Objective: To evaluate the effectiveness of a multifaceted educational intervention for general practitioners to improve the outcomes of older people with asthma. Design: Cluster randomised controlled trial. Participants and setting: 42 GPs recruited from metropolitan Melbourne between 1 August 2006 and 31 July 2007, randomly assigned to an intervention or control group, and 107 patients with asthma, aged 55 years or older (consecutive patients recruited by the GPs). Main outcome measures: Evaluation by means of a videorecorded consultation with a simulated patient for GPs; and for patients, asthma control and quality of life, lung function and action plan ownership at baseline and at 4 months. Results: GPs in the intervention group scored significantly higher than those in the control group for the content and style of their consultation with simulated patients. At 4 months’ follow-up, there was no significant difference between patient groups in the asthma control scores, asthma-related quality of life or lung function. Conclusion: This trial showed an improvement in GPs’ performance in delivering asthma care to older people. Despite this, there was no significant improvement in patient outcomes. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12607000634471.
Abstract Neuroimaging in dementia has focused on documenting any burden of vascular disease or excluding any reversible intracranial pathology. We review the use of computed tomography to examine for medial temporal lobe atrophy in dementia and compare this with a case series of such measurements from our memory clinic. Measures of medial temporal lobe atrophy were used to separate patients with Alzheimer’s disease from those with normal cognition, mood disorders or other forms of early dementia.
Background Immersive virtual reality (IVR) is a form of distraction therapy that has shown potential as an analgesia and sedation sparing agent. This study assessed the effect of IVR on the self-administered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center. Methods and findings This study was a single-center, randomized control trial at St Vincent's Hospital in Melbourne, Australia. Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone. The primary outcome measure was intra-operative propofol use. Secondary outcomes included pattern of propofol use over time, use of adjunct analgesia, unmet propofol demand, and patient satisfaction survey scores. Of 50 total patients, 25 received IVR in conjunction with PCS, and 25 received PCS alone. All patients received adjunct analgesia from the treating Anesthesiologist. Median propofol use/hour over the entire procedure in the control group was 40 (11.1, 93.9) mg/hour compared with 45 (0, 94.7) mg/hour in the IVR group (p = 0.90). There were no differences in patterns of propofol use over the course of each procedure. Adjusting for various baseline characteristics did not change the results. Postoperative satisfaction scores were equivalent in both groups. The VR intervention was well tolerated by all patients, with no report of major side effects. Key limitations were relatively small sample size, the non-blinded nature of the study, and use of adjunct analgesia. Conclusions In patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.
Appropriate and rational use of drugs in the elderly is a matter of growing medical and social concern. The elderly as a group are particularly prone to adverse drug reactions. Such reactions have often been due to inappropriate drug prescribing, based on incomplete recognition and knowledge of changes in drug handling with age and pathological states associated with ageing. Recognition of such changes with modification of prescribing practice may lead to benefits by minimising the incidence of adverse drug reactions. This article discusses the current knowledge of age-related changes in drug absorption, distribution, clearance and sensitivity and some implications of these changes for clinical therapeutics in the elderly.
Abstract A cluster of four cases of surgical and burn wound aspergillosis occurred in a 900-bed, adult, tertiary-care hospital. The source was traced to the outside packages of dressing supplies, which had become contaminated during construction in the central Inventory Control area. This resulted in patients with large exposed surface areas being inoculated directly with Aspergillus spores.
Abstract. The Southern California Bight is adjacent to one of the world's largest urban areas, Los Angeles. As a consequence, anthropogenic impacts could disrupt local marine ecosystems due to municipal and industrial waste discharge, pollution, flood control measures, and global warming. Santa Monica Basin (SMB), due to its unique setting in a low-oxygen and high-sedimentation environment, can provide an excellent sedimentary paleorecord of these anthropogenic changes. This study examined 10 sediment cores, collected from different parts of the SMB between spring and summer 2016, and compared them to existing cores in order to document changes in sedimentary dynamics during the last 250 years, with an emphasis on the last 40 years. The 210Pb-based mass accumulation rates (MARs) for the deepest and lowest oxygen-containing parts of the SMB basin (900–910 m) have been remarkably consistent during the past century, averaging 17.1±0.6 mg cm−2 yr−1. At slightly shallower sites (870–900 m), accumulation rates showed more variation but yield the same accumulation rate, 17.9±1.9 mg cm−2 yr−1. Excess 210Pb sedimentation rates were consistent with rates established using bomb test 137Cs profiles. We also examined 14C profiles from two cores collected in the deepest part of the SMB, where fine laminations are present up to about 450 yr BP. These data indicate that the MAR was slower prior to ∼1900 CE (rates obtained were 9 and 12 mg cm−2 yr−1). The δ13Corg profiles show a relatively constant value where laminations are present, suggesting that the change in sediment accumulation rate is not accompanied by a change in organic carbon sources to the basin. The increase in sedimentation rate towards the Recent occurs at about the time previous studies predicted an increase in siltation and the demise of a shelly shelf benthic fauna on the SMB shelf. X-radiographs show finely laminated sediments in the deepest part of the basin only, with centimeter-scale layering of sediments or no layering whatsoever in shallower parts of the SMB basin. The absence of finely laminated sediments in cores MUC 10 (893 m) and MUC 3 (777 m) suggests that the rate at which anoxia is spreading has not increased appreciably since cores were last analyzed in the 1980s. Based on core top data collected during the past half century, sedimentary dynamics within SMB have changed minimally during the last 40 years. Specifically, mass accumulation rates, laminated sediment fabric, extent of bioturbation and % Corg have not changed. The only parameter that appeared to have changed in the last 450 years was the MAR, with an apparent > 50 % increase occurring between ∼1850 CE and the early 1900s. The post-1900 CE constancy of sedimentation through a period of massive urbanization in Los Angeles is surprising.
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