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Biomedical subjects

M Mira

Publications and source records attributed to M Mira.

At least 19 recordsLinked to original sources
PubMed2002

A phase II trial of cisplatin and vinorelbine in patients with recurrent or metastatic squamous cell carcinoma of the head and neck.

OBJECTIVE: We assessed the response rate and the toxicity of cisplatin plus vinorelbine in patients with this condition. PATIENTS AND METHOD: Forty-two patients were included. Therapy consisted of cisplatin, 100 mg/m(2) on day 1, and vinorelbine, 25 mg/m(2) on days 1 and 8, given every 21 days. Therapy was continued up to six courses or progressive disease. RESULTS: One hundred fifty-nine courses were given (median, three per patient). Dose reduction was applied in 13% of courses and 43% of patients. Grade 3 to 4 neutropenia appeared in 11% of courses and 35% of the patients. One patient died of febrile neutropenia. Ten percent of patients attained a complete response, and 23% attained a partial response (overall 33%, 95%CI 19%-47%). The median duration of response and median survival were 6 months. Twenty-four percent of patients remain alive at 1 year. CONCLUSIONS: The combination of cisplatin and vinorelbine is moderately active in patients with recurrent or metastatic carcinomas of the head and neck and avoids the inconvenience of prolonged infusions of 5-fluorouracil.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

Iron deficiency in Australian-born children of Arabic background in central Sydney.

OBJECTIVES: To determine the prevalence of iron depletion and deficiency, and iron-deficiency anaemia, along with risk factors for iron depletion, in Australian-born children aged 12-36 months of Arabic-speaking background. DESIGN: Community-based survey. SETTING: Central Sydney Area Health Service (CSAHS), NSW, April to August, 1997. PARTICIPANTS: All children born at five Sydney hospitals between 1 May 1994 and 30 April 1996, whose mothers gave an Arabic-speaking country of birth and resided in the area served by the CSAHS. MAIN OUTCOME MEASURES: Full blood count (haemoglobin, mean corpuscular haemoglobin, mean corpuscular volume), plasma ferritin concentration, haemoglobin electrophoresis, potential risk factors for iron depletion. RESULTS: Families of 641 of the 1,161 eligible children were able to be contacted, and 403 agreed to testing (response rate, 62.9% among those contacted). Overall, 6% of children had iron-deficiency anaemia, another 9% were iron deficient without anaemia, and 23% were iron depleted. Multiple logistic regression analysis showed three significant independent risk factors for iron depletion: <37 weeks' gestation (odds ratio [OR], 5.88, P=0.001); mother resident in Australia for less than the median time of 8.5 years (OR, 1.96, P=0.016); and daily intake of >600 mL cows' milk (OR, 3.89, P=<0.001). CONCLUSION: Impaired iron status is common among children of Arabic background, and targeted screening is recommended for this group.

Adolescent↗
PubMed2001

Continuity of care in diabetes: to whom does it matter?

The Australian health care system allows patients to move around to seek medical treatment. This may impact negatively on continuity of care. To determine factors associated with continuity of care for persons with diabetes, the profiles of 479 patients attending the Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia, were examined. The majority of patients (87.7%) attended only one general practitioner and had been under the care of the referring doctor for a median of 6.2 years. These patients were older (P=0.02), but were comparable with those attending multiple doctors in terms of their type, duration and treatment of diabetes as well as their clinical and complication profile. There was also a relationship between age and the length of time under the care of the referring doctor (P=0.0002). The HbA(1c), lipid, blood pressure and treatment profiles of patients attending the referring doctor short, medium or long-term were comparable. However, there was an upward trend in the proportion of patients with a history of cerebrovascular disease, ischaemic heart disease or any complication of diabetes with each incremental increase in length of time under the referring doctor. Appropriately, patients seek continuity of care as they age and their health needs become more complex.

Aged↗
PubMed2001

Use of Medicare services related to diabetes care: the impact of rural isolation.

This study used Medicare data for people living in New South Wales (NSW) (1993-1997) to examine the impact of rural isolation on the utilisation of diabetes health care services. The relative odds of attending a specialist was slightly higher for people in urban areas when compared to their rural counterparts but reached as high as 1.85 in regard to attendance to consultant physicians. Surveillance of diabetes parameters over the 5 year period showed greatest improvement in rural areas. The proportion of patients each year with glycaemic control assessed by quantification of glycosylated haemoglobin (HbA1c) or renal function and vascular risk by microalbuminuria estimation rose to 57.4% and 12.3%, respectively, in rural areas compared to 55.2% and 11.3% in major urban areas. This study has shown that the level of monitoring in rural areas is equal to urban areas, despite decreased access to medical care, highlighting the vital role GPs play in diabetes management in rural NSW.

Clinical Laboratory Techniques↗
PubMed2001

Immunization coverage of Australian-born children of Arabic-speaking background in Central Sydney.

OBJECTIVES: To examine the immunization coverage rates of 12-36-month-old Australian-born children from an Arabic-speaking background in Central Sydney as determined by parental report and documentary evidence. METHODOLOGY: Eligible children were identified by examination of the records of five hospitals. Eligibility criteria were that the mother gave an Arabic speaking country of birth and a Central Sydney post code (as her place of residence) and the child was born between 1 May 1994 and 30 April 1996. Parents of all eligible children were invited to participate, either by a special appointment to answer a structured questionnaire, or by telephone survey. Of the 1157 eligible children identified from hospital birth records, only 641 could be contacted, of whom 584 (91.1%) agreed to participate. Full information on age appropriate immunization rates, as reported by parents and documented in records, could be assessed for 403 children. RESULTS: Parents reported that 97.6% of children were fully immunized. When the child's immunization status could be verified from either the child's personal health record and/or the service provider, the rate of full, age-appropriate immunization was 94.3% (95% confidence intervals 92.0-96.6) compared to a parent-reported rate of 98.0%. General practitioners provided 76.2% of immunizations. CONCLUSION: While a substantial proportion of children identified from birth records could not be contacted, comparisons with census data and other analyses indicate that this sample is likely to be representative of the general population of 12-36-month-old Australian-born children from an Arabic-speaking background. This group appeared to be highly immunized. Further studies examining why the rates for this ethnic group are high in Central Sydney may determine strategies which will enhance immunization rates in other communities.

Analysis of Variance↗
PubMed2001

Differential shared care for diabetes: does it provide the optimal partition between primary and specialist care?

AIMS: To establish whether a system of differential shared care between general practitioners and specialists is compatible with patients receiving the level of care they require. METHODS: We sought to trace 200 shared care patients whose care had been kept at the general practitioner level after initial referral and compared them with a group of patients who had been re-referred to the Royal Prince Alfred Hospital Diabetes Centre for specialist review. RESULTS: There were no significant differences in glycaemic, blood pressure and lipid levels of returned and non-returned patients at initial assessment. However, non-returned patients were less likely to have a history of macrovascular disease or risk factor (adjusted odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2-0.6). Their referral letter was also more likely to emphasize their type and/or duration of diabetes (adjusted OR 4.6; 95% CI 2.5-8.4). Nearly half (47.1%) of the non-returned group changed their doctor in the years following their initial specialist review, increasing their likelihood of not being re-referred five-fold (adjusted OR 5.0; 95% CI 2.9-8.8). At initial assessment, non-returned patients were given less treatment recommendations (adjusted OR 0.5; 95% CI 0.3-0.7). Doctors registered with the Diabetes Shared Care Programme referred more patients than their non-shared care counterparts. However, a higher proportion of these doctors (52.5% vs. 21.3%; chi(2) = 16.5, 1 d.f., P = 0.00005) were selective in whom they re-referred. CONCLUSION: Differential shared care encourages appropriate referral to specialist services, without compromise to standards of care. Diabet. Med. 18, 554-557 (2001)

Australia↗
PubMed2001

An instrument for collecting problem oriented, problem linked data in primary medical care.

AIM: To describe a new form for collecting problem oriented, problem linked data from primary care. METHOD: A novel form is described which has been used to collect these data. These data were validated against secondary data collections. RESULTS: The form has been used to record 10,937 encounters in a variety of primary care settings. The form was acceptable to general practitioners (GPs) and was completed on 87% of eligible patients in a one week data collection. Data captured provide descriptive data about the problems encountered and services provided during the consultation. These elements of the medical record are linked so that it is possible to address questions about patterns of service provision. Uncomplicated lower urinary tract infection is used as an example of how data from the form can be used to examine clinical practice and resource utilisation. CONCLUSION: A method has been demonstrated to collect problem oriented, problem linked data which may be used for clinical costing and to demonstrate compliance with clinical practice guidelines.

Chi-Square Distribution↗
PubMed2000

Serological survey of measles and rubella immunity in Sydney preschool children.

OBJECTIVES: To estimate the prevalence of serological evidence of immunity to measles and rubella in preschool children in central and southern Sydney (NSW, Australia) and the prevalence of immunity in children with either documented or parentally reported immunization. METHODS: Geographical cluster random sampling was used to select children aged between 18 and 60 months to participate in the present study. Standardized interviews obtained information on each child's reported (by parents) immunization status and documentary evidence of immunization was recorded from the Personal Health Record. Venous blood was collected, serum was separated and stored frozen until tested. Measles and rubella antibodies were measured using ELISA, with either immunofluorescence or haemagglutination inhibition being used to clarify equivocal results. The study was conducted from 1992 to 1994 in conjunction with surveys of blood lead concentrations, iron status and micronutrient status. RESULTS: Parents of 726 of 953 children identified between 9 and 60 months of age agreed to participate in the lead, immunization, iron status and micronutrient studies. Sufficient blood for antibody testing was obtained from 580 children, aged 18 to 62 months at the time of collection. Parents reported that 94.7% (95% confidence interval (CI) 92.7-96.5%) of children had received a measles-mumps or measles-mumps-rubella (MMR) immunization. General practitioners administered 72.8% of these immunizations. The prevalence of serological evidence of immunity to measles and rubella was 88.8% (95% CI 86.2-91.4%) and 91.9% (95% CI 89.6-94.2%). respectively. There was documented evidence of measles and rubella immunization for 88.4% (95% CI 85.7-91.2%) and 86.4% (95% CI 83.4-89.3%) of children, respectively. Of children with documented measles immunization, 91.6% (95% CI 89.2-94.0%) had detectable measles antibody. Of children with documented rubella immunization 97.2% (95% CI 95.8-98.6%) had detectable rubella antibody. CONCLUSIONS: Measles and rubella immunization rates in central and southern Sydney are relatively high and most of these immunizations are provided by the private sector. Immunity to rubella in children with documented rubella immunization is at the level that would be expected from seroconversion studies. Immunity to measles in children with documented measles immunization is slightly lower than expected from seroconversion studies, highlighting the need for the second MMR immunization in preschool children, as well as making near universal immunization imperative if this disease is to be eradicated.

Antibodies, Viral↗
PubMed2000

The pattern of diabetes care in New South Wales: a five-year analysis using Medicare occasions of service data.

OBJECTIVE: To use Medicare occasions of service data to establish the pattern and standard of care received by people with diabetes. METHOD: Information about visits to medical practitioners as well as utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997 was retrieved using a Health Insurance Commission data file. Individuals were deemed to have diabetes if an HbA1c which can only be ordered for a person with known diabetes, had been performed over the five-year period. RESULTS: On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. A large proportion of patients also received care at the specialist and consultant physician level, 51.2% and 38.6% respectively, a three to four fold increase when compared with their non-diabetic counterparts. There was also a 1.3 to 1.8 fold increase in the mean number of attendances to the various medical practitioners. Surveillance of diabetes parameters was inadequate but small improvements were seen over the 5 year study period (proportion of persons with diabetes with a HbA1c performed: 48.8% to 56.8%; Lipids: 49.4% to 52.0%; HDL cholesterol: 18.3% to 18.8%; microalbuminuria: 4.7% to 11.6%). CONCLUSION: This study has highlighted the heavy burden imposed by diabetes on our health care system. IMPLICATIONS: The use of Medicare occasions of service data represents a cost efficient way of monitoring health service utilisation.

Diabetes Mellitus↗
PubMed1999

Diabetes management: shared care or shared neglect.

Shared care is increasingly being advocated as a way of managing patients with diabetes. While this approach has been supported by clinical trials, the success of shared care in 'real life' is not well established. If health care professionals leave undone what they think is done by others, shared care can become neglected care. Follow up of 200 'shared care' patients who had been referred to the Royal Prince Alfred Diabetes Centre, Sydney, Australia on two or more occasions between October 1995 and September 1998 showed that the majority of specialist recommendations regarding metabolic control (76%), referral to an ophthalmologist (73%) and blood pressure treatment (76%) had been implemented by the primary care physician; however, they were less likely to implement recommendations regarding lipid treatment (55%). The median HbA1c (7.6% vs. 8.4%; P = 0.04), cholesterol (5.6 vs. 6.8 mmol/l; P = 0.0005) and triglyceride (2.0 vs. 2.8 mmol/l; P = 0.05) levels for patients in whom recommendations had been implemented were significantly lower at the time of second referral. Doctors registered with the Diabetes Shared Care Programme and those who wrote longer letters were more likely to implement recommendations than their counterparts (87.2%, versus 70.9%; chi2 = 4.12, 1 df; P = 0.04 and 56 words (inter-quartile range (IQR): 36-71) versus 45 words (IQR: 23-59); P = 0.02, respectively). It therefore appears that diabetes care can be well provided by a shared care approach. However, further monitoring of different shared care models is warranted.

Australia↗
PubMed1999

Can GP input into discharge planning result in better outcomes for the frail aged: results from a randomized controlled trial.

OBJECTIVE: We aimed to assess whether GP input into discharge planning for high-risk aged in-patients admitted under the care of a geriatrician results in improved patient outcomes. METHODS: We conducted a prospective randomized controlled trial in Sydney, Australia. The subjects were 364 patients aged 60 years and over. The main outcome measures included community service referral, accommodation changes, length of stay, readmission rate, length of time to first readmission and patient satisfaction with discharge arrangements. RESULTS: No significant differences were found with regard to length of stay, readmission rates or time to first readmission. Test-group subjects were significantly more likely to be recommended for community services at discharge and to report that hospital personnel had discussed their discharge plan with them. Significantly more of the test group reported that their return home was well prepared. CONCLUSIONS: Although GP pre-discharge visits did not alter the likelihood of 'hard outcomes such as risk of readmission', the results suggest that quality of care is enhanced amongst patients receiving a pre-discharge visit and that GPs can perform a key role in planning post-discharge care with other services.

Aged↗
PubMed1999

Information technology and general practice. A survey of general practitioner attitudes towards computerisation.

AIM: General practitioners in the central Sydney area were surveyed to quantify the extent of, and attitudes towards, computerisation in Australian general practice. METHOD: Two surveys were mailed to all GPs in the central Sydney area, first in 1994, and again in 1996. The majority of questions in both surveys were identical. The results were collated and descriptive and comparative statistics calculated. RESULTS: There was an increase in the use of computers for clinical tasks and, GPs' attitudes towards computerised prescribing systems became more positive. There was a persistent negative attitude towards the actual costs of computerisation. CONCLUSION: Methods are now required to transform the increased use of computers by GPs into improved outcomes for them and their patients.

Attitude to Computers↗