bluuebunny/crossref_metadata_2025_split huggingface dataset:
G‐CSF stimulated donor granulocyte collections for prophylaxis and therapy of neutropenic sepsis
Authors: Grigg A. , Vecchi L. , Bardy P. , Szer J. 
Published: March 2008

Abstract Background: The administration of granulocyte colony‐stimulating factor (G‐CSF) increases the granulocyte count in normal donors and enables the collection of large numbers of mature myeloid cells by leukapheresis. This has potential value in the treatment of sepsis unresponsive to antibiotics in patients with severe neutropenia. Aim: To evaluate the tolerability of granulocyte collections in normal donors receiving G‐CSF, the optimal method of collection and the clinical factors influencing the efficacy of granulocyte infusions. Methods: Analysis of the outcome of 55 granulocyte collections from 26 donors for progressive bacterial or fungal sepsis in neutropenic patients (n‐8) or as prophylaxis in patients with recent fungal infections undergoing allogeneic bone marrow transplantation (BMT) (n=3). Results: G‐CSF was well tolerated in most donors. Fatigue occurred commonly after the second collection. The median WCC per 200–220 mL bag was 351X1097L. Collections were optimised with the use of a sedimenting agent (dextran) and a deepened interface setting on the cell separator. There was only a weak correlation between the number of granulocytes infused and the increment in the patient, but levels were usually maintained 0.5X 1097L for the next 24 hours. The infusions were successful in three septic patients without multi‐organ dysfunction and prophylactically, in two patients with localised fungal infections undergoing MBT The infusions were not beneficial in patients with septicaemia and established organ dysfunction or with extensive pulmonary aspergillosis. Conclusions: G‐CSF mobilised granulocyte collections are feasible and the preliminary evidence suggests that the infusion of these cells may be useful early in the prophylaxis or treatment of severe neutropenic sepsis.
Sotalol proarrhythmia: a report of five cases and an audit of the use of sotalol in a teaching hospital
Authors: Basta M. N. , Leitch J. W. , Fletcher P. J. 
Published: March 2008

Abstract Background: Polymorphic ventricular tachycardia is an uncommon complication of sotalol use. Aims: The aims of this study were: (1) to report five cases of sotalol proarrhythmia and (2) to audit the use of sotalol in a teaching hospital population. Methods: Five patients with sotalol proarrhythmia (defined as new ventricular arrhythmias associated with sotalol administration) were identified over an 18 month period. Sotalol use for patients admitted to the John Hunter Hospital was audited over a six month period with 85 patients (55 males) identified from die pharmacy database. Medical records were reviewed and the details of treatment including sotalol dose and indication determined. Creatinine clearance was estimated by the Cockcroft and Gault regression equation. Results: The audit indicated that sotalol was prescribed predominantly for management of atrial arrhythmias (80%). Paroxysmal atrial fibrillation was the most common indication (71%). Although female patients were older (72±13 vs 62+15 years, p<0.001) and had a lower creatinine clearance (55±24 vs 82±32 mg/minute, p<0.001) than male patients, they were prescribed similar doses of sotalol (206±112 vs 193±93 mg/day). The ratio of sotalol dose to creatinine clearance was higher in female patients (4.0±2.6 vs 2.16±1.5, P<0.01). The five patients with proarrhythmia (torsades de pointes in four patients and polymorphic ventricular tachycardia in one patient) were all female. Daily sotalol dose (odds ratio for each 160 mg tablet 4.9 [95% confidence interval 1.5–16] and female gender (p<0.01) were significant risk factors for proarrhythmia'. Conclusion: Sotalol dose was not appropriately adjusted for creatinine clearance which is age and gender dependent. Female patients have an increased risk of proarrhydimia and should receive lower doses of sotalol.
Streptococcus pneumoniae carriage and penicillin/ ceftriaxone resistance in hospitalised children in Darwin
Authors: Skull S. A. , Leach A. J. , Currie B. J. 
Published: March 2008

Abstract Background: The prevalence of resistant Streptococcus pneumoniae (SP) is increasing worldwide. Pneumococcal prevalence and susceptibility patterns are not known for children in the Top End of the Northern Territory. Aims: To determine the prevalence of nasopharyngeal carriage of pneumococci in children hospitalised in Darwin, and the extent of penicillin and ceftriaxone resistance in these isolates. Methods: Nasopharyngeal swabs were collected on admission from 85 children who had not received antimicrobials for their admission illness. Antimicrobial resistance was determined following selective culture for SP isolates. Minimal inhibitory concentrations (MICs) for penicillin and ceftriaxone were determined using the E‐test method. Results: The overall prevalence of nasopharyngeal SP carriage was 44%. Carriage occurred more often in Aboriginal children from rural areas (56%) than in urban children (24%) (OR 3.94, 95% CI 1.35 ‐ 11.78, p<0.01). Thirty per cent of isolates were penicillin resistant, 35% were ceftriaxone resistant, and 49% were resistant to at least one of these. One isolate showed high‐level resistance to both antimicrobials; all other resistant isolates were of intermediate‐level resistance. For the same isolate, MICs for ceftriaxone were more often higher than those for penicillin. Five isolates had intermediate resistance to ceftriaxone whilst remaining sensitive to penicillin. Conclusions: The prevalence of pneumococcal resistance to penicillin and ceftriaxone in hospitalised children in Darwin is much higher than previously reported in Australia. This has implications for future antimicrobial management and highlights the need for regular regional surveillance of SP resistance. The development of conjugate pneumococcal vaccines for children under two years is a priority.
Changes in job aspirations during physician training in Australia
Authors: Kanagarajah S. , Page J. H. , Heller R. F. 
Published: March 2008

Abstract Background: There is uncertainty regarding the effects of physician training on planned practice features of Australian physician trainees, for example plans for urban or rural, full‐time or part‐time and academic/research or purely clinical practice. These plans may differ between male and female trainees and between generalists and sub‐specialists. Aim: To examine the changes in anticipated practice patterns over the course of advanced physician training. Methods: Longitudinal study of doctors in Australia who passed the Part I clinical examination of the Royal Australasian College of Physicians in 1991, 1992 and 1993, followed annually up until 1995. Changes in future practice plans regarding full‐ or part‐time work, rural or urban practice and pure clinical work or a mixture with research were examined among generalist and specialist trainees and among men and women. Statistical analysis included the calculation of chi square for trend statistics and intraclass correlation coefficients. Results: At least one follow‐up questionnaire was received from 80% of the 334 original respondents. The majority had been able to obtain their training job of choice. By the time of last follow‐up, around 80% planned to practise in a capital city, indicating a shift during training from those who initially stated no preference. There was also a shift towards combining research with clinical practice and among women wishing to practise part‐time only. Generalists were more likely to wish to practise outside a capital city than specialists. Conclusions: The training programme should be revised so that careers in rural and provincial centres are encouraged and so that it is sensitive to the needs for physicians to develop research capacity. Training and career opportunities should allow all candidates (particularly women) wishing part‐time employment to achieve their full career potential.
Adult asthma and gastro‐oesophageal reflux: the effects of omeprazole therapy on asthma
Authors: Teichtahl H. , Kronborg I. J. , Yeomans N. D. , Robinson P. 
Published: March 2008

Abstract Background: Approximately 40–60% of patients with asthma have gastro‐oesophageal reflux (GOR) and it has been postulated that this may worsen asthma severity. Aims: To investigate the effect of the potent gastric acid inhibitor omeprazole 40 mg orally daily on peak expiratory flow rate (PEFR), asthma symptoms and histamine bronchial responsiveness in adult patients with both asthma and GOR. Methods: This was a double blind, randomised, placebo controlled, crossover study. Upper gastrointestinal endoscopy, 24 hour oesophageal pH measurements, spirometry and histamine bronchoprovocation test (HIT) were performed prior to entry. Phase 1:2 week placebo run‐in period, with baseline recording of PEFR, asthma and GOR symptoms, and use of inhaled p2‐agonist. Phase 2: patients randomised to receive either placebo or omeprazole 40 mg/d for four weeks. Phase 3: placebo for two weeks. Phase 4: patients crossed over to opposite treatment from that of phase 2. Spirometry, and diary cards were assessed at beginning and end of phases 2 and 4. HIT was performed at the end of phase 2 and at the beginning and end of phase 4. Results: Twenty patients (eight female and 12 male) completed the study. The evening but not morning PEFR (% predicted) were significantly higher on omeprazole vs placebo (82 ± 4% SEM vs 79 ± 4% SEM; p<0.05). No significant differences were found in FEVj, FVC, histamine bronchial responsiveness and diurnal variation of PEFR between placebo and omeprazole treatments. Similarly, there were no significant differences during placebo and omeprazole periods in day time wheeze, cough, breathlessness, p2‐agonist use or night time wheeze and breathlessness. Day and night heartburn symptoms were significantly better on omeprazole vs placebo (p<0.05). Conclusions: Omeprazole 40 mg daily improved evening PEFR in asthma patients with GOR. However, asthma symptoms, inhaled β2‐agonist use and histamine bronchial responsiveness did not change.
Perhexiline improves symptomatic status in elderly patients with severe aortic stenosis
Authors: Unger S. A. , Robinson M. A. , Horowitz J. D. 
Published: March 2008

Abstract Background: The prognosis of severe symptomatic aortic stenosis is poor without aortic valve replacement, with no previous reports of beneficial effects of any medical treatment on either symptoms or outcome. However, this condition is increasingly a disease of the elderly and cardiothoracic surgery is associated with significant mortality and morbidity in this group. Aims: We postulated that perhexiline, a novel anti‐ischaemic agent with an oxygen‐sparing metabolic effect in the myocardium (via inhibition of carnitine palmitoyltransferase‐1) and no adverse haemodynamic effects, may improve symptomatic status in elderly patients with severe aortic stenosis. We report here our initial experience with perhexiline treatment in such patients. Methods: Elderly patients with symptomatic severe aortic stenosis, who were deemed unsuitable for aortic valve replacement, were treated with perhexiline, the drug dosage titrated according to steady state plasma perhexiline concentrations. NYHA functional class was determined prior to and three months following commencement of perhexiline, and changes were analysed using McNemar's test. Results: Fifteen patients, age range 73–87, were followed for up to 30 months (median 18 months). Symptomatic status improved in 13 of the 15 patients over the first three months of perhexiline therapy (p<0.01), five patients becoming asymptomatic. Twelve month actuarial survival was 80% (95% CI=57, 100). Perhexiline was well tolerated, with no withdrawals due to toxicity or deteriorating clinical status. Conclusion: Therapy with perhexiline was associated with a marked improvement in clinical status in this group of elderly patients with severe aortic stenosis.
Transfusion transmitted Yersinia enterocolitica infection in New Zealand
Authors: Theakston E. P. , Baker B. W. , Morris A. J. , Woodfield D. G. , Streat S. J. 
Published: March 2008

Abstract Aims: To update and summarise cases of transfusion‐transmitted Yersinia enterocolitica infection in New Zealand and to evaluate critically suggested methods to reduce this rare but frequently fatal complication of blood transfusion. Methods: Case reports of four recent transfusion‐transmitted Y enterocolitica infections in New Zealand are given and previous reports reviewed. Literature review and evaluation of proposed methods to decrease the incidence of transfusing yersinia contaminated blood. Results: There have been eight cases of transfusion‐transmitted Y enterocolitica infection in New Zealand in the past five years. Four of the five deaths have been directly caused by the transfusion. This gives a transfusion incidence rate of one:65,000 and a fatality rate of one: 104,000 units transfused. This fatality rate is more than 80 times higher than that reported in the United States. Conclusions: Why the incidence of transfusion‐transmitted yersinia is so high is not clear, since we do not store blood as long as many other countries, particularly the United States. In Auckland, however, the cases came at a time when the number of yersinia isolates from the community is reported to be rising.Many suggestions for the prevention of this problem have been put forward reflecting the fact that there is as yet no perfect solution. Those which are easy to implement and cheap to perform are largely already in place and investigation is continuing into the other alternatives.
Time delay in the treatment of acute myocardial infarction (AMI): a comparison of primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolysis
Authors: Hitchcock T. , Kidd H. M. , Taylor R. 
Published: March 2008

Abstract Background: If primary percutaneous transluminal coronary angioplasty (PTCA) cannot be performed within times comparable to thrombolysis, the possible advantages of that management may be offset by the logistic difficulties associated with its delivery. Aim: To measure and compare the time delay involved in administration of thrombolysis and primary PTCA over a one year period and examine causes for delay greater than 60 minutes. Method: Prospective data collection on all patients treated with primary PTCA or thrombolysis. A quality improvement process was applied. Results: Eighty‐five patients were treated with thrombolysis with a delay of 39±8 (SD) minutes, 12 patients being treated more than 60 minutes after presentation. Primary PTCA was used in 79 patients with a delay of 48±12 (SD) minutes, 21 patients being treated after more than 60 minutes. Time delays in the two management groups were significantly different (p=0.03) but that in primary PTCA during routine hours was not significantly different from that in thrombolysis treated patients (p=0.07). Causes for revascularisation delay greater than 60 minutes from presentation are discussed. Conclusions: With appropriate facilities and organisation, patients with acute myocardial infarction presenting within normal working hours can be treated with primary PTCA without compromising their care due to time delay. Many patients managed with primary revascularisation by thrombolysis or primary PTCA with a delay of more than 60 minutes have identifiable clinically appropriate delays.
Sublingual nifedipine in human pregnancy
Authors: Gallery E. D. M. , Gyory A. Z. 
Published: March 2008

Abstract Background: Nifedipine is widely used for acute lowering of blood pressure in obstetric hypertensive emergencies. It has not been approved for this indication or widely assessed. Aims: To examine retrospectively the efficacy of nifedipine over a 12 month period in a high risk obstetric service. Methods: Chart review of all patients admitted to hospital in the antenatal period with moderate to severe hypertension. Description of their management, usage of nifedipine, and pregnancy outcome. Results: Sublingual nifedipine resulted in significant lowering of blood pressure without hypotension. Pregnancy outcome was satisfactory in all patients. Conclusions: Sublingual nifedipine was effective, easy to administer, and without serious complications in this retrospective study.
Early management and outcome of acute stroke in Auckland
Authors: Anderson N. E. , Bonita R. , Broad J. B. 
Published: March 2008

Abstract Background: Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. Aims: To compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. Methods: All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. Results: One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty‐seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of die 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in‐hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. Conclusions: In Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT.
Implementation of guidelines for No‐CPR orders by a general medicine unit in a teaching hospital
Authors: Lowe J. , Kerridge I. 
Published: March 2008

Abstract Background: No‐cardiopulmonary resuscitation (CPR) orders are frequently used to limit the use of cardiopulmonary resuscitation in patients who die in hospital. International research has consistently highlighted major deficiencies in the formulation, documentation and communication of such orders. There has been little Australian research into No‐CPR orders and the impact of clinical guidelines. Aims: This audit aimed to examine compliance with published guidelines for No‐CPR orders previously developed by the hospital Clinical Ethics Committee. Methods: The notes of all patients who died while under the care of the General Medicine Unit during June‐December 1994 were reviewed to evaluate the use of No‐CPR orders. Adherence to hospital No‐CPR guidelines was evaluated as well as the principal diagnosis, age, level of care and competence of patients to state their wishes. Results: A No‐CPR order was documented in 61% (n=40) of the 66 patients who died during this period. Of these patients 80% were judged to be incompetent and were unable to be involved in decisions not to resuscitate. There was substantial compliance with the guidelines, with the exception of documenting involvement of nursing staff. Conclusions: No‐CPR orders are frequently implemented as a result of failure to respond to curative therapy and do not represent abandonment of the patient. Although this study demonstrates the value of No‐CPR guidelines and the audit process, the findings raise fundamental issues regarding the involvement of nursing staff, and of patients, that need to be further addressed.
Inappropriate sinus tachycardia (1ST): management by radiofrequency modification of sinus node
Authors: Jayaprakash S. , Sparks P. B. , Vohra J. 
Published: March 2008

Abstract Background: Inappropriate sinus tachycardia (IST) is a rare form of supraventricular arrhythmia. It can cause disabling symptoms and may be refractory to medical treatment. In symptomatic drug refractory patients, sinus node excision or total ablation of the sinus node with permanent pacemaker implantation was the only therapeutic option. Recently, radiofrequency (RF) modification of the sinus node has been reported to be an effective treatment for this condition. Aim: To present our experience with sinus node modification using RF energy in the management of 1ST Methods: Between 1989> to 1996 three patients (two females and one male), aged 28–36 years were diagnosed with symptomatic IST All had failed multiple drugs and hence underwent sinus node modification using RF. In the first two patients, the site of RF application was guided by anatomical landmarks using fluoroscopy to localise the presumed most superior portion of the crista terminalis and also the earliest site of atrial activation. In fhe third patient, a 20 pole electrode catheter was used to map the crista terminalis and guide the ablation. Success was defined by 20–30% reduction in the heart rate with normal atrial activation sequence after ablation. Results: The three patients described here had IST by clinical, electrocardiographic and electrophysiological criteria and were refractory to multiple antiarrhythmic drugs. The number of RF applications were 11, 15, and three applied at the site of earliest atrial activation for the control of heart rates. Patient 3 had a early recurrence at one month and underwent repeat sinus node modification (five RF applications). All three patients who underwent RF modification of the sinus node had a successful outcome. The procedure was uncomplicated and the patients remain asymptomatic during follow up (20, 12 and three months) with satisfactory control of heart rate, although one patient requires atenolol which was previously ineffective. Conclusions: RF modification of the sinus node is feasible and effective for IST, and should be the treatment of choice in patients refractory to medical therapy.