The chronic obstructive pulmonary disease strategy.
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Biomedical subjects
Publications and source records attributed to J Burdon.
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Fibre-optic bronchoscopy in adults is a common procedure in clinical respiratory practice. Under controlled conditions it is safe, resulting in relatively few significant adverse events. The present position paper updates guidelines previously published by The Thoracic Society of Australia and New Zealand and is based on evidence obtained by searching the Medline and Embase databases. The level of evidence to support recommendations is indicated in the text. Where no evidence has been found, the guidelines reflect the opinions of the authors. Specific recommendations are made regarding sedation and anaesthesia, the cleaning of bronchoscopes and the training of bronchoscopists.
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OBJECTIVE: The aim of the present study was to determine treatment practices for spontaneous pneumothorax (PTX) in Australia. METHODOLOGY: A questionnaire regarding treatment of PTX was posted to all medically qualified members of the Thoracic Society of Australia and New Zealand resident in Australia. RESULTS: Fifty-three per cent (n = 226) of questionnaires were returned. Twenty-one responses were judged to be informal and rejected from analysis. The results indicate a general agreement in the treatment of small and large PTX but a wide variation in PTX of intermediate size. CONCLUSION: Opinion regarding the optimal treatment for PTX of intermediate size was found to vary considerably. There is a need for evidence-based development and publication of best practice guidelines for PTX.
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BACKGROUND: Breathlessness is common during pregnancy and is usually due to hormonal changes or mechanical factors. However, it is important to ensure that no other cause for this symptom is present, and to exclude underlying or co-existent conditions.
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In common with much of subSaharan Africa, falciparum malaria is a major cause of mortality and morbidity amongst the indigenous population of northeast Zaire1 although there are some mountainous areas in the east of the region that are relatively free from the parasite. There are a significant number of expatriate church workers (missionaries) in the area who work mainly in the health and development sector or directly with the local church in bible translation, evangelism, etc. The lifestyle of these workers, who tend to live close to the indigenous population, and their length of stay in a malarious region means that they are at high risk of contracting malaria.1 This population has been inadequately studied concerning its use of chemoprophylaxis and other measures necessary to reduce the risk of malaria. Many countries have published guidelines2-4 on the use of chemoprophylaxis for the prevention of malaria in travelers. This study was planned to investigate whether these guidelines were being followed by this group of missionaries. It also enabled the author to investigate who or what influences decisions regarding malaria prophylaxis amongst this population.
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An implantable venous access system provides a reliable and painless entry site for intravenous treatment. This study reports the authors' experience with such a system in adult patients with cystic fibrosis. Sixty five (87%) of 75 PAS Ports were placed successfully in 57 patients with cystic fibrosis. Because of early difficulties in advancing the catheter in patients whose veins had been traumatized by repeated courses of intravenous antibiotics, a technique was developed whereby venous entry was gained by direct subclavian puncture. This catheter insertion method was used in 53 (82%) attempts and the catheter was then passed by subcutaneous tunnelling to the port site on the ventral aspect of the upper arm. Fifty seven (88%) insertions were successful under local anaesthetic. The major early and late complications were iatrogenic pneumothorax (six cases) and infection (five cases), respectively. Late complications were more common when there was coexisting disease, e.g. diabetes mellitus, or an acute severe respiratory exacerbation, or when the Port was used for parenteral feeding. In conclusion, the PAS Port can be inserted safely by direct subclavian puncture. It was well tolerated and universally liked by the patients.
A multicentre, randomised, open, parallel-group study was performed to compare the efficacy, tolerability and ease of handling of salmeterol xinafoate 50 micrograms twice daily via the Diskus inhaler with terbutaline sulphate 500 micrograms four times daily via the Turbuhaler inhaler. Two hundred and sixty-three patients (aged 18-79 years, baseline FEV1 50-90% predicted, mean PEFR 85% of response to salbutamol) were randomised to treatment with salmeterol (n = 136) or terbutaline (n = 127). A statistically significant difference in favour of salmeterol was seen between treatment groups for the primary efficacy variable, mean morning PEFR (difference in adjusted means 25.4 l/min, p < 0.001). Within the groups randomised to each device, ease of handling assessments favoured the Diskus inhaler over the Turbuhaler inhaler. More patients liked the Diskus inhaler than the Turbuhaler inhaler (98% vs 72%, p < 0.001). The Diskus inhaler received better scores than the Turbuhaler inhaler for all features assessed in the device questionnaire.