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Heidelberg, Australia

Bucknall T.K.,Deakin University | Jones D.,Monash University | Bellomo R.,Austin Health | Staples M.,Monash University
Resuscitation | Year: 2013

Aim: To determine the point-prevalence of patients fulfilling hospital-specific Medical Emergency Team (MET) criteria and their subsequent outcomes. Method: Inpatients from 10 hospitals with established METs were enrolled for a prospective, point-prevalence study. If MET criteria were present during a set of vital signs, the ward manager was notified. MET activations, unplanned Intensive Care Unit (ICU) admissions, cardiac arrests, Limitations of Medical Treatment (LOMT), hospital discharge and follow-up mortality data were collected. Results: Of 1688 patients recruited, 3.26% (. n=. 55) fulfilled MET criteria in a single set of vital signs. None of the 55 received MET review within 30. min of notification, 2 (3.6%) had MET review within the next 24. h, none experienced cardiac arrests or unplanned ICU admissions during the follow-up period, and 13 (23.6%) had a LOMT order prior to fulfilling MET criteria. In-hospital mortality was significantly higher for patients fulfilling MET activation criteria (9.1%) compared to those that did not (2.6%; p=. 0.005, RR. =. 2.95; 95% confidence interval (CI) 1.22-7.15), as was mortality at 30 days (RR. =. 2.64; 95% CI 1.37-5.11) and 60 days (RR. =. 1.94; 95% CI 1.11-3.40). The 30 day mortality in patients without an LOMT order was similar to patients without MET criteria (RR. =. 0.94; 95% CI 0.24-3.7). Conclusions: Approximately 1 in 30 hospitalised patients fulfilled MET criteria during data collection. The presence of MET criteria was associated with increased hospital, 30 and 60 day mortality, although much of this increased mortality seemed to be due to issues around end-of-life care. Despite ward manager notification, subsequent MET activation occurred infrequently in these hospitals with established METs. Further research is needed to assess factors that influence staff initiation of a MET call. © 2012 Elsevier Ireland Ltd.

Villemagne V.L.,Austin Health
International psychogeriatrics / IPA | Year: 2011

Molecular neuroimaging techniques such as PET are proving valuable in the early and differential diagnosis of Alzheimer's disease (AD).With the advent of new therapeutic strategies aimed at reducing β-amyloid (Aβ) burden in the brain to potentially prevent or delay functional and irreversible cognitive loss, there is increased interest in developing agents that allow assessment of Aβ burden in vivo. Amyloid imaging with PET has proven useful in the discrimination of dementias, showing significantly higher Aβ burden in the gray matter of AD patients when compared with healthy controls or patients with frontotemporal dementia. ApoE ε4 carriers, independent of diagnosis or disease severity, present with higher Aβ burden than non-ε4 carriers. Amyloid imaging matches histopathological reports in aging and dementia, reflecting the true regional density of Aβ plaques in cortical areas. It also appears to be more sensitive than FDG-PET for the diagnosis of AD. In healthy older people there is an increasing prevalence of amyloid positive scans with age, rising from 20% in the seventh decade to 60% in the ninth decade. Of people with mild cognitive impairment (MCI), 40-60% present with detectable cortical Aβ deposition. In both groups, Aβ deposition is associated with a higher risk for cognitive decline and dementia due to AD. These observations suggest that Aβ deposition is not part of normal aging, supporting the hypothesis that it occurs well before the onset of symptoms and is likely to represent preclinical AD in asymptomatic persons and prodromal AD in MCI. Further longitudinal observations, coupled with different disease-specific tracers and biomarkers, are required to confirm this hypothesis and further elucidate the precise role of Aβ deposition in the course of AD.

Ho W.K.,Austin Health
Australian Family Physician | Year: 2010

Background: Venous thromboembolism, comprising deep vein thrombosis (DVT) and pulmonary embolism, is common in Australia and is associated with high morbidity. Objective: This article provides a summary of the risk factors for DVT of the lower limb and discusses the diagnosis of the condition using a diagnostic algorithm incorporating clinical assessment, D-dimer testing and imaging studies. It also briefly reviews the clinical significance of isolated distal lower limb DVT and superficial vein thrombosis. Discussion: Many conditions in the lower limb mimic DVT. Diagnosing DVT on clinical grounds without objective testing is unreliable. Patients incorrectly diagnosed as having DVT may be subjected to unnecessary anticoagulation and its associated risks of bleeding. In contrast, there is a risk of thrombus extension and embolisation when DVT is missed or inappropriately treated.

Background:This randomised phase II study evaluated the efficacy and safety of panitumumab added to docetaxel-based chemotherapy in advanced oesophagogastric cancer.Methods:Patients with metastatic or locally recurrent cancer of the oesophagus, oesophagogastric junction or stomach received docetaxel and a fluoropyrimidine with or without panitumumab for 8 cycles or until progression. The primary end point was response rate (RECIST1.1). We planned to enrol 100 patients, with 50% expected response rate for combination therapy.Results:A total of 77 patients were enrolled. A safety alert from the REAL3 trial prompted a review of data that found no evidence of adverse outcomes associated with panitumumab but questionable efficacy, and new enrolment was ceased. Enrolled patients were treated according to protocol. Response rates were 49% (95% CI 34–64%) in the chemotherapy arm and 58% (95% CI 42–72%) in the combination arm. Common grade 3 and 4 toxicities included infection, anorexia, vomiting, diarrhoea and fatigue. At 23.7 months of median follow-up, median progression-free survival was 6.9 months vs 6.0 months and median overall survival was 11.7 months vs 10.0 months in the chemotherapy arm and the combination arm, respectively.Conclusions:Adding panitumumab to docetaxel-based chemotherapy for advanced oesophagogastric cancer did not improve efficacy and increased toxicities.British Journal of Cancer advance online publication, 11 February 2016; doi:10.1038/bjc.2015.440 www.bjcancer.com. © 2016 Cancer Research UK

Manley K.J.,Austin Health
Journal of Renal Care | Year: 2014

Objective: To investigate self-reported upper gastric symptoms experienced by patients with chronic kidney disease (CKD) and compare associations between uraemic symptoms and saliva composition. Methods: In a cross-sectional observational study, 30 patients with Stages 4 and 5 CKD were selected from a tertiary hospital renal outpatient clinic. Subjects answered a questionnaire to assess upper gastrointestinal (GI) symptoms. A saliva sample was collected to determine biochemical composition. Possible associations between saliva composition and uraemic upper GI symptoms were assessed. Results: Only 3 (10%) patients reported no upper GI symptoms whilst 19 (63%) complained of a dry mouth, 16 (56%) had a change in taste, 9 (30%) had nausea, 7 (23%) vomited and 7 (23%) dry retched. Lower saliva bicarbonate concentration related to both dry mouth (p<0.003) and dry retching (p<0.01). An elevated level of saliva calcium was also implicated in a dry mouth sensation (p<0.01). Nausea was associated with higher saliva sodium levels (p<0.03) and a higher saliva sodium/potassium ratio (p<0.02). Conclusion: Altered saliva composition in patients with Stages 4 and 5 CKD may be associated with uraemic upper GI symptoms. In particular, lower saliva concentrations of bicarbonate are associated with dry mouth and retching. Higher saliva calcium levels are also related to a dry mouth whilst higher saliva sodium levels and a greater sodium/potassium ratio are associated with nausea. Further studies investigating strategies to improve uraemic symptoms via changes in saliva are required. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

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