bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing asthma in accident and emergency departments: an assessment in non teaching hospitals
Authors: Jayasuriya R. , Westley‐Wise V. , Dunn T. , Nydam K. , Jeffs D. 
Published: March 2008

Abstract Background: The management and follow‐up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals. Aims: To study the adequacy of assessment, treatment and follow‐up of patients presenting at A&E departments in non‐teaching hospitals. Methods: A twenty‐five per cent sample of presentations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demographics, assessment, management and referral was extracted from the A&E case notes and medical records of cases with documentation of a final diagnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals. Results: Of 359 presentations with a final diagnosis of asthma, 88% were self referred and only 5% were first presentations. Objective measures of airways obstruction was not documented in 34% of admissions and 48% of nonadmissions. There was no documented follow‐up in 28% of cases. The assessment and management of asthma in A&E was significantly poorer in smaller hospitals. Conclusion: Evidence of high use of A&E as a primary care facility by asthma patients was found in the study. There is a need to implement protocols to optimise assessment and treatment of asthma in smaller hospitals. (Aust NZ J Med 1993; 23: 672–677.).
Interferon alpha and doxorubicin in malignant mesothelioma: a phase II study
Authors: Upham J.W. , Musk A.W. , van Hazel G. , Byrne M. , Robinson B.W.S. 
Published: March 2008

Abstract Background: Malignant mesothelioma is a tumour which is generally resistant to chemotherapy. While the addition of interferon to chemotherapy improves response rates in some other malignancies, such a combination has not been evaluated in the treatment of mesothelioma. Aims: To assess the anti‐tumour effects and toxicity of interferon‐alpha combined with doxorubicin in the treatment of pleural mesothelioma. Methods: Twenty five patients (mean age 54 ± 11 years) were enrolled in a phase II study. All patients had a confirmed histological diagnosis, measurable tumour, a life expectancy of at least three months, and no prior chemotherapy or interferon. Interferon alpha‐2a, 9 × 106 U sc daily, was administered together with doxorubicin 25 mg per m2 i.v. weekly, for 12 weeks. Response status was assessed by tumour measurements on clinical examination and thoracic CT scans before and after treatment. Results: A partial response was observed in four patients (16%; 90% CI, 8–30%), 11 remained stable, while six had progressive disease. Four patients withdrew within the first month because of toxicity. The median survival of all patients was 11 months (95% CI, 3–19). Dose modification as a result of toxicity was required in all patients. Lethargy, weight loss, leukopenia and vomiting were the most common side effects. Conclusions: The combination of interferon‐alpha and doxorubicin showed only modest activity and was associated with significant toxicity. It cannot be recommended in the treatment of malignant pleural mesothelioma. (Aust NZ J Med 1993; 23: 683–687.)
Adult congenital heart disease: principles and management guidelines: Part II
Authors: Wilson N. J. , Neutze J. M. 
Published: March 2008

Part 1 of this article (Aust NZ J Med 1993; 23: 498–503) discussed the concept of a new medical group of young adults with repaired congenital heart defects. Medical and life issues for these individuals include career prospects, insurability, pregnancy and contraception, genetic counselling, appropriate exercise, risks of non‐cardiac surgery, and the need for infective endocarditis prophylaxis.Most adults with congenital heart disease lead remarkably normal lives but need intermittent medical follow‐up, some as inpatients. Medical management guidelines are discussed in Part II of this review by highlighting important individual lesions.
Mortality results in GUSTO
Authors: van de Werf Frans 
Published: March 2008

Abstract:The mortality results for the four arms of the GUSTO trial are presented. The 30 day mortality results were as follows: streptokinase (SK) and subcutaneous heparin (n=9796), 7.2%, SKand intravenous heparin (n=10,377) 7.4%, accelerated tissue plasminogen activator (t‐PA) and intravenous heparin (n = 110,344) 6.3%, and combined SK and t‐PA (n=10,328) 7.9%. This is a relative risk reduction of 14% for the accelerated t‐PA regimen compared with the two SK regimens equivalent to an absolute risk reduction of ten lives saved per 1000 patients treated. Predefined subgroups who showed a greater benefit with t‐PA versus SK were patients under the age of 75, anterior infarct location and those treated within four hours of onset of symptoms. (Aust NZ J Med 1993; 23: 000‐000.)
Repeat thrombolysis
Authors: Cross David 
Published: March 2008

Abstract:Since 20% of patients with myocardial infarction (MI) have had a previous infarction, and reinfarction within one year after infarction occurs in 9% of cases, it is important to clarify the role of repeat thrombolysis.After streptokinase (SK) administration, IgG antibodies rise to a peak at two weeks and slowly fall over the next 12 months, but 50% of patients still have antibody levels sufficient to neutralise a standard dose of SK up to four years after initial SK administration. On this evidence, SK or anistreplase should not be readministered, except perhaps in the first two to three days after initial treatment. The efficacy of tissue plasminogen activator (t‐PA) and urokinase is not affected by prior treatment with SK. (Aust NZ J Med 1993; 23: 749–752.)
The role of angioplasty in acute myocardial infarction
Authors: Ross Allan 
Published: March 2008

Abstract:The role of primary angioplasty versus thrombolytic therapy for the treatment of coronary thrombosis has been the subject of recent randomised trials. They have shown a higher early patency rate after angioplasty with no differences in later patency. Recurrent ischaemia was more frequent after thrombolysis, but the one study that examined myocardial salvage showed no difference. There were fewer intracerebral bleeds in the angioplasty group, but owing mostly to much higher than usual stroke occurrence in the thrombolysis group.With less than 800 patients in all the studies, no final conclusions can yet be drawn about effects on mortality and larger studies are needed. Primary angioplasty is an option when operators are skilled and the procedure can be done quickly. (Aust NZ J Med 1993; 23: 753–755.)
ISIS 5 possibilities
Authors: Hunt David 
Published: March 2008

Abstract:There are five major therapeutic groups for possible evaluation in the ISIS 5 trial. They include intravenous beta‐blocking agents, glucose‐insulin‐potassium (GIK) therapy, newer anticoagulant and antithrombotic agents (hirudin and Hirulog), newer thrombolytic drugs such as recombinant plasminogen activator (r‐PAJ and surfactant and emulsifying agents such as Rheothrx. Many pilot studies are underway. Selection of agents will depend on the scientific interest of collaborating hospitals as well as the agent's safety and efficacy.
Acute treatment of paroxysmal tachycardia by adenosine
Authors: Ho K.Y. , Wilson N. J. , Smith W. M. 
Published: March 2008

Abstract Background: Adenosine has proven efficacy in clinical trials and in the electrophysiological laboratory for the treatment of paroxysmal tachycardia. Aims: To evaluate the efficacy and safety of adenosine administered in a clinical setting by non‐consultant staff. Methods: Incremental doses of adenosine were administered intravenously to five children and 32 adults during 39 episodes of paroxysmal tachycardia in a clinical setting. Structural heart disease was present in 43% of patients. Results: Of 35 episodes of narrow complex tachycardia, adenosine terminated 26 of 28 episodes of supraventricular re‐entrant tachycardia (SVRT), one episode of ectopic atrial tachycardia, and induced transient atrioventricular block to reveal atrial arrhythmias in four. Termination of SVRT occurred at a mean (SD) dose of 9.2 (4.0) mg in adults and 0.09 (0.04) mg/kg in children, but two patients had later spontaneous reinitiation of SVRT. Two patients with narrow complex tachycardia who failed to respond to adenosine were subsequently found to have ventricular tachycardia. Adenosine was therapeutic or diagnostic in three of four episodes of broad complex tachycardia. Overall, by intention to treat by the clinician, adenosine was therapeutic or diagnostic in 34 of 39 episodes (87%). Breathlessness (26%), chest tightness (18%) and flushing (18%) occurred transiently. There were no episodes of hypotension. Adenosine was given safely to 15 patients in whom verapamil was considered contraindicated. Conclusions: Adenosine is a safe treatment for both narrow and broad complex tachycardias; usually effective for the former and diagnostic for the latter.
A comparison of hepatitis C virus (HCV) RNA and – antibody as markers of infection and predictors of infectivity
Authors: Beardsley A. M. , LaBrooy J. T. , Rozen L. , Gowans E. J. 
Published: March 2008

Abstract Background: The diagnosis of hepatitis C virus (HCV) infection currently relies on the detection of antibody to HCV (anti‐HCV). However, anti‐HCV positivity may indicate past infection, current infection or possibly non‐specific reactivity. For confirmation of current infection the virus needs to be assayed directly and this is possible by the polymerase chain reaction (PCR). Aims: The aims were to compare HCV RNA and anti‐HCV as markers of infection in two groups of individuals: (i) a heterogeneous group with suspected HCV infection and (ii) a small group of blood and bone marrow donors, and their respective recipients. Methods: Serum samples were tested for alanine aminotransferase (ALT) as part of a liver function screen, for anti‐HCV by ELISAII, and HCV RNA was detected by PCR. Single round and nested PCR was performed using primers designed from the sequence of the 5′‐untranslated region of the HCV genome. Results: Of the 36 subjects in the heterogeneous group, 19/22 anti‐HCV‐positive patients with chronic non‐A non‐B hepatitis (NANBH) were viraemic, and the majority (17/19) demonstrated elevated ALT. However, HCV RNA was undetected in seven anti‐HCV‐positive patients, four of whom suffered autoimmune hepatitis Type I and three were low risk blood donors. Of the remaining subjects (seven/36) who were anti‐HCV‐negative, three/seven were HCV‐RNA‐positive and included two with acute post‐transfusion (PT) NANBH and a recent needlestick victim who contracted HCV. In the second group, four individuals (donors), including a mother with a history of drug use, were implicated in transmission to three recipients. ALT levels were normal in all donors but raised in two of the recipients. PCR determined which of two anti‐HCV‐negative blood donors was infectious, confirmed transmission between a bone marrow donor and recipient, and indicated that anti‐HCV detected in a newborn child represented passive transfer of antibody. Conclusions: Anti‐HCV detected by ELISA II is a useful marker of chronic HCV infection, particularly in association with raised ALT. However, HCV RNA is a superior marker of acute HCV infection, a more reliable predictor of infectivity and is more specific.
Seroprevalence of hepatitis A antibodies among residents of a centre for people with developmental disabilities
Authors: Bell J. C. , Crewe E. B. , Capon A. G. 
Published: March 2008

Abstract Background: In February 1993,11 cases of hepatitis A virus (HAV) were identified in permanent residents of a centre for young people with developmental disabilities. Aims: To define the extent of the outbreak in the centre, to determine the seroprevalence of hepatitis A antibodies (anti‐HAV) in permanent residents, and to ascertain risk factors for serological evidence of HAV infection. Methods: A cross‐sectional serological survey of 270 permanent residents, aged eight to 40 years, in a centre for people with developmental disabilities, was conducted in western Sydney. Using a radioimmunoassay technique, sera were tested for anti‐HAV (IgM and total antibody). We used logistic regression to determine risk factors for presence of anti‐HAV. Results: Blood samples were collected from 259 permanent residents (96%). Serological testing revealed anti‐HAV in 128 residents tested (49%). Presence of anti‐HAV was associated with living in specific residential units, and with residents' age and length of stay at the centre, but was not associated with reported behavioural factors. Conclusions: More than half of the residents of the centre were susceptible to HAV infection. Behavioural characteristics of the residents and their close contact with each other make HAV transmission difficult to control. HAV vaccine should be promoted in communities at risk, such as those with developmental disabilities. (Aust NZ J Med 1994; 24: 365–367.)
Accuracy of reported family history of heart disease: The impact of ‘don't know’ responses
Authors: Silberberg J. , Wlodarczyk J. , Hensley M. , Ray C. , Alexander H. , Basta M. , Hughes J. 
Published: March 2008

Abstract Background: Usual ‘Yes/No’ definitions of a family history of heart disease do not allow for ‘Don't know’ responses. In some families, misclassification of family history may result if these are not considered. Aims: To study the accuracy of family history reporting and the impact of ‘Don't know’ responses. Methods: We compared reported family history of coronary heart disease (CHD) and cancer among 360 deceased relatives of 59 probands with ‘gold standard’ diagnoses recorded on official death certificates. Results: For first degree relatives, sensitivity of reporting was 81% for CHD, 86% for any heart disease and 60% for cancer, while for second degree relatives, sensitivity was 73%, 69% and 90%, respectively. When ‘Don't know’ responses were classified as ‘No’, sensitivity in first degree relatives was not affected, but in second degree relatives, it fell to 49%, 41% and 60%, respectively. Specificities were unchanged. These data show that in families where information beyond first degree relatives is considered, failing to account for ‘Don't know’ responses is likely to lead to misclassification of family history of CHD. (Aust NZ J Med 1994; 24: 386–389.)
Rates of progression to end stage renal failure in nephropathy secondary to Type 1 and Type 2 diabetes mellitus
Authors: Bruce R. , Williams L. , Cundy T. 
Published: March 2008

Abstract Background: Diabetic nephropathy is now the commonest single cause of end‐stage renal failure (ESRF) in New Zealand. Aims: To investigate differences in the natural history of established nephropathy in Type 1 and 2 diabetes. Methods: Retrospective analysis of the rate of progression to ESRF in 17 subjects with Type 1 diabetes (predominantly European) compared to 29 subjects with Type 2 diabetes (all Polynesian). The rate of decline of renal function was determined from serial creatinine measurements (median 5, range 3–8) during progression of chronic renal failure to end stage. Glomerular filtration rate (GFR) was estimated from creatinine measurements using the Cockcroft Gault equation, and the regression slope of these measurements against time was used to determine rate of change of renal function. Results: GFR fell significantly more rapidly in the group with Type 2 diabetes than in those with Type 1 diabetes: median 1.7 (interquartile range 1.2 to 2.3) mL min‐1 month‐1 vs 1.1 (interquartile range 0.4 to 1.5) mL min‐1 month‐1, p = 0.017. During the study period the mean reduction in diastolic blood pressure in subjects with Type 1 diabetes (15 mmHg) was greater than that in the Type 2 subjects (8 mmHg), but the stage at which antihypertensives were commenced was similar in the two groups. Glycaemic control was worse in the subjects with Type 1 diabetes (p < 0.005). The differences in blood pressure control were not significant on analysis of covariance which indicated that ethnicity was the major determinant of the different rates of decline of GFR between the groups. We conclude that in subjects with diabetic nephropathy the rate of progression to ESRF is more rapid in Polynesians with Type 2 diabetes than in Europeans with Type 1 diabetes. This could contribute to the apparent excess of Type 2 diabetic subjects of Polynesian origin on renal replacement programmes in New Zealand. (Aust NZ J Med 1994; 24: 390–395.)
Phase II study of glycosylated recombinant human granulocyte colony‐stimulating factor after HLA‐identical sibling bone marrow transplantation
Authors: Lickliter J. D. , Roberts A. W. , Grigg A. P. 
Published: March 2008

Abstract Background: The lengthy period of neutropenia which follows allogeneic bone marrow transplantation (BMT) results in significant morbidity and some mortality. Recombinant human granulocyte colony‐stimulating factor (rhuG‐CSF) effectively reduces neutropenia and morbidity when given after autologous BMT, but has not been adequately investigated in allografts. Aims: To assess the tolerability, safety and efficacy of rhuG‐CSF after allogeneic BMT. Methods: rhuG‐CSF was administered to 13 adult patients with haematological malignancies after HLA‐identical sibling BMT. Five μg/kg of rhuG‐CSF was given daily by subcutaneous bolus injection, commencing four hours after marrow infusion and continuing until the neutrophil count was ≥ 1.0 × 109/L on three consecutive days. Graft‐versus‐host disease (GVHD) prophylaxis was cyclosporin and short‐course methotrexate (days 1, 3, 6 and 11). Prophylactic intravenous (IV) antibiotics were administered from the onset of neutropenia. The control group consisted of patients with comparable diagnoses, transplanted before and after the current study using identical supportive care and GVHD prophylaxis policies. Results: Although time to recovery of the neutrophil count to >0.1 × 109/L was similar, the rhuG‐CSF‐treated patients experienced accelerated recovery to > 0.5 × 109/L, which occurred at a median of 15 days (range 11–21) after marrow infusion in study patients compared to 18.5 days (range 14–41) in the controls (p = 0.04). No significant differences were detected in any of the indices of transplant‐related morbidity examined, including the number of days of fever, the incidence of culture‐positive infections, the usage of antibiotics, the requirement for parenteral nutrition and IV morphine, the maximum severity of mucositis and GVHD, and the day of discharge. Conclusion: Within the context of this study, rhuG‐CSF had limited impact on the clinical outcome of HLA‐identical sibling BMT. (Aust NZ J Med 1994; 24: 541–546.)
Sheepskins and bedding in childhood, and the risk of development of bronchial asthma
Authors: Flannery E. M. , Herbison G. P. , Hewitt C. J. , Holdaway M. D. , Jones D. T. , Sears M. R. 
Published: March 2008

Background: Sheepskin bedding might increase house dust mite exposure and so explain some of the increasing prevalence or severity of childhood asthma. Methods: Relationships between use of different types of bedding, and diagnoses of asthma, symptoms of wheezing, skin prick test evidence of house dust mite sensitivity, and airway responsiveness to methacholine, were examined retrospectively in a birth cohort of children followed longitudinally to age 15 years. Results: In the whole cohort, no associations were identified to suggest a causal relationship between use of any type of bedding and development of features of asthma. Although not an a priori hypothesis, we noted that among children with a family history of atopic disease, those who were house dust mite sensitive were more likely to have used an innerspring mattress (29.6% vs 10.2% who had not used an innerspring mattress, ρ= 0.005). Conclusion: In this subgroup, increased airway responsiveness and mite sensitivity were significantly associated with use of innerspring mattresses, although whether this is a causal or secondary association is not certain. Use of a sheepskin in the bed in early childhood was not an additional risk factor for the development of asthma. (Aust NZ J Med 1994; 24: 687–692.)
Trends in the incidence of end‐stage renal failure due to hypertension and vascular disease in Australia, 1972–1991
Authors: Stewart J. H. , Disney A. P. S. , Mathew T. H. 
Published: March 2008

Background: Despite the known protective effects upon renal function of lowering blood pressure in primary chronic renal disease, diabetes and malignant hypertension, the number of patients entering dialysis and transplantation programmes with renal failure due to hypertension or vascular disease remains high. Aims: To analyse the trends in incidence of arteriopathic end‐stage renal failure. Methods: Calculation of mean annual age‐ and sex‐specific rates (by decade) and truncated age‐standardised rates for entry into Australian end‐stage renal failure programmes in the period 1972–1991. Statistical analysis by chi‐squared test, assuming a Poisson distribution of cases. Results: End‐stage renal failure attributed primarily to hypertension or vascular disease fell to less than half its former level over the period of observation in persons aged 15–54 years. This change has occurred only in the diagnostic category ‘malignant hypertension’. Trends in persons aged 55 years and over are more difficult to analyse because of changing criteria for entry into renal failure programmes, but there has been no indication of any fall in incidence. Conclusions: The aetiology and pathology of arteriopathic renal failure is diverse, with different patterns in young and old adults. The formerly common pathology in young adults is largely preventable by modern antihypertensive therapy, while arteriopathic renal disease in older persons is not. (Aust NZ J Med 1994; 24: 696–700.)
Asthma severity and morbidity in a population sample of Sydney schoolchildren: Part II ‐ Importance of house dust mite allergens
Authors: Peat J. K. , Tovey E. , Gray E. J. , Mellis C. M. , Woolcock A. J. 
Published: March 2008

Abstract Background: Despite an increasing prevalence of childhood asthma, few studies have quantified the strength of associations between asthma and its aetiological factors. Aims: To quantify the risk factors associated with childhood asthma and to investigate the characteristics of children most at risk. Methods: We studied a population sample of 1339 schoolchildren aged eight‐11 years living in Sydney, NSW. Questionnaires were used to measure respiratory illness, histamine inhalation test to measure airway hyperresponsiveness (AHR), skin prick tests to measure atopy and ELISA assay to measure house dust mite allergen (Der p I) levels. ‘Current asthma’ was defined as the presence of wheeze in the previous year and AHR. Results: The mean Der p I level in 72 homes was 22.5 μg/gm dust which is high compared to suggested thresholds of 2 μg/gm for sensitisation and 10 μg/gm for exacerbation of symptoms. Sensitisation to house dust mites was the most important risk factor for current asthma (odds ratio 7.0, 95% CI 9.4, 22.2). Sensitisation to ryegrass was of minor importance (odds ratio 2.0, 95% CI 1.4, 3.1). The presence of AHR was strongly related to the degree of sensitisation to house dust mite allergen and children with skin wheals greater than 4 mm had frequent morbidity caused by asthma. Conclusions: To reduce the high prevalence of childhood asthma in NSW, it is imperative that we design interventions which recognise that house dust mite allergens are a dominant risk factor and that children with large skin wheal reactions to this allergen are most at risk for severe illness including disturbed sleep, days missed from school and urgent medical attention.