bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment and relevance of enzyme‐linked immunosorbent assay for antibodies to Saccharomyces cerevisiae in Australian patients with inflammatory bowel disease
Authors: Moore M. M. , Fabricatorian D. , Selby W. S. 
Published: March 2003

Abstract The frequency of antibodies to Saccharomyces cerevisiae (ASCA) in Crohn’s disease, ulcerative colitis and non‐inflammatory bowel disease controls has been compared using two commercially available assays. The Medizym test resulted in sensitivity of 50% and specificity
of 93% for Crohn’s disease. The corresponding figures for the QUANTA Lite assay were 79% and 74%,
respectively. Using ASCA and ­perinuclear antineutrophil cytoplasmic antibody (pANCA) in combination, the sensitivity and
specificity of ASCA+/pANCA− for Crohn’s disease using the Medizym kit were 50% and
100%, respectively, compared with 79% and 93% using QUANTA Lite. ASCA−/pANCA+ was 100% specific for ulcerative colitis with either assay. ASCA can be found in ­Australian patients with Crohn’s disease at a similar frequency to that reported overseas. (Intern Med J 2002; 32: 349−352)
Measurement variability in sleep disorders medicine: the Victorian experience
Authors: Manser R. L. , Rochford P. , Naughton M. T. , Pierce R. J. , Sasse A. , Teichtahl H. , Ho M. , Campbell D. A. 
Published: March 2003

Abstract Background: Surveys of laboratories in North America have documented significant diversity in the working definitions used for reporting respiratory events in sleep studies. Aim: To assess sources of variability in the measurement of sleep‐disordered breathing (as defined by the Apnoea−Hypopnoea Index) between sleep laboratories in Victoria, Australia. Methods: A self‐complete written questionnaire was constructed following literature review and interviews with staff at three separate sleep laboratories. The survey was sent to all laboratories listed in Victoria by the Australasian Sleep Association. The first part of the survey related to the type of equipment used to record sleep and other variables during overnight polysomnography and the second part related to the definitions and methods used to report results. Results: Seventeen out of 18 laboratories returned the surveys. There were variations identified in the types of sensors used to measure particular signals. There were also inconsistencies identified in the criteria used to score arousals, apnoeas and hypopnoeas by different laboratories. The variability was greatest for hypopnoea definitions. Conclusions: There is considerable variation in the methods used to measure and define sleep‐disordered breathing between sleep laboratories in Victoria. The extent to which these variations influence the comparability of reported results between laboratories requires further evaluation. The survey findings may assist the process of developing and implementing local guidelines for the performance and reporting of polysomnography. (Intern Med J 2002; 32: 386−393)
Quality of care of patients hospitalized with acute coronary syndromes
Authors: Scott I. A. , Denaro C. P. , Flores J. L. , Bennett C. J. , Hickey A. C. , Mudge A. M. 
Published: March 2003

Abstract Background:  Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high‐risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions.Aim:  To evaluate the quality of in‐hospital care for patients with ACS, using explicit quality indicators.Methods:  Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main out­come measures were 12 process‐of‐care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received ­specific interventions (i.e. patients with clear indi­cations and lacking contraindications).Results:  Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta‐blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid‐lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely per­formance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin‐converting‐enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non‐invasive risk assessment (23%) and (ii) formal in‐hospital and post‐hospital cardiac rehabilitation (47% and 7%, respectively).Conclusion:  There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non‐invasive procedures for identifying high‐risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation. (Intern Med J 2002; 32: 502−511)
Evaluation of health‐care worker vaccination in a tertiary Australian hospital
Authors: Stewart S. , Murray S. B. , Skull S. A. 
Published: March 2003

Abstract Background : Maintaining a complete vaccination status for health‐care workers (HCWs) is important to minimize morbidity among staff and patients. Despite recommendations from public‐health authorities to support this process, not all hospitals have adequate policy and practice in place.Aims : To independently assess the implementation and impact of a new policy aimed at improving HCW vaccination coverage in a tertiary Victorian hospital.Methods : Two cross‐sectional surveys were conducted by telephone in July and October 2000 for a random sample of HCWs, before and after the introduction of the policy. These surveys examined knowledge, attitudes and practices surrounding vaccination and self‐reported vaccination status. Policy implementation was assessed by ascertaining completion of compulsory vaccination status forms and attendance at suggested appointments to review vaccination status.Results : Only 19% of 269 HCWs reported a complete vaccination status at baseline. Most (76%) had not heard of or seen vaccination guidelines and 39% kept written vaccination records. This was despite a belief in the importance of vaccination (94%) and a willingness to update if necessary (96%). At follow up there was no improvement in any outcome. Only 11/26 (42%) newly employed HCWs surveyed received and returned compulsory vaccination status forms. Of the few HCWs who attended recommended vaccination appointments, all received vaccinations.Conclusions : HCW vaccination coverage and knowledge of vaccination requirements were poor. Although attending a physician to discuss vaccination status did result in vaccination, few HCWs made such an appointment. While policy development is an important first step towards improving vaccination coverage, effective implementation requires ongoing evaluation, adequate resources and HCW education. (Intern Med J 2002; 32: 585−592)
Live donor renal transplantation in Australia 1964−1999: an evolving practice
Authors: Prasad S , Russ G. , Faull R. 
Published: March 2003

Abstract Background:  Australia has a low cadaver organ donor (CD) rate by international standards, leading to the increasing use of live donor (LD) renal grafts.Aims:  To review the Australian experience with LD transplants from 1964 to 1999.Methods: Data were obtained from the Australian and New Zealand Dialysis and Transplant Registry. Survival was assessed by the Kaplan−Meier method.Results:  A total of 1584 LD and 10 252 CD transplants was performed between 1964 and 1999. While the CD rate dropped over the last decade, the LD rate increased, maintaining the overall transplan­tation rate. Only 3.6% of grafts before 1980 were LD, increasing to 28.4% during 1995−1999. Patient and graft survival of LD grafts was superior to CD grafts. Most LD grafts were from live related donors (LRD), most commonly parents or siblings. The number of transplants from live unrelated donors (LURD) has risen (1980−1989, n = 6; 1990−1999, n = 143), ­primarily due to more spousal donation, with no ­difference in survival between LRD and LURD groups. Grafts from older donors (>50 years of age) increased, with no graft survival difference between donors <50 years and donors >50 years. LD transplants performed prior to commencement of dialysis increased, with survival similar to grafts performed after dialysis.Conclusion: The pattern of renal transplantation in Australia has changed, with increasing numbers of LD transplants, growing use of unrelated and older donors, and more transplants before dialysis commences. Long‐term patient and graft survival advantages have been maintained, supporting the growing use of live donors to expand the donor pool. (Intern Med J 2002; 32: 569−574)
Adjuvant chemotherapy in colon cancer: what is the evidence?
Authors: Haydon A. 
Published: March 2003

Abstract Over the last 12 years, numerous randomized trials have addressed the role of adjuvant chemotherapy in resected colon cancer. Together, these studies give conclusive evidence of the benefit of adjuvant 5‐fluorouracil combined with folinic acid in stage III (node positive) disease and this is now considered the standard of care. The chemotherapy appears to be equally effective whether it is given daily for 5 days per month or on a weekly schedule. The overall effect is a relative reduction in tumour ­recurrence of 25% or an absolute improvement in survival of 10%.However, doubt remains as to the role of adjuvant chemotherapy in stage II colon cancer. To date, most of the randomized trials have demonstrated a relative reduction in tumour recurrence but have not shown any significant impact on survival. It seems likely that this inability to demonstrate a survival benefit from adjuvant chemotherapy in stage II disease relates to the fact that the trials have been underpowered to do so. Nevertheless, the absolute survival advantage is only about 2% and clinicians need to weigh this against the costs and toxicities of the treatment when managing these patients. (Intern Med J 2003; 33: 119−124)
Comparison of endtidal CO2 and arterial blood gas analysis in paediatric patients undergoing controlled ventilation with a laryngeal mask or a face mask
Authors: Özlü O. , Öcal T. 
Published: March 2003

SummaryEndtidal CO2 (PeCO2) and arterial blood gas tensions were compared between laryngeal mask (LMA) and face mask (FM) ventilation in paediatric outpatients. Following premedication with midazolam, anaesthesia was induced with either thiopentone or isoflurane and atracurium. Anaesthesia was maintained with N2O, O2 and isoflurane. Manually controlled ventilation was applied with a nonrebreathing system. Both PeCO2 and arterial blood gas tensions were measured at 5 and 15 min after skin incision. The mean PaCO2 values in the LMA group were 36.6±7.4 and 37.5±6.4 mmHg and PaCO2–PeCO2 were 1.8±2.4 and 2.5±3.3 mmHg, respectively. The mean PaCO2 values in the FM group were 41.3±8.1 and 43.4±8.9 mmHg; and PaCO2–PeCO2 were 5.3±3.6 and 8.8±7.0 mmHg, respectively. These values were lower in the LMA group (P< 0.05). We have concluded that monitoring of PeCO2 is more reliable for estimating blood gas values during controlled ventilation with a LMA than a face mask.
Resistance to vecuronium in burned children
Authors: UYAR M. , HEPAGUŞLAR H. , UĞUR G. , BALCIOĞLU T. 
Published: March 2003

SummaryWe compared the time‐course of action of vecuronium in 16 burned children undergoing excision and autograft surgery with that of ten unburned children. Standardized anaesthesia was induced with thiopentone 4–6 mg kg−1 and fentanyl 1 μg??kg−1 and maintained with endtidal 1–1.5% isoflurane in N2O/O2. Neuromuscular responses were monitored by acceleromyography (TOF‐Guard, Organon Teknika/Biometer) with supramaximal train‐of‐four (TOF) stimuli delivered every 15 s. Vecuronium 0.1 mg kg−1 was administered intravenously. Onset was recorded as the time, in seconds, between the initial bolus of vecuronium and a decline in the first twitch of TOF (T1) to 5% of control. The times for the recovery of T1–25%, 50% and 75% of control, recovery index and the recovery of TOF 25% and 50% were recorded. Onset of action was found slower in burned patients (189??70 s) than in control (98??20 s) (P< 0.01). Recovery times of T125, T150, T175, TOF25 and TOF50 were significantly shorter in burned patients indicative of decreased sensitivity to vecuronium (P< 0.01).
Sedation failures in children undergoing MRI and CT: is temperament a factor?
Authors: Voepel‐Lewis Terri , Malviya Shobha , Prochaska Gerrie , Tait Alan R. 
Published: March 2003

SummaryThis study examined the relationship between temperament and sedation failure during magnetic resonance imaging (MRI) and computerized tomography (CT). One hundred and two children (aged 3–7 years) who underwent MRI or CT with or without sedation were studied. Demographics, sedatives administered, efficacy of sedation, and adverse events were recorded. Parents completed the Behavioural Style Questionnaire for 3–7 years olds during their wait. Eight children underwent MRI successfully without sedation, 83 were successfully sedated, and 11 procedures were aborted. Children whose sedation failed were less adaptable than children whose sedation was successful (P =0.04). Children who underwent MRI without sedation were more persistent than children who were sedated (P =0.05), and more persistent and less active than those whose sedation failed (P =0.02 and 0.03, respectively). The child's underlying temperament may contribute to sedation outcomes during MRI and CT. A presedation assessment of the child's temperament may therefore assist in decisions regarding sedation.
Safety and efficacy of peribulbar block as adjunct to general anaesthesia for paediatric ophthalmic surgery
Authors: Deb Kallol , Subramaniam Rajeshwari , Dehran Maya , Tandon Radhika , Shende Dilip 
Published: March 2003

Methods: Fifty children (age 5–14 years, ASA I–II) undergoing elective ophthalmic surgery were chosen for the study. Of these, 25 received intravenous pethidine (control group) and 25 received a peribulbar block (block group) for perioperative analgesia, and were monitored intraoperatively and postoperatively by an investigator blinded to the analgesic technique.Results: Intraoperative values of haemodynamic variables were significantly higher in the control group (P < 0.01). Requirement for intraoperative rescue analgesic and postoperative analgesia was higher in the control group (P < 0.05 andP < 0.001, respectively). Children in the block group had lower postoperative pain scores at all times. Incidence of oculocardiac reflex was significantly higher (P < 0.001) in the control group. Seventy‐six percent of children in the control group had postoperative nausea and vomiting compared to 20% children in the block group (P < 0.001).Conclusions: There were no complications related to the block. Peribulbar block appears to be a safe and useful analgesic technique for paediatric ophthalmic surgery.
Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airwayTM, tracheal tube and face mask
Authors: Özlü Onur , Türker Arzu Kiliç , Özgün Gülten , Soykan Irfan 
Published: March 2003

Background: Distal oesophageal pH was measured during controlled ventilation in children with the laryngeal mask airway (LMATM), tracheal tube (TT) and face mask (FM). Methods: Fifty‐six children scheduled for inguinal surgery with a standardized general anaesthetic technique were randomly allocated to receive LMA (n=21), TT (n=18) or FM (n=19). A 14 Fr pH probe was placed into the distal oesophagus and pH values were measured over 1 min at 2‐min intervals during the first 20 min of anaesthesia. Results: The median values of pH were 4.4 (3.5–5.5), 4.2 (3.3–4.9), 4.1 (3.2–5.1), 4.1 (3.3–5.0), 4.0 (3.3–4.9), 4.0 (3.4–5.1); 4.2 (3.3–5.1), 4.2 (3.6–5.0), 4.2 (3.5–5.0), 4.2 (3.5–5.2), 4.2 (3.5–5.0), 4.1 (3.5–5.0) and 4.2 (3.6–5.0), 4.2 (3.8–5.8), 4.1 (2.8–5.2), 4.2 (3.3–5.1), 4.2 (3.4–5.1), 4.3 (3.4–5.1) for LMA, TT and FM groups, respectively. Conclusions: There was no difference in the median pH values, within and between the groups (P > 0.05). We conclude that there is no difference in gastro‐oesophageal reflux, when using a LMA, TT or FM during controlled ventilation in anaesthetized children.
Comparison of caudal morphine and tramadol for postoperative pain control in children undergoing inguinal herniorrhaphy
Authors: Ozcengiz D. , Gunduz M. , Ozbek H. , Isik G. 
Published: March 2003

Objectives: We compared the quality and duration of analgesia, the effect on perioperative sevoflurane requirement after a single, presurgical caudal block with either tramadol or morphine in children undergoing inguinal herniorrhaphy. Our study was also designed to evaluate the preemptive analgesic efficacy of morphine administered caudally in children. Methods: Patients were randomly divided into three groups to receive 2 mg·kg–1 tramadol (group T, preemptive group) or morphine sulphate 0.03 mg·kg–1 (group M, preemptive group). The patients in control group (group C, postincisional group) received morphine sulphate 0.03 mg·kg–1 at the end of surgery, caudally. Cardiorespiratory data, sedation and pain were recorded for 24 h following recovery from anaesthesia. Results: There were no differences between the three groups in baseline blood pressure or heart rate; or duration of anaesthesia, surgery. The inhaled sevoflurane concentration was significantly lower in group M and group T than in the control group. The quality and duration of postoperative pain relief did not differ between the three groups. There were no intergroup differences in postoperative nausea, vomiting, or other complications. Conclusions: Caudal tramadol (2 mg·kg–1) provided reliable postoperative analgesia similar to caudal morphine (0.03 mg·kg–1) in quality and duration of pain relief in our study children who were undergoing herniorrhaphy. We also concluded that presurgical caudal morphine or tramadol reduced perioperative sevoflurane requirements and either presurgical or postsurgical caudal morphine did not make any difference to postoperative analgesia.
Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children
Authors: CHENG CLAUDIA A.Y. , AUN CINDY S.T. , GIN TONY 
Published: March 2003

Background: The purpose of our study was to determine whether a smaller dose of rocuronium than previously reported could provide similar intubating conditions to suxamethonium during rapid‐sequence induction of anaesthesia in children. Methods: One hundred and twenty ASA I, unpremedicated children, aged 1–10 years, who were undergoing elective surgery, were randomized into three groups to receive rocuronium 0.6 mg·kg–1, rocuronium 0.9 mg·kg–1 or suxamethonium 1.5 mg·kg–1. The study was double‐blinded, anaesthesia and timing of injection was standardized to alfentanil 10 μg·kg–1, thiopentone 5 mg·kg–1 and the study drug. Intubation was attempted at 30 s after injection of neuromuscular relaxant and intubating conditions graded as excellent, good, poor or impossible. Results: All 120 children were successfully intubated within 60 s without need for a second attempt after administration of neuromuscular relaxant. Differences between suxamethonium and rocuronium 0.6 mg·kg–1 and between the two doses of rocuronium were statistically significant (P=0.016 and 0.007, respectively). Conclusions: Rocuronium 0.9 mg·kg–1 provides similar intubating conditions to suxamethonium 1.5 mg·kg–1 during modified rapid‐sequence induction using alfentanil and thiopentone in children (P=0.671). Rocuronium 0.6 mg·kg–1 was inadequate.
Sevoflurane versus halothane: effect of oxycodone premedication on emergence behaviour in children
Authors: MURRAY DAVID J. , COLE JENNIFER W. , SHROCK CHARLES D. , SNIDER REBECCA J. , MARTINI JOHN A. 
Published: March 2003

Background: Clinical studies have provided conflicting conclusions about whether the frequency of emergence agitation is increased in children following sevoflurane anaesthesia. The purpose of the study was to determine a frequency and duration of agitation with halothane and sevoflurane anaesthesia and whether oxycodone premedication affected the incidence of emergence agitation in children. Methods: We measured and compared halothane and sevoflurane recovery in 130 patients using a 5‐point scale measuring emergence behaviour every 10 min during the first 60 min of recovery or until discharge. Results: We used this 5‐point scale to assess the presence or absence of emergence agitation and found a frequency of emergence agitation of more than 40% in children who received halothane and sevoflurane anaesthesia. Conclusions: Oxycodone reduced the frequency of agitation in children who received halothane, but not in the children who received sevoflurane anaesthesia.
Is haemostasis biological screening always useful before performing a neuraxial blockade in children?
Authors: ROUX CORINNE LE , LEJUS CORINNE , SURBLEB MARIELLE , RENAUDIN MARIETTE , GUILLAUD CHRISTIAN , WINDT ARIANE DE , LASNIER BETTY , PINAUD MICHEL 
Published: March 2003

Background: Because of the lack of controlled studies, there is no consensus of opinion about the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to compare the influence of two different strategies of coagulation evaluation on the incidence of diagnosed coagulopathies leading to a modification of the preoperative or anaesthetic management in children who were scheduled for caudal, epidural or intrathecal block. Methods: For a 24‐month period (period 1, retrospective study, n=751), haemostasis screening was undertaken only after family and personal history and physical examination in all patients. For the following 24 months (period 2, prospective study, n=958), a standardized questionnaire was used. In addition, routine tests (prothrombin, partial thromboplastin time, platelet count) were performed in children who where not yet walking. In older children, coagulation tests were undertaken as in period 1. Results: Overall, 26 significant abnormalities were diagnosed. Coagulation tests were performed in 16.2% (period 1) and 78.2% (period 2) of the children, who were not yet walking. Routine tests did not improve the diagnosis of haemostasis abnormalities justifying a modification of the preoperative and anaesthetic management (2.2% from 406 children in period 1 vs 4.1% from 266 children in period 2). The predictive positive value of routine tests (period 2) was 19%, vs 45% for specific tests (period 1) (P < 0.001). In older children, the use of a standardized form increased the number of haemostasis screenings without improvement of diagnosis leading to modified preoperative management (0.3% from 315 children in period 1 vs 0.5% from 628 children in period 2). Conclusions: When routine testing is performed in nonwalking children, the screening number increases without leading to a higher number of anaesthetic management changes, suggesting that routine testing does not seem to provide much extra information in the absence of a positive history.