The Australian Measles Control Campaign, 1998

The 1998 Australian Measles Control Campaign had as its aim improved immunization coverage among children aged 1-12 years and, in the longer term, prevention of measles epidemics. The campaign included mass school-based measles-mumps-rubella vaccination of children aged 5-12 years and a catch-up programme for preschool children. More than 1.33 million children aged 5-12 years were vaccinated at school: serological monitoring showed that 94% of such children were protected after the campaign, whereas only 84% had been protected previously. Among preschool children aged 1-3.5 years the corresponding levels of protection were 89% and 82%. During the six months following the campaign there was a marked reduction in the number of measles cases among children in targeted age groups.     

Prevention of perinatal group B streptococcal infection: current controversies

Group B streptococcus (GBS) is the most frequent cause of neonatal sepsis in the United States. The Centers for Disease Control and Prevention (CDC) issued guidelines for its prevention in 1996. This article details areas of controversy with those guidelines and offers recommendations for resolution. We recommend that a prevention policy be adopted by all hospitals. If a screening-based policy is chosen, compliance is essential. Penicillin is the antibiotic of choice for GBS prevention. Increasing resistance to clindamycin and erythromycin might eliminate them as alternative choices in patients allergic to penicillin. Group B streptococcal prophylaxis might not be necessary in women who have repeat elective cesarean delivery. In asymptomatic women, a positive urine culture for GBS should be considered clinically equivalent to a positive vaginal or rectal sample for screening. Neonatal sepsis caused by organisms other than GBS must be monitored carefully by all hospitals providing obstetrics services.     

Treatment outcome of patients with brain metastases from malignant germ cell tumors

BACKGROUND: Multiinstitutional experience with the management of cerebral metastases from malignant germ cell tumors (MGCT) is presented. METHODS: Clinical data regarding brain metastases from MGCT at diagnosis (Group 1 [56 patients]) or after cisplatin-based chemotherapy (Group 2 [83 patients]) were collected retrospectively. All patients in Group 1 received "conventional" cisplatin-based chemotherapy supplemented by cerebral radiotherapy (36 patients) and/or neurosurgery (10 patients). In the patients in Group 2 cerebral metastases were detected a median of 9 months after the initiation of chemotherapy. Thirty-five patients received chemotherapy, 59 patients received radiotherapy, and 25 patients underwent neurosurgery. RESULTS: The 5-year cause specific survival rate in Group 1 was 45% (95% confidence interval [CI], 31-59%). Neurosurgery and the absence of extracerebral, nonpulmonary visceral disease, but not cerebral radiotherapy, were independent predictors of good prognosis. The 5-year cause specific survival rate in Group 2 was 12% (95% CI, 4-20%), but was 39% among patients with an isolated brain recurrence (24 patients). Radiotherapy, but not chemotherapy, represented an independent predictor of good prognosis together with brain metastases at first recurrence and the absence of extracerebral recurrence. CONCLUSIONS: Among patients with brain metastases at the time of diagnosis of an MGCT, cisplatin-based chemotherapy resulted in a 5-year cause specific survival rate of 45%, with cerebral radiotherapy having limited impact. The 5-year cause specific survival rate for all patients with brain metastases after cisplatin-based chemotherapy was 12%, but increased to 39% in patients with an isolated brain recurrence. Cerebral radiotherapy (and neurosurgery) represent essential treatment modalities for patients in whom brain metastases are diagnosed after induction chemotherapy.     

Audit and Re-audit of the CSP Core Standards of Physiotherapy Practice

The third edition of the Core Standards of PhysiotherapyPractice has been piloted in eight sites, representing the whole breadth of the physiotherapy profession. Part of the pilot involved auditing patient records and soliciting patient feedback using a questionnaire, both in two stages. The first audit was carried out before physiotherapists had knowledge of the content of the new standards. The re-audit was carried out after a period of awareness-raising and implementation of any changes arising from the first audit. All audit criteria including the patient feedback were specifically generated from the standards.Significant and important improvements were reported from the patient record audits, especially in the standards relating to recording of patients' expectations, patients' goals, and use of outcome measures.The patient feedback questionnaire showed a consistently high level of achievement but less real change between the two audits. Some issues around consent improved, as did privacy. Performance against some criteria deteriorated, although not significantly, for example patients' perceptions of the effectiveness of treatment. Documentation in patient records has shown important improvements as a result of the new standards. Feedback from patients suggests little change in conformance with those standards and criteria more appropriately measured by patients.Audit is a useful tool for disseminating and implementing national standards when carried out in partnership with physiotherapy managers.     

The influence of randomized trials on the use of anticoagulants for atrial fibrillation.

INTRODUCTION: Anticoagulants and anti-platelet drugs have been shown in randomized trials to reduce the risk of stroke in patients with atrial fibrillation (AF). We therefore investigated their use in patients known to be in AF before a stroke, transient ischaemic attack (either cerebral or ocular) or retinal artery occlusion to assess the influence of trials on clinical practice. METHODS: Inpatients and outpatients with acute stroke, transient ischaemic attack or retinal artery occlusion were prospectively identified by a stroke physician from 1990 to 1997. The presence or absence of AF before the vascular event, and prior use of anticoagulant and anti-platelet drugs were recorded at the time of the assessment and verified using information from general practitioner and hospital case notes. RESULTS: Of 1934 patients with stroke or retinal artery occlusion, 191 (10%) were in AF before their ischaemic event. Anticoagulants had been used in 40 (21%) of these, but only in 32 (2%) of the 1743 patients in sinus rhythm [odds ratio (OR) 14.2, 95% confidence interval (CI) 8.6-23.2]. Anti-platelet drugs had been used in 62 (32%) of those with AF compared with 500 (30%) of those in sinus rhythm (OR 1.2, 95% CI 0.9-1.64). Of the 161 patients in AF without contraindications to anticoagulants, only 36 (22%) were taking them. Although there was a statistically significant increase in anticoagulant use from 8% in 1990 to 23% in 1996, this could be explained solely by a fall in the age of the patients referred to our hospital. CONCLUSION: Anticoagulation is probably under-used in AF. We found no conclusive evidence that anticoagulation trials have influenced clinical practice. This raises issues about the dissemination and implementation of trial results.     

老年胃癌患者围手术期并发症及其处理

目的 研究老年胃癌患者的临床特点,总结老年胃癌患者的年龄、术前各种合并症等对术后并发症发生的影响.方法 总结自2005年1月至2007年1月接受手术的181例胃癌患者的临床资料,其中老年患者(年龄大于65岁者)65例,回顾性分析老年胃癌患者的年龄、术前各种合并症与术后并发症发生的关系.结果 老年胃癌组术前合并症总发生率为83%,非老年胃癌组为59%;老年胃癌组中有52%存在2种或2种以上合并症,发生率最高的合并症为高血压,达40%;老年胃癌患者的根治率为86%,非老年胃癌组的根治率为93%;老年胃癌组术后并发症的发生率为37%,术前合并高血压、糖尿病、肺部疾病、低蛋白血症、贫血者术后并发症发生率较高.结论 老年胃癌患者手术治疗后的总并发症发生率和病死率与非老年胃癌患者相比无差异.     

Retention and Metabolic Fate of [3H]-Melatonin in the Spotted Skunk

Two experiments were designed to determine which tissues accumulate [3H]-melatonin and the metabolic fate of this hormone in the spotted skunk. Tritiated melatonin was injected into the jugular vein of 10 anesthetized skunks 1-3 h before the onset of darkness and allowed to circulate for 22 min before the vasculature was flushed with saline to clear radioactivity from the blood. Selected tissues were removed from five skunks and oxidized in a Packard Biological Oxidizer which yielded 95 +/- 5% recovery of radioactivity. Relatively high amounts of radioactivity were found in the pineal (367 +/- 304 dpm/mg tissue), ovary (69 +/- 38 dpm/mg), pituitary (89 +/- 56 dpm/mg), liver (107 +/- 29 dpm/mg), and kidney (63 +/- 15 dpm/mg). Relatively small amounts of [3H] were found in different brain regions (approximately 6-7 dpm/mg). The uterus, pancreas, and temporalis muscle also accumulated radioactivity (approximately 13 dpm/mg). The lung retained the least amount of radioactivity (4 +/- 1.3 dpm/mg). In the second experiment, hypothalami, pituitaries, and ovaries were removed from the remaining five females. Radioactivity from these tissues was extracted and subjected to thin-layer chromatography. Melatonin accounted for approximately 70% of the radioactivity recovered while 6-hydroxymelatonin and unidentified more polar compounds made up the majority of the melatonin metabolites. These data indicate that tissues other than the hypothalamus are able to accumulate [3H]-melatonin.     

Pilot study of a 4-week Pain Coping Strategies (PCS) programme for the chronic pain patient

Purpose. A 4-week Pain Coping Strategies (PCS) programme has been developed for chronic pain patients who may still be undergoing medical interventions but who would benefit from learning pain management skills. The long-term negative behaviours associated with chronic pain may be prevented by introducing pain management strategies at an earlier stage. The PCS programme combines all the fundamental aspects of the traditional Pain Management Programme including exercise, relaxation, pacing, medication review, pain pathways, posture and challenging negative thoughts.

Method. The study compared 31 patients' mood, functional status and physical ability pre and 6 weeks post the programme using the Hospital Anxiety and Depression Scale (HAD), Canadian Occupational Performance Measure (COPM) and a series of physical tests. A paired samples t-test showed a significant improvement in levels of depression and anxiety, functional status and physical ability.

Results. The results reveal that an early intervention programme may be effective for chronic pain patients by promoting self-management and teaching positive coping strategies.

Conclusions. The current study has found promising results for a brief early intervention for chronic pain, regardless of completion of medical interventions.