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Biomedical subjects

A Bauman

Publications and source records attributed to A Bauman.

At least 91 records · Page 5Linked to original sources
PubMed1996

Phase I/II study of combined granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor administration for the mobilization of hematopoietic progenitor cells.

PURPOSE: To study the toxicity and efficacy of combined granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) administration for mobilization of hematopoietic progenitor cells (HPCs). MATERIALS AND METHODS: Cohorts of a minimum of five patients each were treated subcutaneously as follows: G-CSF 5 micrograms/kg on days 1 to 12 and GM-CSF at .5, 1, or 5 micrograms/kg on days 7 to 12 (cohorts 1, 2, and 3); GM-CSF 5 micrograms/kg on days 1 to 12 and G-CSF 5 micrograms/kg on days 7 to 12 (cohort 4); and G-CSF and GM-CSF 5 micrograms/kg each on days 1 to 12 (cohort 5). Ten-liter aphereses were performed on days 1 (baseline, pre-CSF), 5, 7, 11, and 13. Colony assays for granulocyte-macrophage colony-forming units (CFU-GM) and erythroid burst-forming units (BFU-E) were performed on each harvest. RESULTS: The principal toxicities were myalgias, bone pain, fever, nausea, and mild thrombocytopenia, but none was dose-limiting. Four days of treatment with either G-CSF or GM-CSF resulted in dramatic and sustained increases in the numbers of CFU-GM per kilogram collected per harvest that represented 35.6 +/- 8.9- and 33.7 +/- 13.0-fold increases over baseline, respectively. This increment was attributable both to increased numbers of mononuclear cells collected per 10-L apheresis and to increased concentrations of progenitors within each collection. The administration of G-CSF to patients already receiving GM-CSF (cohort 4) caused the HPC content to surge to nearly 80-fold the baseline (P = .024); the reverse sequence, ie, the addition of GM-CSF to G-CSF, was less effective. The CFU-GM content of the baseline aphereses correlated with the maximal mobilization achieved (r = .74, P = .001). CONCLUSION: Combined G-CSF and GM-CSF administration effectively and predictably mobilizes HPCs and facilitates apheresis.

Adolescent↗
PubMed1996

Asthma, health behaviors, social adjustment, and psychosomatic symptoms in adolescence.

The association of health behaviour, indicators of social adjustment, and psychosomatic symptoms with diagnosed asthma was assessed in a community-based sample of 4550 adolescents in South Western Sydney, Australia. The results of this survey found an asthma prevalence among 11-15-year-olds of 17.5%, being consistent with previous studies. Tobacco use and alcohol consumption were higher among asthmatic compared with nonasthmatic adolescents. Asthmatics reported feeling lonely more often, having a number of negative social perceptions and feelings, and having more frequent psychosomatic symptoms. The findings of the study suggest that adolescents with asthma represent an important vulnerable group of school children. Asthma education may need a greater life-style change focus, besides asthma self-management training.

Adolescent↗
PubMed1995

Evaluation of a community arthritis program in Australia: dissemination of a developed program.

OBJECTIVE: To evaluate the effectiveness of a community-based arthritis education program conducted in a number of locations throughout the Sydney, Australia, metropolitan area. METHODS: The program, based on earlier work, comprised 6 weekly sessions of 2.5 hours' duration. The study sample included 175 men and women with different types of arthritis, divided into intervention (n = 104) and control (n = 71) groups. Five outcome measures were selected to evaluate effectiveness of the program: pain perception, knowledge level, self-efficacy, disability index, and self-management behavior. RESULTS: The results indicated that the program was effective in increasing knowledge level (F[1,222] = 10.3, P = 0.001 at 6 weeks; F[1,108] = 7.8, P = 0.006 at 6 months), and a statistically significant difference was found in disability satisfaction 6 months after intervention (F[1,98] = 5.9, P = 0.01], but no statistically significant difference was found in pain perception, self-efficacy, and disability index. CONCLUSION: This research supports some of the successful outcomes which follow an arthritis education program: increased knowledge level and increased disability satisfaction.

Aged↗
PubMed1995

Prospective study of intra-abdominal hypertension and renal function after laparotomy.

The value of postoperative monitoring of intra-abdominal pressure (IAP) in surgical patients has not been established. This study prospectively evaluated the occurrence of increased IAP and its association with renal impairment and outcome in surgical patients admitted to an intensive care unit. One hundred consecutive patients after laparotomy were studied, 88 of whom had complete IAP measurements. IAP was measured using an intravesical catheter and was considered increased when equal to 20 mmHg or above. Renal impairment was defined as a postoperative serum creatinine concentration of greater than 130 mumol/l, or an increase in serum creatinine of greater than 100 mumol/l within 72 h of surgery. The median (range) APACHE (Acute Physiology And Chronic Health Evaluation) II score of the patients was 13.5 (4-43). The incidence of raised IAP was 29 of 88 (33 per cent). Renal impairment was present in 29 of 88 (33 per cent), of whom 20 of 29 (69 per cent) had raised IAP (P < 0.01). The odds ratios (95 per cent confidence interval) for the development of renal impairment and death in patients with increased IAP were 12.4 (3.8-41.7) and 11.2 (2.8-47.9) respectively. There is a clinically significant association between increased IAP and renal impairment in patients admitted to an intensive care unit after laparotomy.

Abdomen↗
PubMed1995

Asthma management and morbidity in Australian general practice: the relationship between patient and doctor estimates.

The aims of this study were to describe asthma management and morbidity in patients attending general practitioners in Australia, and to assess the relationship between patient reports and those of their general practitioner (GP). The sample comprised consecutive patients attending 46 general practitioners chosen at random in five regions of New South Wales, Australia. A total of 4538 patients were screened, 607 (13.4%) reported ever having diagnosed asthma, and the 501 who reported asthma in the previous 12 months completed a detailed questionnaire. Three hundred and thirty-four patients also had information about their asthma management recorded by their GP. The patient questionnaire asked about asthma symptoms, therapy, lung function measurement, and asthma-related morbidity. The GP questionnaire asked the doctor to record similar information about the patients. Two-thirds of the patients used regular inhaled beta 2-agonist medication, and one-half reported using preventive therapy. Only 24% owned a peak flow meter and 9% had a written plan of action for asthma attacks. Although preventive therapy and airway function assessment were more common in those with frequent symptoms (> 2-3 times per week), this group were still sub-optimally managed. In the matched sample (n = 334), doctors reported prescribing bronchodilator and preventive medication, measuring airway function and recommending peak flow meter use more often than suggested by patient-reported data. The study concludes that many patients do not attend for regular review, and that management remains sub-optimal, particularly in young adults. Data from patient surveys may underestimate clinical practice, as assessed from doctors' records. This should lead to patient-derived estimates of management being interpreted with caution in epidemiological studies. Further attention to patient understanding and compliance with prescribed asthma management advice is needed in order to better manage asthma in the community.

Adolescent↗
PubMed1995

A 5-year follow-up of a controlled trial of an arthritis education programme.

A 5-yr follow-up of an arthritis education programme is reported. After adjustment for those lost, deceased or moved away, the 5-yr response rate was 75% among intervention subjects and 78% among controls. Individuals who participated in the education programme maintained their increased knowledge in some aspects. The relative difference in pain and disability over 5 yr was greater in the control group. Most individuals were less active at practising exercise after 5 yr. Improvement in performing exercise and joint protection shown at 12-months follow-up did not persist. Additional questions after 5 yr showed that participants in the education programme had significantly more contact with rheumatologists, physiotherapists and occupational therapists. The participants developed an increased internal sense of control of the disease between 12 months and 5 yr. There was also a significant reduction in reported problems with their disease after 12 months, maintained after 5 yr. This may indicate that patient education contributes to the patient's feeling of responsibility for, and ability to cope with, their diseases.

Arthritis↗
PubMed1995

Evaluation of the prevalence of drug and alcohol abuse in motor vehicle trauma in south western Sydney.

This study estimated prospectively the prevalence of high drug and alcohol levels in road trauma cases who met the criteria for activation of the Liverpool Hospital's trauma team. Urine analysis of road trauma victims between October 1992 and October 1993 was undertaken for drug and alcohol estimation. A total of 164 drivers were studied. A urine alcohol concentration (UAC) exceeding 0.08 g/dL was detected in 27 drivers (16.5%). Cannabinoids were detected in the urine of 25 drivers (15.2%), in 17 the concentrations exceeded 400 ng/mL. In one instance amphetamine, cocaine and heroin were detected in the same injured driver. Combined use of alcohol with some other drugs was detected in only four drivers. Alcohol and cannabinoid levels were prevalent in the urine of injured drivers in this study, particularly in young males who remain over-represented in the group of injured drivers. In the population surveyed other drugs were rarely detected. The role of cannabinoids in road trauma and the use of cannabinoids in young male drivers will however need to be monitored more extensively.

Accidents, Traffic↗
PubMed1995

Asthma management and mode of acquisition of inhaled bronchodilators.

BACKGROUND: Controversy has existed about the benefits and disadvantages associated with the availability of inhaled bronchodilators over the counter (OTC). AIMS: To compare sociodemographic features, use of preventive medications, use of medical services and control of asthma in adults who purchased inhaled bronchodilators OTC with those who purchased on prescription (script). METHODS: A cross-sectional telephone survey of 772 adults 18 years and over who used inhaled bronchodilators for their asthma. Symptoms, asthma medications, and management practices were determined by a structured questionnaire administered by trained telephone interviewers. RESULTS: Two hundred and thirty adults purchased their bronchodilator OTC and 542 on script. OTC purchasers were more likely to be male (OR: 1.5), have had tertiary education (1.5) and be in paid employment (2.8); they were less likely to report frequent symptoms (wheeze, nocturnal symptoms or EIA more than once a week) (0.71); were less likely to use preventive medications more than twice a day (0.57) and were less likely to have consulted a general practitioner in the previous year (0.38). However, poor control of asthma symptoms was evident in both OTC and script groups. Forty per cent of the OTC group who had symptoms more than two to three times a week and 34% of the script group were not using preventive medication. CONCLUSIONS: Undertreatment and suboptimal management of asthma were apparent in both OTC and script groups.

Adult↗
PubMed1995

Incidental depiction of cigarettes and smoking in Australian magazines, 1990-1993.

The study aimed to assess evidence of any increase in apparently incidental photographic depictions of cigarettes or smoking in Australian magazines following the ban on tobacco advertising in the print media introduced in January 1991. We examined 27,704 pages in 20 Australian magazines popular among young people or aimed at low socioeconomic groups during three sample periods in 1990 (before the ban), 1991 and 1993 (after the ban). All photographs showing cigarettes or smoking were counted and a smoking rate per page was calculated. When all 20 magazines were combined, there was a 75 per cent increase in the rate of photographs of smoking per page from 1990 (six months before the ban) to 1991 (six months after the ban). However, there was a reduction of 36 per cent in the rate of smoking photographs per page between 1991 and 1993 (18 months after the ban) and a nonsignificant increase of 12 per cent across the three sample periods. Photographs of smoking are infrequent in Australian magazines (mean: 1:147 pages, range: 1:17 pages to zero). There appears to be a commendable constraint by many Australian magazine editors in limiting the publication of photographs that show smoking or cigarettes. Some magazines never show smoking, indicating that a goal of total absence of photographs of smoking is achievable. Some magazines have room for improvement.

Advertising↗
PubMed1995

Professed religious affiliation and the practice of euthanasia.

Attitudes towards active voluntary euthanasia (AVE) and physician-assisted suicide (PAS) among 1,238 doctors on the medical register of New South Wales varied significantly with self-identified religious affiliation. More doctors without formal religious affiliation ('non-theists') were sympathetic to AVE, and acknowledged that they had practised AVE, than were doctors who gave any religious affiliation ('theists'). Of those identifying with a religion, those who reported a Protestant affiliation were intermediate in their attitudes and practices between the agnostic/atheist and the Catholic groups. Catholics recorded attitudes most opposed to AVE, but even so, 18 per cent of Catholic medical respondents who had been so requested, recorded that they had taken active steps to bring about the death of patients.

Attitude of Health Personnel↗
PubMed1995

Serial mass-media campaigns to promote physical activity: reinforcing or redundant?

Changes associated with two serial, nationwide, mass-media-based campaigns to promote physical activity conducted by the National Heart Foundation of Australia in 1990 and 1991 were examined. Surveys conducted before and after each campaign found statistically significant differences in message awareness (46% vs 71% in 1990; 63% vs 74% in 1991). In 1990, there were significant increases in walking, particularly among older people, and in intentions to exercise. No such changes were apparent in 1991. In the case of these two campaigns, conducted 1 year apart, the second may have been redundant.

Adolescent↗
PubMed1995

Spirometric standards for healthy adult lifetime nonsmokers in Australia.

The aim of this study was to develop suitable spirometric prediction equations for asymptomatic Caucasian adults in the Australian population. These equations were compared with those of previous studies and constants were presented which, when associated with the prediction equations, permitted the calculation of 5% tolerance intervals for lung function. The 1,302 subjects (aged 18-78 yrs) who underwent pneumotachograph spirometry, using techniques recommended by the American Thoracic Society, were a sample from metropolitan Adelaide, South Australia. The variables recorded were sex, age, height, mass, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), forced mid-expiratory flow (FEF25-75%) and FEV1/FVC ratio. Complete data were obtained for 614 females and 621 males, but the sample was reduced to 249 females and 165 males when only lifetime nonsmokers with no adverse bronchial symptoms were selected. Prediction equations of normal lung function were obtained from the reduced sample by multiple regression, with age, height and functions of both age and height as predictors. The derived equations did not differ significantly from the majority of previously reported equations and were generally superior in their ability to predict the lung function of the asymptomatic ex-smokers who were part of the original sample. Analysis of the sensitivity, specificity and predictive power of 5% tolerance limits for the presence of symptoms revealed the important roles of FEV1, FEV1/FVC and FEF25-75% in diagnostic testing. The present prediction equations are recommended for use on the Australian population and on populations with similar Caucasian characteristics.

Adult↗
PubMed1994

Phase II study of amonafide in gastric adenocarcinoma. An Illinois Cancer Center trial.

Twelve patients with recurrent, metastatic, or inoperable gastric adenocarcinoma were enrolled in an Illinois Cancer Center phase II trial of amonafide (nafidimide), a novel compound that acts as a DNA intercalator. Treatment consisted of a 60-minute infusion of amonafide which was administered daily for 5 consecutive days every 3 weeks at a starting dose of 300 mg/m2/d. Doses were modified according to the grade of toxicity experienced and eight patients underwent dose escalations. All 12 patients were evaluable for response and toxicities were predominantly hematologic. Stabilization of disease for at least 28 days was observed in seven patients and disease progression was noted in five. The median survival was 7.4 months. Doses were sufficient to produce severe bone marrow toxicity in one-third of the patients treated. None of the patients responded to therapy, implying a true response rate less than .221. Based on the results of this study, amonafide showed no activity against gastric adenocarcinoma; however toxicity appeared acceptable at the 300 mg/m2/d x 5 consecutive days every 3 weeks dose and schedule.

Adenine↗
PubMed1994

Do nurses know when to summon emergency assistance?

At Liverpool Hospital in 1989, mortality from cardiopulmonary arrest was 71% in the general wards, and 64% in the Emergency department. In an attempt to identify and treat seriously ill patients before they progressed to cardiac arrest, a medical emergency team (MET) was established. The MET replaced the existing cardiac arrest team and comprised a nurse from the intensive care unit (ICU), a resuscitation registrar (an anaesthetics trainee), a medical registrar and a senior registrar from the ICU. The resuscitation registrar was the team leader. The calling criteria for the MET were based on predetermined physiological variables, abnormal laboratory results, and specific conditions or if nursing or medical staff were concerned by the patient's condition. A study was conducted 2 years following implementation of the MET system, to determine registered nurses' (RNs) opinions, knowledge and use of the system. A questionnaire distributed to 141 nurses rostered on the chosen study date revealed a positive attitude the MET, although there was a low awareness regarding the availability of the MET information booklet. 53% of nurses had called the MET in the last 3 months; all would call the team again in the same circumstances. The correct response in three of four hypothetical situations presented was to call the MET. The number of correct responses varied between scenarios from 17-73%. Hypotension did not appear to alert nurses to summon emergency assistance. Some nurses, despite the presence of severe deterioration and patient distress, called the resident rather than the MET.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Problems following discharge after intensive care.

Intensive care units (ICUs) are now present in most acute care hospitals. While long-term studies on patients admitted to these units have been performed to identify mortality, functional outcome and quality of life, there is little information on the recovery period in the weeks immediately following discharge. The aim of this study was to identify and describe the sequelae found in patients at 3 months after leaving the ICU. The study was conducted over a 6-month period during 1991, in a university teaching hospital in Sydney, Australia. 54 patients with a length stay (LOS) of greater than 48 hours in the ICU were included. Each patient was interviewed in an outpatient clinic attached to the ICU. Information collected included pre-admission details, reason for admission, treatments provided and complications encountered. General health state, social and employment details, functional status, referral patterns since discharge and recollection of ICU stay were studied. The major findings indicated that many of the patients interviewed were returning towards near normal general health, but were suffering mild to moderate physical and psychosocial sequelae. In the majority of cases the problems were not incapacitating. The predominant complaints were minor to severe pain, sleeping difficulties, tiredness and breathlessness. Financial problems were reported by a small number of patients. Depression, irritability or a feeling of loneliness were present in over one-third of the group. More than half the patients required referral for further assessment. 34% of patients had no recollection of their ICU stay. 16 patients (29.6%) reported unpleasant memories including nightmares and hallucinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1994

Referral of surgical patients to an anaesthetic clinic: a decision-making analysis.

Effective utilization of an anaesthetic clinic depends on appropriate referral of high-risk surgical patients. The decision-making behaviour of anaesthetists and nurses was examined to identify factors that influence the referral of patients to an outpatient anaesthetic clinic. Eleven consultant anaesthetists, seven anaesthetic trainees and sixteen nurses working in anaesthetic areas estimated the likelihood that they would refer patients for each of the 30 scenarios presented. The relative importance of each factor influencing the decision to refer as determined by the 34 participants were: type of procedure (22%), co-morbidities (18%), fitness (13%), history of anaesthetic problems (12%), medications (11%), age (10%), obesity (8%) and anxiety (6%). Indicative risk factors identified were aged 65 years or over, unable to climb more than two flights of stairs, presence of significant medical problems, gross obesity, history of anaesthetic problems, taking regular medications, scheduled for major surgery and expressed anxiety about the anaesthetic. There were large variations in the decision-making behaviour among health professional groups.

Adult↗