients who report a RIA before their stroke; and data from randomised trials to determine the effectiveness, risks and costs of treatments for RIA. Results: About 111,000 Australians have had a prior RIA. Each year, about 37,000 Australians suffer a stroke, of whom up to 8000 (22%) have had a prior (‘warning’) RIA. Targeting effective stroke prevention strategies to RIA patients with relevant treatable conditions may reduce the individual's stroke risk by two‐thirds (individual strategies) and possibly further (combination strategies). However, because the attributable risk of RIA for stroke is only about 22% (and may be less, given the role of other causal risk factors for stroke), strategies of stroke prevention in RIA patients can only reduce stroke incidence by up to 15% (from 22% to 7%). Conclusions: The potential benefits of the ‘high risk’ approach to stroke prevention appear to be less than the ‘population’ approach, but both approaches are necessary and complementary. Indeed, the cost of implementing the ‘high risk’ approach may be less than the cost of the strokes prevented (255 million; i.e. 15% of 1.7 billion).
Evidence‐based cardiac practice
Authors: Silagy Chris 
Published: March 2008

AbstractIncreasing attention is being placed on using an evidence‐based approach within health care decision making. In order to apply this approach to a particular clinical scenario, the relevant clinical evidence must be available, accessible, accepted, applied, and audited. Cardiovascular medicine is a discipline in which a large body of evidence is available. The development of the Cochrane Library, as a source of systematic reviews concerning the effects of health care, will make this evidence more accessible. However, caution is required in interpreting systematic reviews, particularly when meta‐analytic techniques are used, to ensure that potential sources of bias in the identification and synthesis of the primary studies are minimised. A further challenge is to develop strategies to ensure the evidence is accepted and applied in clinical practice. Although there are no magic bullets to change behaviour of positions, there are a number of strategies which have been shown to influence change positively in clinical practice.
Evaluation of radiation dose and risk to the patient from coronary angiography
Authors: Harrison D. , Ricciardello M. , Collins L. 
Published: March 2008

Abstract Background: Coronary angiography is a commonly performed diagnostic procedure with life saving benefits for the patient. However, because of its potential to deliver a high radiation dose, caution is warranted. Aim: The purpose of this study was to determine the effective dose to an average patient from coronary angiography, to estimate the associated radiation risk in terms of fatal malignancy, and to examine ways effective dose may be reduced. Method: The dose‐area product data from 210 examinations was used to determine the effective dose to the average patient by means of a commercially available software programme. Subsequently, the effective dose was used to estimate radiation risk based on die population averaged probability coefficients given in ICRP 60 and contrasted against age‐related risk coefficients from the NRPB. The components of effective dose and radiation risk were examined to identify the organs most at risk. Results: The average effective dose was found to be 3.4±1.3 mSv. The risk of fatal malignancy was estimated as 170 per million cases, or around one in 6000. The average lung dose was 14.7 mSv, with the risk of fatal lung cancer estimated as 125 per million cases or one in 8000. Conclusions: The average effective dose in this study was less than half that of most other studies. The lung was identified as the critical organ and the estimated risk of fatal cancer amounted to an increase of 0.017% above the normal incidence for the general population. The study affirmed that using a reduced cine frame rate, low dose pulsed fluoroscopy, added copper filtration and a conscious effort to reduce screening time can significantly reduce patient dose.
Transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of refractory ascites
Authors: Williams D. B. , Waugh R. , Selby W. 
Published: March 2008

Abstract Background: The Transjugular Intrahepatic Portosystemic Shunt (TIPS) corrects portal hypertension and has proven to be effective in controlling variceal bleeding in patients with cirrhosis. Several reports have now appeared suggesting a possible role in patients with refractory ascites. Aims: To examine the outcome of TIPS for the treatment of refractory ascites in patients with cirrhosis. Methods: Fifteen patients underwent TIPS for ascites between April 1992 and December 1996. The clinical findings, response to treatment, complications, shunt patency and survival of these patients were analysed. Results: TIPS was successfully placed in all patients. The mean period of follow‐up was 375 days (range: 14–1165 days). In eight patients (53%) there was a reduction in the degree of ascites after shunt insertion, with six patients (40%) having complete resolution. Age, Child‐Pugh class or portal pressure gradient, before or after the procedure, were not predictive of response. Of five patients with renal insufficiency (serum creatinine >130 umol/L), only one had improvement in ascites control. Six patients (40%) required shunt revision during follow‐up, either for acute thrombotic occlusion (two) or stent stenosis (four). New or worsening encephalopathy developed in ten patients (67%). Two patients (13%) died of liver failure within 30 days. Cumulative survival was 46% at one year and 18% at two years. Treatment response was associated with increased survival (ρ=0.02), with median survival of 658 days as compared with 71 days for treatment failure. Conclusions: TIPS can be effective in the treatment of refractory ascites in patients with cirrhosis. Our experience suggests the benefit may be less for patients with advanced liver disease and renal impairment. Controlled trials are needed to compare TIPS with other treatment modalities such as large volume paracentesis or peritoneovenous shunting.
Prevalence and vascular associations with migraine in older Australians
Authors: Mitchell P. , Wang J. J. , Currie J. , Cumming R. G. , Smith W. 
Published: March 2008

Abstract Background: Migraine is a common disorder with recently described vascular associations, yet there are few Australian population‐based data describing migraine prevalence. Aims: To assess the prevalence and vascular associations with lifetime past history of typical migraine headache in a representative sample of older Australians. Methods: The Blue Mountains Eye Study examined 3654 permanent residents aged 49 or older living in two postcode areas, west of Sydney (82.4% participation) during 1992–4. A structured interview was administered, including questions about past or present history of typical migraine. The diagnosis was consistent with International Headache Society criteria. Results: A lifetime past history of typical migraine was given by 17% of participants, including 22% of women and 10% of men, a female:male ratio of 2.3:1. A marked trend for declining lifetime migraine frequency with increasing age was found for both sexes. Modest statistically significant associations were found with vascular disease history, after multivariate adjustment, which included vascular risk factors. These associations were stronger in men than in women. Among men, typical migraine was significantly associated with history of angina, odds ratio (OR) 2.0, acute myocardial infarction (OR 1.9) and stroke (OR 2.2). Among women, statistically significant associations were present only with history of myocardial infarct (OR 1.8). Conclusions: These data indicate similar prevalence rates for lifetime typical migraine history in a representative sample of older Australians, compared to recent US and Canadian populations. Modest, statistically significant associations between typical migraine and past history of vascular disease were found, with the strongest associations found in men.
Prevalence and demographic determinants of metronidazole resistance by Helicobacter pylori in a large cosmopolitan cohort of Australian dyspeptic patients
Authors: Katelaris P. H. , Nguyen T. V. , Robertson G. J. , Bradbury R. , Ngu M. C. 
Published: March 2008

Abstract Background: The pre‐treatment sensitivity of Helicobacter pylori to metronidazole is a key determinant of successful eradication therapy and should influence local choice of therapy. However, there are few data defining the prevalence of metronidazole resistance (MR) in Australia. Aim: To determine prospectively the prevalence and demographic determinants of MR in H. pylori isolates from a large and cosmopolitan cohort of dyspeptic patients in Sydney. Methods: Consecutive dyspeptic patients undergoing endoscopy had gastric biopsies for histology, urease test and culture. Metronidazole resistance was determined by E‐test after subculture. An MIC >8 μg/mL defined MR. Patient age, gender, birthplace and history of previous nitroimidazole use were recorded. Results: In 732 patients, H. pylori was present in 46.4%. Culture was successful in 81% and subculture for MR in 88% of these. In 237 evaluable patients the overall MR rate was 59.1%. Five patients had had prior triple therapy for H. pylori (of which four of five had MR). Therefore, the primary MR rate in the study population was 58.6% (136/232). MR was more prevalent in younger patients (ρ=0.0002). The MR rate was 70.4% in patients 18–39 years, 66.7% in those aged 40–59 years and lowest (38.9%) in those 60 years or older (ρ=0.002). The MR rate was highest in patients born in Southeast Asia (72.8%, 59/81) and significantly higher than in Australian born (48.1%, 26/54), or Southern European (46.2%, 24/52) born patients (ρ=0.002). There was no gender difference. Logistic regression to determine the impact of each variable (birthplace, age and gender) on MR identified Southeast Asia birthplace as a factor associated with greater likelihood of harbouring an MR isolate (OR 1.88, ρ=0.02). Southern European born patients had the lowest risk of MR (OR 0.70, ρ=0.02) as did patients older than 60 years (OR 0.56, ρ=0.04). A definite history of prior metronidazole use was infrequent and not predictive of MR. Conclusions: While a high rate of MR is not unexpected in patients born in developing countries, the high rate in Australian born patients is surprising and of concern. This may relate to the high local usage of nitroimidazoles as monotherapy and has important implications for the effectiveness of metronidazole containing triple therapies.
Tenoxicam does not alter renal function during anaesthesia in normal individuals
Authors: Slaven G. M. , Fawcett J. P. , Walker R. J. , Hodgson B. F. , Zacharias M. 
Published: March 2008

Abstract Background: Anaesthesia and surgery alter renal function. Inhibition of prostaglandin synthesis by non‐steroidal anti‐inflammatory drugs (NSAIDs) administered with anaesthesia may further compromise renal function. Aim: To study the effects of tenoxicam (NSAID) administered immediately prior to anaesthesia on renal function in normal individuals undergoing routine surgery. Methods: A randomised single blind placebo controlled study comparing tenoxicam (40 mg intravenously) with placebo was carried out in 20 healthy (ASA I) patients undergoing lower spinal surgery. Glomerular filtration rate (GFR) was determined by creatinine clearance and renal tubular function measured as osmolar and free water clearance. Results: GFR fell by 60% at the end of surgery but returned to pre‐operative values by six hours post‐operatively. There was no difference between placebo or tenoxicam with regard to changes in GFR. Tubular function was not altered by tenoxicam. Conclusions: Current clinical practice of using NSAIDs for post‐operative analgesia in low risk individuals appears to have no adverse effects on renal function.
The Medical Emergency Team (MET): a model for the district general hospital
Authors: Daly F. F. S. , Sidney K. L. , Fatovich D. M. 
Published: March 2008

Abstract Background: Most hospitals have a Cardiac Arrest Team, activated after cardiopulmonary arrest. The Medical Emergency Team (MET) is a newer concept, encompassing a proactive response to a wide range of emergencies with the aim of preventing irreversible organ failure and cardiopulmonary arrest. Aim: To describe the application of the MET model to the district general hospital, the spectrum of clinical conditions encountered, outcomes and administrative problems. Method: Data regarding each MET activation was collected prospectively. Results: The MET responded to 68 calls to 63 patients in 12 months. The mean age was 60.4 years (range: neonatal to 94 years). The most common conditions leading to MET activation were chest pain (19.1%), cardiopulmonary arrest (14.7%), seizures (14.7%) and respiratory distress (13.2%). Conclusion: This paper demonstrates that the application of the MET model to the district general hospital improves the process of patient care. We are unable to conclude whether the MET alters morbidity or mortality for hospital inpatients.
Population analysis of once‐daily dosing of gentamicin in patients with neutropenia
Authors: Peterson A. K. , Duffull S. B. 
Published: March 2008

Abstract Background: Aminoglycoside antibiotics are used as first‐line therapy in the treatment of patients with febrile neutropenia. However, there is little information on the pharmacokinetics of aminoglycosides in this specific patient group and whether they differ from the accepted population values. Aim: To determine the population pharmacokinetics of gentamicin for patients with febrile neutropenia, with or without sepsis. Methods: Data were collected from 26 patients with febrile neutropenia receiving once‐daily gentamicin. Patient age, height, weight, estimated lean body weight (LBW), gender, serum creatinine (SCr), creatinine clearance (ClCr), and serum drug concentration data were collected. Severity of infection and degree or neutropenia were assessed. An initial two‐stage population analysis using a Bayesian dose‐individualisation programme was performed to estimate likely population values of the parameters. If these were significantly different from typical values then a true population analysis was to be performed. Results: Data for 13 female and 13 male patients were collected. Median age was 57 years (range 19 to 87 years), estimated LBW (kg)=66 (±10), ClCr. (1/hour)=5.6 (±2.0) (mean ±SD). Results of the two‐stage approach follow [initial population values in square brackets]: Cl (l/hour)=0.73 (±0.12)XClCr+0.01×LBW [0.70 (±0.27)xClCr+0.01×LBW]; Vd (1)=0.28 (±0.05)XLBW [0.27 (±0.06)×LBW]. Conclusions: The population values of CI and Vd from the two‐stage approach do not differ significantly from initial population values of CI and Vd. Patients receiving gentamicin for febrile neutropenia may be considered pharmacokinetically similar to the general population receiving gentamicin. (Aust NZ J Med 1998; 28: 311–315.)
The effects of nebulised isotonic saline and terbutaline on breathlessness in severe chronic obstructive pulmonary disease (COPD)
Authors: Poole P. J. , Brodie S. M. , Stewart J. M. , Black P. N. 
Published: March 2008

Abstract Background: There is anecdotal evidence that nebulised saline relieves breathlessness at rest in patients with severe chronic obstructive pulmonary disease (COPD). It is unclear whether nebulised beta agonists are any more effective than nebulised saline in relieving breathlessness at rest in these individuals. Aim: To compare the effects of nebulised saline and nebulised terbutaline on breathlessness at rest in patients with severe COPD. Methods: We studied 18 patients with severe COPD with a mean age of 71.1 years, forced expiratory volume in 1 second (FEV1) of 0.58 L and vital capacity (VC) of 1.59 L, in a randomised, double‐blind, crossover trial. The subjects received three doses of nebulised saline on one study day, and three doses of nebulised terbutaline (cumulative dose 10 mg) on the other. Breathlessness was measured using Likert and Visual Analogue Scales (VAS). Results: Both treatments led to a significant improvement in breathlessness on VAS and Likert scales but there was no significant difference in breathlessness scores for saline compared with terbutaline. There was a small but significant increase in FEV1 with terbutaline of 74 mL, but no change with saline. Conclusions: A saline aerosol has no effect on lung function but reduces breathlessness at rest in subjects with severe COPD. Nebulised saline may be considered as an adjunct to the use of nebulised bronchodilators for the treatment of breathlessness in patients with COPD.
Management of germ cell carcinoma: state of the art
Authors: Levi J. A. 
Published: March 2008

AbstractThe management of all stages of germ cell carcinomas is fairly well defined with generally high rates of cure. In stage I disease surveillance and chemotherapy on relapse is as successful as initial adjuvant chemotherapy. More than 95% of patients will survive. In stage II disease either three to four cycles of chemotherapy, or retroperitoneal node dissection and subsequent chemotherapy if more than six nodes are positive or nodes are >2 cm diameter, or there is extra nodal extension, are equivalent with survival >95%.For stage III disease, a new international prognostic classification has determined that the level of tumour markers, presence of non pulmonary visceral disease, or a mediastinal primary, indicate a poorer prognosis. Long term follow up studies reveal an overall percentage of relapses (4–5%) beyond two years and the need for long term follow up.
The primary angioplasty vs thrombolysis debate
Authors: Thompson Peter L. 
Published: March 2008

AbstractEarly and complete coronary reperfusion can improve survival in myocardial infarction. Primary angioplasty can achieve TIMI grade 3 flow (complete restoration) in over 90% of cases. In comparison thrombolysis can achieve TIMI grade 3 flow in only just over 50%. Comparative trials have shown superior rates of death and reinfarction with a low haemorrhagic risk with PTCA compared with thrombolysis. Early clinical trials showed a clear superiority of primary angioplasty over thrombolysis but larger trials with larger number of endpoints have shown less impressive superiority. Wider application in community studies has not shown the benefits promised in the earlier studies, possibly due to dilution of experience. The impact of newer stent regimens vs non‐newer thrombolytic and antithrombotic regimens can only be determined by further clinical trials.
Intervention with PTCA and CABG following thrombolysis for acute myocardial infarction
Authors: Tideman Philip A. , Fabri Jackie K. , Aylward Philip E. , Simes R. J. 
Published: March 2008

AbstractThe patterns of revascularisation with percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in the GUSTO 1 trial patients in Australia are described.In comparison with rates documented in earlier trials of thrombolytic therapy in Australia, the rates of revascularisation post‐thrombolysis increased by 50%, primarily due to a doubling in the rate of use of PTCA. However, the rates were low by international comparisons. There were marked variations in the rates of revascularisation between States, but no correlation with differences in mortality between States. The main predictors of post thrombolysis PTCA were prior angina, mild infarction and access to PTCA facilities.
The GUSTO 2b and related studies
Authors: Aylward Philip 
Published: March 2008

AbstractDirect anti‐thrombin inhibitors such as hirudin have theoretical advantages over heparin. Two large studies in acute coronary syndromes were designed to test the thrombin hypothesis by demonstrating improved outcomes in hirudin treated patients. TIMI 9 assessed the effect of hirudin in patients with ST elevation receiving thrombolytic therapy. GUSTO 2 assessed the full spectrum of acute coronary syndromes of ST elevation and non‐ST elevation. Over 15,000 patients were entered into the studies and no major benefit was demonstrated for hirudin. This may, however, relate to endpoints measured and the timing of the anti‐thrombin.
Detection of reperfusion after thrombolytic therapy by the analysis of released biochemical markers
Authors: Cross David B. 
Published: March 2008

AbstractAlthough the advent of thrombolytic therapy for acute coronary occlusion has substantially reduced the mortality of acute myocardial infarction (AMI), the best available thrombolytic regimens only achieve adequate reperfusion in a little over half the patients who are treated. The ability to detect failure of reperfusion by non‐invasive means would permit further therapy in this patient group who currently have a high mortality. As coronary reperfusion causes a rapid release of many myocardial proteins into the blood stream, analysis of the rate of release of markers such as myoglobin, troponin, and creatine kinase (CK) during the first 90 minutes after thrombolytic therapy can identify about 80% of the patients in whom thrombolytic therapy has been ineffective. An ideal marker of reperfusion would be rapidly released after reperfusion, rapidly cleared from the circulation, highly myocardial specific, and amenable to rapid quantitative assay to permit ‘real time’ determination of coronary patency status. At present myoglobin and cardiac troponins appear most promising for detection of reperfusion, but other markers such as CK isoforms may prove useful if reliable rapid assays become available.