Bagg W, Whalley GA, Sathu A
… +3 more, Gamble G, Sharpe N, Braatvedt GD
Aust N Z J Med
· 2000 Jun · PMID 10914752
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BACKGROUND: Endothelial function is known to be abnormal in patients with diabetes and acute hyperglycaemia may play an aetiological role. AIMS: The aim of this randomised controlled study was to determine if acute syste...BACKGROUND: Endothelial function is known to be abnormal in patients with diabetes and acute hyperglycaemia may play an aetiological role. AIMS: The aim of this randomised controlled study was to determine if acute systemic hyperglycaemia impairs endothelial function in normal subjects. METHODS: Endothelial function was assessed by the change in brachial artery diameter in response to forearm ischaemia using B-mode ultrasound in ten healthy subjects (eight male) aged 19-35 years. Brachial artery blood flow velocity and diameter were measured before and after five minutes of forearm ischaemia. Measurements were performed in the supine position after an overnight fast, before and after 60 minute infusions of 0.9% saline or 10% dextrose. Measurements were made on two separate occasions at least 24 hours apart, and subjects were randomised to saline first or dextrose first. The largest diameter measured after ischaemia was divided by the resting arterial diameter to calculate percent dilatation of the artery from baseline, and is reported as flow-mediated dilatation (FMD). RESULTS: Dextrose infusion resulted in a significant rise in mean (SD) serum glucose 5.2 (0.1) to 9.2 (0.3) mmol/L and insulin concentration 6.3 (1.4) to 20.6 (3.7) mU/L p<0.002. Brachial artery blood flow velocity and diameter increased significantly from baseline after ischaemia (p<0.002). Mean FMD (SEM) before and after infusion were not, however, significantly different (p=0.4) (pre-saline 7.3 [1.0]%, post saline 5.2 [1.5]% and predextrose 8.1 [2.0]%, post dextrose 5.9 [1.7]%). CONCLUSIONS: These data suggest that acute hyperglycaemia does not impair FMD in normal subjects.
Nair B, Kerridge I, Dobson A
… +2 more, McPhee J, Saul P
Aust N Z J Med
· 2000 Jun · PMID 10914751
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BACKGROUND: To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the process of ACP and the use of advance care directives (ACD) is suboptim...BACKGROUND: To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the process of ACP and the use of advance care directives (ACD) is suboptimal in residential care institutions. By comparison there are few Australian data. AIM: To study the process of ACP and the prevalence of ACD in residential care. METHODS: Cross-sectional study using a questionnaire in the Hunter area, NSW, Australia. RESULTS: Very low levels of formal advance directives were found (available for only 0.2%). Only 1.1% of residents had 'no-CPR' orders documented in the medical record, while 5.6% had a formal guardian and 2.8% had an enduring guardian. Informal processes of advance planning were much more prevalent. Sixty-five per cent had a 'person responsible' recorded to make decisions for them while in 13% of cases, there was 'staff consensus' as to the optimal care for the patient. However, in 10.6% there was no clear process for medical decision making identified. CONCLUSIONS: Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore current processes of decision making.
Aust N Z J Med
· 2000 Jun · PMID 10914750
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AIMS: To explore predictive power of Lp(a), of conventional lipoprotein profiles and their carrier proteins, and of biometric measurements, for the presence and severity of angiographically documented coronary disease in...AIMS: To explore predictive power of Lp(a), of conventional lipoprotein profiles and their carrier proteins, and of biometric measurements, for the presence and severity of angiographically documented coronary disease in high-risk patients, and to compare risk profiles in men and women. METHODS: We determined coronary artery disease (CAD) risk factors in 1308 Australian Caucasian patients (313 women and 995 men) aged < or =65 years who consecutively underwent coronary angiography. RESULTS: In univariate analyses of the risk factors, lipid profiles, Lp(a), cigarette smoking, diabetes, hypertension and obesity were all higher in men and women with CAD and changed significantly with the number of significantly diseased vessels (> or =50% luminal obstruction). When stepwise logistic regression analysis was applied, age (OR 1.06, 95% CI: 1.04-1.09), TC/HDL-C (OR 1.29, 95% CI: 1.15-1.45), male gender (OR 2.64, 95% CI: 1.67-4.16), hyperLp(a) (> or =300 mg/L) (OR 2.09, 95% CI: 1.42-3.07), lifetime smoking dose (OR 1.02, 95% CI: 1.01-1.03), diabetes (OR 2.19, 95% CI: 1.14-4.18) and waist/hip ratio (OR 14.53, 95% CI: 1.21-174.90) were predictive of the disease. Both Lp(a) levels and percentage of hyperLp(a) increased linearly with the number of significantly diseased vessels. When the analyses were conducted in men and women separately, hyperLp(a), TC/HDL-C, lifetime smoking dose and age remained as significant predictors in both groups but the waist/hip ratio was only predictive in women. CONCLUSIONS: As Lp(a) is an independent predictor of the occurrence and extent of coronary stenosis and relevant to treatment options, we suggest that it should be measured routinely in the coronary risk profile assessment of high-risk patients.
Hall SE, Williams JA, Senior JA
… +2 more, Goldswain PR, Criddle RA
Aust N Z J Med
· 2000 Jun · PMID 10914749
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BACKGROUND: People who return to living in the community after a hip fracture are considered to have the best outcome. However, their quality of life (QOL) and its relationship with function over the longer term have not...BACKGROUND: People who return to living in the community after a hip fracture are considered to have the best outcome. However, their quality of life (QOL) and its relationship with function over the longer term have not been fully assessed. AIMS: This case control study of community dwelling subjects six to 12 months post hip fracture aims to investigate their QOL and functional independence. METHOD: The Short Form-36 (SF-36) was utilised to measure QOL. The Modified Barthel Index (MBI), the Frenchay Activities of Daily Living Index (FAI), the Timed 'Up & Go' (TUG), and the Berg Balance Scale (Berg) were used to measure functionality. RESULTS: Ninety-two subjects and 92 controls were recruited. Despite being age and gender matched, the hip fracture subjects scored significantly (p<0.05) worse than the controls in all measures of function. The fracture group was slower on the TUG (19 vs 10.5 seconds), had more difficulties with balance (46 vs 54 out of 56), and was less active and more dependent than the control group (FAI 24 vs 31 out of 42). The SF-36 has eight domains: physical function, role physical, bodily pain, mental health, role emotional, social function, general health and vitality. The control group had a higher (p<0.05) perception of their QOL in all domains. CONCLUSION: The effects of impaired balance and mobility along with reduced functional and social independence are reflected in the diminished QOL perceived by the fracture group. This indicates that many do not return to their pre-fracture lifestyle.
Aust N Z J Med
· 2000 Jun · PMID 10914748
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BACKGROUND: Information is lacking about the extent to which Australasian physicians apply methods of evidence-based medicine (EBM) in routine practice. AIMS: To assess the frequency and predictors of use of EBM methods...BACKGROUND: Information is lacking about the extent to which Australasian physicians apply methods of evidence-based medicine (EBM) in routine practice. AIMS: To assess the frequency and predictors of use of EBM methods in a sample of consultant physicians in adult medicine. METHODS: Self-administered questionnaires were distributed to a convenience sample of 545 physicians from October 1998 to January 1999. RESULTS: One hundred and eleven questionnaires were returned (20% response rate). Ninety-eight (88%) respondents formulated five or less clinical questions per week; 69 (62%) undertook five or more evidence searches per week, the majority as MEDLINE searches involving therapeutic topics. Respondents identified insufficient time (74%), limited search skills (41%), and limited access to evidence (43%) as search impediments. In determining evidence quality, 37% frequently relied on global impressions, while 22% frequently applied explicit critical appraisal (p=0.008). Efficiency of literature searches was rated on average as good/very good by 18%, fair by 52% and poor by 30%. As a result of EBM, 47% frequently had confidence in pre-existing decisions increased, 39% gained improved knowledge, and 5% altered clinical decisions. Frequently encountered inhibitors to changing practice were personal conservatism (40%), organisational constraints (40%), and interdisciplinary tensions (39%). Perceived weaknesses of EBM included: limited applicability to individual patients (26%); evidence deficiencies (25%); and too time consuming (13%). In making EBM more attractive, one third requested reliable evidence sources at the point of care. CONCLUSIONS: The application of EBM to routine practice by physicians is constrained by deficient EBM skills, limited access to evidence, lack of time, and cognitive and environmental factors. Targeted education in EBM and systems that quickly deliver high-quality evidence at the point of care are needed in realising the full potential of EBM to improve care.