bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scleroderma and silicone gel breast prostheses — the Sydney study revisited
Authors: Englert H. , Morris D. , March L. 
Published: March 2008

Abstract Background: Silicone augmentation mammoplasty has been postulated as a cause of environmentally‐induced scleroderma. While representing a small proportion of all alleged causes of scleroderma, the issue has huge social, ethical and medicolegal ramifications. The hypothesis, however, has been recently questioned in results of comparative studies.We have previously reported no association between augmentation mammoplasty and scleroderma. However, all information was self‐reported including augmentation mammoplasty status, and the prosthesis type was not identified. In addition, data were not available from untraceable cases. The current study addresses these issues. Aims: To validate self‐reported augmentation mammoplasty status, re‐analyse rates of exposure to silicone gel breast prostheses in 556 scleroderma patients and 289 general practice controls and evaluate whether silicone gel breast prostheses are causally linked to scleroderma. Methods: Study design ‐ population‐based case‐control study; Cases ‐ scleroderma patients resident in Sydney for at least six consecutive months between 1974–1988; Controls ‐patients from 29 randomly selected Sydney general practices, age‐ and gender‐group‐matched with cases.Validation of augmentation mammoplasty exposure was ascertained from the general medical practitioner of each interviewed case and control, or from the medical records of each deceased or untraceable case. Validation of the date of surgery and prosthesis type was from the relevant plastic surgeon. For each augmentation mammoplasty‐positive case, validation of both the date and nature of the scleroderma onset was from the patient's medical records. Controls were given a ‘control date’ for disease onset to adjust for duration of potential exposure. Results: Validation of augmentation mammoplasty status was possible in 252 (87.2%) living controls, and 532 (95.7%) cases, of whom 287 were living. Self‐reported augmentation mammoplasty status was highly reliable in living non‐senile cases (kappa=l), and living validated controls (kappa=0.86).No association was identified between silicone gel augmentation mammoplasty and scleroderma with unadjusted odds ratios of 1.33 (95% CI:0.26–6.71), and 1.00 (95% CI:=0.16–6.16) following adjustment for potential confounders of age, socioeconomic status and ethnicity. Conclusions: This validates the self‐reported augmentation mammoplasty status previously reported and does not support the hypothesis that silicone gel augmentation mammoplasty is an environmental inducer of scleroderma in females.
Near‐fatal asthma in South Australia:descriptive features and medication use
Authors: Campbell D. A. , Luke C. G. , McLennan G. , Coates J. R. , Frith P. A. , Gluyas P. A. , Latimer K. M. , Martin A. J. , Ruffin R. E. , Yellowlees P. M. , Roder D. M. 
Published: March 2008

Abstract Background: Self‐reported prior morbidity levels and medication use among survivors of a near‐fatal asthma attack (NFA) were studied. Aims: To identify deficiencies in asthma management and opportunities for intervention. Methods: A hundred and twenty‐seven consecutive patients aged 15 years or more presenting with a NFA to accident and emergency departments of teaching hospitals were interviewed. Results: High levels of morbidity due to asthma were reported. Most cases (79%) reported symptoms occurring at least weekly in the three months before their NFA. A mean of 20.8 days was reportedly lost from work, school or other usual daily activity in the 12 months before these events. Regular use of beta agonist as nebuliser solution was reported by 27% of cases, increasing to 34.5% in response to increased symptoms, while 41% reported use of nebulised beta agonist in response to the NFA event. Less than half of all cases (46%) reported using an inhaled corticosteroid on a regular basis. Oral corticosteroids were used by 33% of cases at times of increased symptoms in the preceding 12 months. However, only 7% of cases reported initiating or increasing oral corticosteroids at the time of the NFA. Conclusions: Despite high levels of prior asthma morbidity, regular preventive inhaled corticosteroid use was not widespread in this series of NFA asthmatics. By comparison, over‐reliance on regular beta agonist medication was common. Oral corticosteroids were rarely commenced in response to the NFA.
Cost‐effectiveness of coronary angioplasty versus medical treatment: the impact of cost‐shifting
Authors: Kinlay S. 
Published: March 2008

Abstract Background: Coronary angioplasty (PTCA) offers improved symptom control over medical treatment in patients with stable angina and single‐vessel disease. However, it is uncertain if PTCA is more cost‐effective. Cost‐shifting could also influence the provision of PTCA. Methods: Data from the only randomised trial comparing PTCA to medical therapy (ACME study) were used with costs from an Australian teaching hospital to estimate the costs and freedom from angina in 100 patients over three years. The incremental cost‐effectiveness of PTCA, and the potential for cost‐shifting were also examined. Results: Although the total cost of treating 100 patients over three years with PTCA ($678,978) was higher than a medical strategy ($631,078), PTCA was more cost‐effective ($10,930 versus$12,682 per patient free of angina). The incremental cost‐effectiveness of PTCA ($3875 per extra patient free of angina) was also substantially less than the cost of the medical strategy. These should be considered crude estimates as they were based on limited data on resource use. The hospital could reduce costs by pursuing a medical strategy, but 54% of the savings would result from shifting the cost of treating patients to the Federal Government and patients. By performing PTCA on privately insured rather than Medicare patients, die hospital could shift $29,876 per 100 patients to the Federal government and private insurance funds. Conclusions: From society's perspective, PTCA may be more cost‐effective than a medical strategy. However, the financial interests of the hospital are best served by limiting PTCA or restricting PTCA to privately insured patients. Cost‐shifting may have a major impact on the provision of PTCA. The costs of providing medical services need to be weighed against the cost of not providing them.
Predictors of mortality in the prospective Dubbo study of Australian elderly
Authors: Simons L. A. , McCallum J. , Friedlander Y. , Simons J. 
Published: March 2008

Abstract: Background: A prospective study in non‐institutionalised Australian elderly 60 years and over commenced in Dubbo, NSW in 1988. Aim: To examine clinical and socio‐demographic predictors of all‐causes mortality Methods: The data were derived from a community‐based sample comprising 1236 men and 1569 women followed for a median period of 62 months. Results: Two hundred and thirty five men (19%) and 184 women (12%) died, 46% of male and 53% of female deaths respectively related to cardiovascular disease. In a proportional hazards model, the significant predictors of mortality were: older age, being married (relative risk [RR]=0.71 for men, 0.74 for women), current smoking for men (RR=3.11), taking more than three alcoholic drinks per day for men (RR=0.37), prior coronary heart disease for men (RR=1.36), severe hypertension for women (RR=1.99), use of anti‐hypertensive medication for men (RR=1.74), diabetes for men (RR=1.62), poor‐fair self‐rated health for women (RR=1.74) and physical disability for men (RR=1.72). Serum cholesterol was associated with mortality in a ‘J‐shaped’ relationship in men and in a reciprocal relationship in women. Blood pressure predicted mortality in an incremental fashion below 75 years, but in older subjects lower pressure was associated with excess mortality. Conclusion: Some predictors of mortality in the well elderly have been identified and a more extended period of follow‐up will possibly resolve contradictory findings in some areas.
Anti‐streptokinase antibodies and streptokinase resistance in an Aboriginal population in northern Australia
Authors: Urdahl K. B. , Mathews J. D. , Currie B. 
Published: March 2008

Abstract Background: Thrombolytic treatment with streptokinase in acute myocardial infarction has proven to be safe and effective in Caucasian populations with relatively low levels of anti‐streptokinase IgG and streptokinase resistance. Higher levels of antibodies, as seen in previous recipients of streptokinase therapy, cause more adverse reactions and may result in lower efficacy. Aims: To examine the levels of anti‐streptokinase IgG and streptokinase resistance in a population subjected to endemic streptococcal infections. Methods and Results: Thirty Aboriginal adults from a remote community in Northern Australia with endemic streptococcal infections and 15 non‐Aboriginal adults from an urban community without endemic infections participated in this study. Aboriginal adults exhibited levels of anti‐streptokinase IgG and streptokinase resistance that, respectively, were almost 20 and 15 times greater than the values of non‐Aboriginal adults. At least 23% of Aboriginal adults had sufficiently high levels of streptokinase resistance to neutralise a standard 1.5 million unit dose of streptokinase. Conclusions: Aboriginal adults from a remote community had dramatically elevated levels of anti‐streptokinase IgG and in vitro streptokinase resistance. Prospective studies are needed to assess the clinical relevance of streptokinase resistance in populations from areas with endemic streptococcal infection.
Video assisted thoracoscopic surgery (VATS) in Asia ‐ its impact and implications
Authors: Yim A. P. C. 
Published: March 2008

Abstract Background: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects. Aims: We examined the impact of VATS on our practice and its implications. Methods: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital. Results: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases. Conclusion: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.
Prevalence of IgE‐mediated allergy to latex in hospital nursing staff
Authors: Douglas R. , Czarny D. , Morton J. , O'Hehir R. E. 
Published: March 2008

Abstract Background: IgE‐mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex. Aims: To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital. Methods: A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed. Results: Thirty‐one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13%vs 4%, p=0.05). Eighty‐seven per cent of the nurses who were latex skin test positive were also positive to banana extract. Conclusions: IgE‐mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.
Early prediction of risk in patients with suspected unstable angina using serum troponin T
Authors: Kerr G. D. , Dunt D. R. 
Published: March 2008

Abstract Background: One‐third of patients with rest angina are reported to have detectable cardiac troponin T in the serum and may be at increased risk of serious cardiac events. Aim: To investigate whether a single early estimation of serum troponin T was an independent predictor of serious cardiovascular complications in patients with suspected unstable angina. Methods: A prospective cohort study in which patients with suspected rest angina had a serum troponin T estimation 14 hours after symptom onset and were classified using discriminator levels of serum troponin T of 0.05 and 0.1 μg/L as well as a number of other variables. All patients were followed for six months to document any cardiac complications and a stepwise logistic regression analysis was conducted to determine independent risk factors of complications. Results: One hundred and sixty‐four patients were evaluated. Using a discriminator level of 0.05 (μg/L 54 patients (33%) had detectable troponin T. The admission ECG was the only independent predictor of cardiac events in hospital ‐ odds ratio 4.0 (95% CI 1.7–9.6). Detectable troponin T did not appear to be an independent predictor of serious complications. During the six‐month follow‐up period, detectable troponin T using a discriminator of 0.05 (μg/L was an independent predictor of serious complications ‐ odds ratio 3.7 (95% CI 1.8–7.6). Conclusions: In patients with suspected rest angina, detectable serum troponin T >0.05 (μg/L is an independent predictor of serious cardiac events during the six‐month follow‐up period although not during hospitalisation. Using a single, early serum troponin T estimation and other variables available at the time of admission, a high risk subgroup who may benefit from early investigation and revascularisation can be identified.
The Family Atherosclerosis Risk Intervention Study (FARIS): risk factor profiles of patients and their relatives following an acute cardiac event
Authors: Goble A. , Race E. , Jackson B. , Oliver R. G. , Phillips P. , Worcester M. C 
Published: March 2008

Abstract Background: Relatives of patients with coronary heart disease have a heightened risk of cardiovascular disease. Attendance at a family‐based screening clinic after an acute cardiac event could motivate patients and relatives to modify their lifestyles. Aims: The Family Atherosclerosis Risk Intervention Study (FARIS) aimed to determine (i) whether a high proportion of patients and relatives would attend a special screening and prevention programme; (ii) whether the risk factor profiles of relatives would be worse than those in the general community; and (iii) whether ongoing management of patients and families together in a special clinic would improve risk factor profiles. Methods: Consecutive patients, together with spouse, siblings and offspring, aged 18 to 69 years, were randomly allocated three months after an acute cardiac event to attend a special outpatient clinic, a screening and advice group, or a control group. Risk factor measures were total cholesterol, HDL cholesterol (HDLC), systolic blood pressure (SBP), body mass index (BMI) and smoking behaviour. This paper presents the risk factor profiles of all FARIS attenders and compares those of family members, age adjusted, with risk factors measured in a multicentre urban cross‐sectional survey conducted in die same period. Differences between groups were compared using t‐tests for numerical variables and ANOVA and chi‐square for categorical variables. Results: Six hundred and twenty‐eight patients and 1723 family members were enrolled, representing 85.9% and 82.7% of eligible patients and relatives respectively. Risk factors were significantly worse amongst family members than among those in the population survey. Conclusion: FARIS has achieved high attendance rates of high risk subjects who are well motivated for secondary and primary prevention of cardiovascular disease.
Interferon therapy for acute hepatitis C viral infection ‐ a review by meta‐analysis
Authors: Quin J. W. 
Published: March 2008

Abstract Background: Hepatitis C viral (HCV) infection poses a major health problem for Australia. Currently interferon therapy is approved only for people with chronic infection, yet the literature contains a number of studies that show that there is a better response to interferon in symptomatic acute HCV. Aim: To review the response to interferon therapy in acute HCV by way of meta‐analysis. Methods: This study was a retrospective review of the data on the use of interferon therapy in acute HCV. The meta‐analysis was performed using the methods of DerSimonian and Laird. Data were presented by calculating the risk difference which estimated efficacy by calculating the proportion of patients in treatment groups who responded better (0 to +1.0) or worse (0 to −1.0) than untreated control groups. Results: A meta‐analysis of six studies on the use of 3MU of interferon alpha 2b (IFN‐a2b) three times a week for six to 24 weeks showed a significant response as measured by long term (>12 months) normalisation of alanine aminotransferase (ALT) and clearance of HCV RNA (as measured by polymerase chain reaction). The risk of difference was +0.31 (95% CI of +0.19 to +0.43,p<0.01) and +0.33 (95% CI of +0.08 to +0.58, p<0.001) respectively.Slightly better results were seen with daily doses of 3MU of interferon beta (IFN‐p) given intravenously over four to seven weeks. This produced a risk difference of +0.57 (95% CI of +0.26 to +0.88, p<0.02) for normalisation of ALT and +0.83 (95% CI of +0.61 to 1.00,p<0.001) for clearance of HCV.Results for higher daily doses of both IFN α and β were limited to a few studies and most were uncontrolled. 6MU of IFN‐a2b three times a week for 16 to 24 weeks produced a risk difference of +0.53 (95% CI +0.17 to +0.89, p<0.05) for normalisation of ALT and +0.44 (95% CI +0.06 to +0.82) for clearance of HCV RNA. Results with 6MU daily for eight weeks of IFN‐β in an uncontrolled study, showed up to 90% patients cleared HCV long term. Preliminary results with 10MU of IFN‐a2b daily for four to six weeks also showed long term clearance of HCV RNA and normalisation of ALT in 90%o of treated patients. Conclusion: Short term (six weeks to six months) treatment of symptomatic acute HCV with interferon (both a and (3) produced a better long term response rate than prolonged therapy (> 12 months) in chronic HCV. Daily doses of 6MU and 10MU produced better responses than 3MU but more studies are needed to determine the optimum regime.
Radiofrequency ablation for cure of atrial flutter
Authors: Kalman J. M. , Vohra J. K. , Jayaprakash S. , Sparks P. B. 
Published: March 2008

Abstract Background: Atrial flutter is a common arrhythmia which frequently recurs after cardioversion and is relatively difficult to control with antiarrhythmic agents. Aims: To evaluate the success rate, recurrence rate and safety of radiofrequency (RF) ablation for atrial flutter in a consecutive series of patients with drug refractory chronic or paroxysmal forms of the arrhythmia. Methods: Electrophysiologic evaluation of atrial flutter included activation mapping with a 20 electrode halo cadieter placed around the tricuspid annulus and entrainment mapping from within the low right atrial isthmus. After confirmation of the arrhythmia mechanism with these techniques, an anatomic approach was used to create a linear lesion between the inferior tricuspid annulus and the eustachian ridge at the anterior margin of the inferior vena cava. In order to demonstrate successful ablation, mapping techniques were employed to show that bi‐directional conduction block was present in the low right atrial isthmus. Results: Successful ablation was achieved in 26/27 patients (96%). In one patient with a grossly enlarged right atrium, isthmus block could not be achieved. Of the 26 patients with successful ablation, mere has been one recurrence of typical flutter (4%) during a mean follow‐up period of 5.5±2.7 months. This patient underwent a successful repeat ablation procedure. Of eight patients with documented clinical atrial fibrillation (in addition to atrial flutter) prior to the procedure, five continued to have atrial fibrillation following the ablation. There were no procedural complications and all patients had normal AV conduction at the completion of the ablation. Conclusions: RF ablation is a highly effective and safe procedure for cure of atrial flutter. In patients with chronic or recurrent forms of atrial flutter RF ablation should be considered as a first line therapeutic option.
Rehospitalisation for asthma within 12 months: unequal rates on the basis of gender at two hospitals
Authors: Heard A. R. , Campbell D. A. , Ruffin R. E. , Smith B. , Luke C. G. , Roder D. M. 
Published: March 2008

Abstract Background: High asthma morbidity has been reported in certain demographic groups in geographical areas of low socioeconomic status (SES). Aim and Methods: We tested for an ecological association between the gender of people being frequently hospitalised for asthma and the SES of the area in which they lived, Results: Women represented 75% of the readmission population at The Queen Elizabeth Hospital (TQEH ‐ low SES hospital) and 55% at Modbury Hospital (moderate‐high SES hospital). Women at TQEH were significantly more likely to have one readmission within 12 months and over 30 times more likely to have two or more readmissions than women at Modbury Hospital. Conclusion: The ecological association observed in this study needs to be confirmed elsewhere in Australia.