Evaluating projects funded by the Western Australian Health Promotion Foundation: first results

The paper describes output measures of performance of the WesternAustralian Health Promotion Foundation (Healthway), using asystem known as graduated project evaluation (GPE). Resultsare reported at the basic and process levels of evaluation on588 health and sponsorship projects, and at the impact levelbased on surveys of 5710 spectators and participants at 53 sport,arts and racing events sponsored by Healthway funds. At thebasic and process levels the average Healthway project reached7449 people directly and generated media coverage of healthmessages on 27.3 occasions. It secured, on average, 0.99 healthystructural reforms in recreational or cultural venues, involvedthe participation of local community members in project administrationin 38% of instances, and provided 1596 person-hours of healtheducation. Non-smoking, safe drinking, nutrition, exercise,sun protection, safe sex and injury prevention health messageswere promoted using 24 different types of sponsor benefits.Of the 5710 respondents surveyed post-event, 67% were awareof the promoted health message and 82% of these understood whatthe message meant. Four per cent of all respondents intendedto take action ranging from seeking information to adoptingthe health behaviour. A comparison of the cost-effectivenessof small and large sponsorship projects is given to illustratethe use of GPE to inform funding decisions. Smaller projectsoutperformed larger projects on all available indicators. Wediscuss the peculiar features of the health promotion foundationconcept, methods to improve its performance and implicationsfor future research.     

BRUCELLOSIS COMPLICATED BY AORTIC VALVE ENDOCARDITIS

A 30 year old veterinary surgeon developed a febrile illness with serological evidence of Brucellosis. He was known to have aortic valve disease and during the course of the illness, the clinical features of endocarditis became evident, with a vegetation visible echocardiographically on the aortic valve. Because of persisting fever despite appropriate antibiotic therapy, aortic valve replacement with a viable cryopreserved allograft aortic valve was undertaken. Organisms consistent with Brucella species were demonstrated in the excised vegetation. The patient received a six week course of antibiotics and his post-operative course was uneventful.     

Left Septal Atrial Tachycardias: Electrocardiographic and Electrophysiologic Characterization of a Paraseptal Focus

Left Septal Atrial Tachycardias. Objective: The objective was to characterize the electrocardiographic and electrophysiological features of focal atrial tachycardia (FAT) originating from the left septum (LS). Background: FAT is recognized to occur at predefined anatomic locations rather than randomly throughout the atria. We describe the ECG and EP features of ATs originating from the LS as an important site for apparent perinodal tachycardias. Methods: Nine patients presenting with LS FAT from a consecutive series of 384 underwent EP/RFA for symptomatic FAT. Results: The mean age was 56 ± 12 years; 7 female with symptoms for 36 ± 28 months. P wave morphology (PWM) was negative/positive in lead V1 and across the precordial leads and negative or negative/positive in inferior leads in all patients. Tachycardia was incessant in 6 out of 9 patients with a mean tachycardia cycle length 421 ± 56 milliseconds. His A was ahead of P wave in all patients (mean ?15 ± 5 milliseconds) and earlier than CS proximal (mean 4 ± 9 milliseconds). Successful acute focal ablation achieved at a mean of 31 ± 12 milliseconds ahead of P wave with no recurrences at a mean follow‐up of 30 ± 28 months. Conclusion: Although the left septum is an uncommon site for focal AT an awareness of this location for harboring foci is particularly important when mapping apparently right‐sided septal tachycardias. (J Cardiovasc Electrophysiol, Vol. 24, pp. 413‐418, April 2013)     

Moderating drinking by correspondence: an evaluation of a new method of intervention

Recognizing the need to offer alternative methods of brief interventions, this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact. One hundred and twenty-one problem drinkers were recruited by media advertisements and were randomly allocated to a full cognitive-behavioural treatment programme (CBT) or to a minimal intervention condition (MI) that gave information regarding alcohol misuse and instructions to record drinking. As predicted, CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period. CBT produced a 50% fall in consumption, bringing the average intake of subjects within recommended maximum levels. Treatment gains at 6 months were well maintained to 12 months. High levels of consumer satisfaction, a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment. However, some drinking occasions still involved high intake for a significant subgroup of subjects, and this issue will be addressed in future programmes. The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas.     

Retrieval of Right Heart Fragments from Implanted Venous Access Catheters in Patients with Malignancy

Chronically implanted venous access catheters are frequently used in patients with malignancy. Fracture and embolization of these catheters may occur during placement, chronic use, or removal. We report four consecutive cases of percutaneous retrieval of catheter fragments from the right heart circulation. A snare formed from an exchange length angioplasty guidewire inserted through a guiding catheter was used successfully in all four patients without complications. Resolution of arrhythmias, chest discomfort, and infection followed the retrieval of the fragments. As larger numbers of patients receive chronically implanted venous catheters, the invasive cardiologist must be familiar with methods of removal. (J Interven Cardiol 1989:2:4)     

Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery

Summary. A total of 304 women, for whom operative delivery was considered necessary in the second stage of labour, were randomly assigned to delivery by vacuum extraction or forceps. Of those allocated to forceps a higher proportion of babies were actually delivered with the allocated instrument; however, the caesarean section rate was also higher in this group. Maternal trauma, use of analgesia and blood loss at delivery were significantly less in the group allocated to vacuum extraction. Vacuum extraction did, however, appear to predispose to an increase in mild neonatal jaundice. More serious neonatal morbidity was rare in both groups and the trial was of insufficient size to rule out a clinically important differential effect of the two instruments on these measures of outcome. Another trial is now needed to address this still open question more rigorously.     

Ventricular tachycardia in a neonate secondary to hyperkalaemia

ABSTRACT. We report a preterm infant with ventricular arrhythmias secondary to hyperkalaemia in the first 48 hours of life. The arrhythmias were life threatening and required pharmacological and electrical cardioversion. Aspects of neonatal hyperkalaemia and related arrhythmias are discussed.