Fifteen years of drug information in Christchurch Hospital

AIM: To determine changes in numbers, demography and type of questions posed to the drug information service (DIS) at Christchurch Hospital over the last fifteen years. METHODS: The database of the DIS was used to retrieve data for one-year periods including the period of establishment in 1985/1986, 1993/1994 and 1999/2000. RESULTS: The number of questions per month increased from 26 in 1985/1986 to 284 in 1999/2000. The majority of questions have related to adverse drug reactions, contraindications/precautions, drug selection, interactions, and administration/dosage. Questions on drug interactions showed the greatest relative increase, from 8% to 19% of all questions. A disproportionate increase in requests came from primary care, which provided 14% of questions in 1985/1986 and 38% in 1999/2000. Computer databases are the major resource used currently whereas journal articles and textbooks dominated in 1985/1986. CONCLUSIONS: There has been a marked increase in use of the DIS despite a relatively constant population base. This may reflect an increased awareness of both the availability of the service and recognition of the complexity of medicines. The computer database is a useful reference source, decreasing repetition of search pathways and allowing audit to assist in the ongoing improvement of the service.     

Patterns of alcohol use and misuse among elderly rest home residents in Christchurch

AIMS: To determine the prevalence of alcohol use and misuse among elderly rest home residents in Christchurch. METHODS: A cross-sectional prevalence survey was conducted among 175 residents aged 65 years and over, randomly selected from 30 rest homes in Christchurch, in 1998. Hazardous patterns of alcohol consumption in the past twelve months were determined by the Alcohol Use Disorders Identification Test (AUDIT) questionnaire, and alcohol dependence in the past 12-months and lifetime was determined by a strctured clinical interview using DSM-IV criteria. RESULTS: Of 246 eligible participants, 175 (71.1%) residents were interviewed, 115 women and 60 men, mean age, 82.6 years (SD=7.8) compared with 83.2 years (SD=6.3) for non-participants. The prevalence of hazardous patterns of alcohol consumption in the past twelve months by the AUDIT (cut-off score 8) was 5.1% (95% CI = 1.8-8.4). According to DSM-IV criteria, the prevalence of lifetime alcohol dependence was 20.5% (95% CI = 13.5-27.6) and for the past twelve months was 0.5% (95% CI = 0-1.7). The prevalence of lifetime alcohol dependence was significantly higher in men 36.7% (95% CI = 23.2-50.1) than women 12.2% (95% CI = 5.6-18.8) (p = 0.0001). CONCLUSIONS: In spite of advanced age, a small proportion of elderly rest home residents consumed quantities of alcohol that put them at risk of future damage to physical or mental health. Lifetime prevalence of alcohol dependence was comparable to the general population estimates and was higher in men than women.     

Postneonatal mortality in Christchurch

The pattern of postneonatal mortality over the past 16 years in Christchurch and New Zealand is described. In Christchurch the postneonatal rate has risen from about four to eight per 1000 live births over this time, while for the rest of New Zealand the rate has been stable at about six. This rise has been due to an increasing number of cot deaths. The reason for this is unknown. Increased child health surveillance may reduce these deaths.     

Caesarean section in Christchurch

Base hospital caesarean section rates in Christchurch have risen from 4.1% in 1967 to 14.1% in 1982. However, the Christchurch district caesarean section rate for 1982 was only 9.6%. Analysis of the indications for caesarean section according to the year showed that most indications have increased in frequency and that between 1977 and 1982 this increase was highly significant for failure to progress and fetal distress. Analysis of the indications for caesarean section according to the type of antenatal booking revealed that in 1982 private patients underwent caesarean section more frequently than clinic patients and that they were more likely to have the caesarean section for failure to progress or fetal distress. Emergency transfer patients had an even higher primary caesarean section rate for most indications.     

Genetic matters: Thirty years of progress using mouse models in nicotinic research

This research update summarizes thirty years of studies on genetic influences on responses to the acute or chronic administration of nicotine. Early studies established that various inbred mice are differentially sensitive to the effects of the drug. Classical genetic analyses confirmed that nicotine effects on locomotion, body temperature and seizures are heritable. A significant inverse correlation between the locomotor and hypothermic effects and the density of nicotine binding sites suggested that differential expression α4β2-neuronal nicotinic acetylcholine receptor (nAChR) mediated some of this genetic variability. Subsequent studies with α4 and β2 nAChR null (decreased sensitivity) and gain of function mutants (increased sensitivity) supports the role of the α4β2*nAChR subtype. However, null mutant mice still respond to nicotine, indicating that other nAChR subtypes also mediate these responses. Mice differing in initial sensitivity to nicotine also differ in tolerance development following chronic treatment: those mice that are initially more sensitive to nicotine develop tolerance at lower treatment doses than less sensitive mice, indicating that tolerance is an adaptive response to the effects of nicotine. In contrast, the sensitivity of mice to pre-pulse inhibition of acoustic startle response is correlated with the expression of α7-nAChR. While genetic variability in nAChR expression and function is an important factor contributing to differences in response to nicotine, the observations that altered activity of opioid, glutamate, and cannabinoid receptors among others also change nicotine sensitivity reinforces the proposal that the genetics of nicotine response is more complex than differences in nAChRs.     

Listeriosis in Christchurch 1967-1984

Between February 1981-May 1982, 18 Christchurch patients were infected with Listeria monocytogenes. Of these eight were pregnant, and three mid-trimester abortions and one neonatal death occurred in this group. One death due to listeriosis occurred amongst the other ten patients. Three patients were part of a small nosocomial outbreak. Prior to February 1981 and since May 1982, infections caused by this organism have been very uncommon. The possible sources of the organism are discussed.     

Gentamicin resistance in Christchurch hospitals.

Prior to June 1976, the isolation of gentamicin resistant organisms was an infrequent occurrence in North Canterbury Hospital Board institutions. During July 1976, 20 different gentamicin resistant organisms were isolated from patients in Christchurch Hospital. Gentamicin resistant organisms hav e been continually isolated from an increasingly wide area since then. The organisms involved are: providence species; Pseudomonas aeruginosa; Klebsiella species; E coli; Staphyloccus aureus; Proteus mirabilis; Staphylococcus epidermidis; Acinetobacter species; Enterobacter species; Haemophilus influenzae; Pseudomonas maltophilia CDC II F; Citrobacter species; Alcaligenes odorans and Pseudomonas species. The spread of gentamicin resistant organisms has occurred rapidly in the hospital environment. The importance of the urinary tract as a reservoir of microorganisms is indicated in this report.     

Three decades of lung cancer in Christchurch

The hospital admission rate and management of bronchogenic carcinoma over a period of three decades has been studied by reviewing admissions to the acute general hospitals in Christchurch, using five year samples. Although there was an improvement in the management of the disease between the first and second decades, this plateaued between the second and third. In the first five year period, (1952-6), 97 (47%) out of 208 patients were dead within a month of diagnosis and six patients lived for more than three years. In 1962-66 (21%) out of 328 patients were dead within a month of diagnosis and 25 patients lived longer than three years. In the last five year period (1972-6) 75 patients (16.8%) out of 707 were dead within one month of diagnosis and 46 survived for more than three years. Twenty-six patients remained alive and well seven to eleven years after diagnosis, a long term survival rate of 3.6%.     

Peritonsillar infection in Christchurch 1981-1984

Retrospective review of the notes of 83 peritonsillar infection sufferers over three years at Christchurch Hospital reveals that the typical sufferer is a young adult male who is most likely to present in winter or summer. Only a quarter of the patients had a significant recent history of tonsillitis but four had had a previous quinsy and six had had a previous tonsillectomy in childhood. Length of symptoms does not appear helpful in differentiating an abscess from a cellulitis. Anaerobic organisms were found in 49% of aspirates and streptococci were the most important aerobic organism. Potential beta lactamase producing organisms, H influenzae, Staph aureus and Bacteroides sp were infrequent and penicillin remains the drug of choice. Appropriate antibiotics and drainage are the essentials of management and tonsillectomy may be indicated.