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M Montalto

Publications and source records attributed to M Montalto.

At least 55 records · Page 3Linked to original sources
PubMed1996

Evaluation of the efficacy and tolerability of four different therapeutic regimens for the Helicobacter pylori eradication.

The aim of our study is to evaluate the efficacy and tolerability of four different therapeutic regimens for Helicobacter pylori eradication. One-hundred and thirty-two consecutive patients suffering from either peptic ulcer or non-ulcer dyspepsia, with Helicobacter pylori infection, were allocated to one of the following 4 groups with different therapeutic regimens: A) omeprazole 20 mg bid for 14 days/amoxycillin 1000 mg bid for 14 days/tinidazole 500 mg bid for 14 days (30 patients, 13 with peptic ulcer); B) omeprazole 20 mg bid for 14 days/amoxycillin 1000 mg bid for 14 days (41 patients, 23 with peptic ulcer); C) omeprazole 20 mg bid for 14 days/azithromycin 500 mg/day for 3 days for 2 consecutive weeks (25 patients, 12 with peptic ulcer); D) omeprazole 20 mg/day for 7 days/clarithromycin 250 mg bid for 7 days/tinidazole 500 mg bid for 7 days/ (36 patients, 14 with peptic ulcer). The Helicobacter pylori status was evaluated by means of histology, culture and urease test, at entry and 8 weeks after treatment. 2 group A, B and D patients, 1 D patient didn't complete the treatment. In evaluable patients, the Helicobacter pylori eradication was obtained in 24 patients of group A (85.71%), in 24 of group B (58.98%), in 11 of group C (45.83%) and in 24 of group D (70.58%). On intention-to-treat analysis, Helicobacter pylori eradication was 80% in group A, 56.09% in group B, 44% in group D and 66.67% in group D. Sideeffects occurred in 6 patients of group A (20.68%), in 5 of group B (12.5%), in 3 group D (8.82%) and none of group C. In conclusion, triple therapy with omeprazole/clarithro-mycin/tinidazole is better for cost/benefit ratio; omeprazole/amoxycillin/tinidazole is more effective than others regimens in the Helicobacter pylori eradication, but causes more side effects; double therapy with omeprazole/azithromycin is the most tolerable and the least efficacy for Helicobacter pylori eradication.

Adult↗
PubMed1995

Differences in work activities between private and community health centre general practitioners.

OBJECTIVE: To investigate differences in the characteristics of general practitioners (GPs) and patients, referral rates, rates of prescribing and ordering of tests and x-rays, and types of counselling and consultation, between private and community health centre (CHC) GPs in Victoria. METHOD: All 51 full-time Victorian CHC GPs were invited to enrol in the Australian Morbidity and Treatment Survey (AMTS) developed by the Family Medicine Research Unit at the University of Sydney in 1992. The control group comprised the 114 Victorian GPs involved in this survey in 1991. RESULTS: Thirty-nine CHC GPs (76%) provided complete data. CHC GPs were more likely to be younger, female, and to have less experience in general practice. Patient age and gender distributions were similar. CHC GPs had higher rates of offering counselling and advice and of referral to allied health professionals, but similar rates of referral to medical specialists to those of private GPs. We found no differences in prescribing after multivariate analysis. CONCLUSIONS: Counselling, and referral to allied health professionals, were the only striking differences after multivariate analysis. It may be that any movement toward non-throughput-related remuneration may, in isolation, have less impact on general practitioner work patterns than imagined. Patient throughput was not measured, and this would be important in any future global assessment of the cost-effectiveness of CHC and private general practitioners.

Adult↗
PubMed1995

Prevention and treatment of low-grade B-cell primary gastric lymphoma by anti-H. pylori therapy.

Mucosa-associated lymphoid tissue (MALT) showing a follicular structure can develop in the gastric mucosa as a response to Helicobacter pylori infection. We emphasize the importance of anti-H. pylori antibiotic therapy in the elimination of acquired MALT. Of the 200 patients studied, acquired MALT was found in 70 of the 151 H. pylori-positive patients, whereas it was present in only five of the 49 H. pylori-negative patients. Thirty-eight H. pylori-positive and MALT-positive patients were treated with antibiotic therapy and reevaluated after 6 months: 21 patients were H. pylori negative/MALT negative, 12 were H. pylori positive/MALT positive, four were H. pylori negative/MALT positive, one was H. pylori positive/MALT negative. In the control group (n = 20), H. pylori and acquired MALT were still present at follow-up. One patient with histological and immunohistochemical evidence of low-grade B-cell gastric MALT lymphoma underwent antibiotic treatment and was reexamined after 8, 12, and 24 weeks: histological examination of biopsy samples showed regression of the MALT lymphoma in tandem with the disappearance of H. pylori colonization. Our data confirm the correlation between H. pylori infection and acquired MALT, as documented by the ability of antibiotic therapy to induce the disappearance of acquired MALT and regression of MALT lymphoma. Considering the potential evolution of MALT into low-grade B-cell MALT lymphoma, H. pylori eradication should play a role in the prevention of this tumor.

Adolescent↗
PubMed1995

General practitioners in hospitals.

The authors review General Practitioners in Hospitals, a report prepared by the School of Medical Education, University of New South Wales (1993) for the Australian Health Ministers' Advisory Council Medical Workforce Group on Hospital Training and Career Development. The authors acknowledge that this report represents the most comprehensive look at GP involvement in hospitals across Australia, but suggest that its conclusion 'general practitioners play a substantial role in the provision of medical care in public hospitals around Australia' may be an overstatement. They discuss shortcomings associated with the study, including: definitional issues; variation in levels of involvement according to hospital type; potential biases introduced by using self-report of hospital administrators as the source of data; insufficient emphasis being placed on the views of GPs; and the validity of extrapolations.

Australia↗
PubMed1995

Using referral letters to measure quality and performance in general practice.

Although quality assurance is a concern of professional Colleges of General Practice and researchers in primary care, there are practical difficulties in measuring performance in general practice. Reliance on medical record audits in general practice has many shortcomings. Referral letters hold many advantages as a tool for audit or quality assessment in general practice: accessibility; acceptability; objectivity; consensus in standard setting for letters; and a positive impact on the quality and cost of management. Professional consensus standards will continue to be developed. If they are to be used for performance measurement, rather than simply serve an educational function, more use can and should be made of referral letters to assess and improve general practitioner performance.

Family Practice↗
PubMed1995

Hospital in the home units. Early issues for GP involvement.

This paper reviews the early challenges for Hospital in the Home units which choose to utilise general practitioner skills. A model is described. Issues surrounding GP selection, remuneration, responsibility, leadership, and other hurdles are described. Since alternatives to GP involvement exist, GPs should be prepared to seize this important opportunity.

Home Care Services, Hospital-Based↗
PubMed1994

True believers? Characteristics of general practitioners in Victorian community health centres.

General practitioners have been part of multidisciplinary services in Victoria Community Health Centres (CHCs) for 20 years. This model institutionalizes a high degree of integration between general practitioners and other primary care and community service personnel. Of 51 eligible full-time general practitioners in Victorian CHCs, 46 were interviewed, using a structured questionnaire. General practitioners in CHCs were younger, less experienced and more likely to be female than other general practitioners. Nearly three-quarters were salaried. The philosophy of practice and the conditions of employment were the commonest reasons for entering CHC practice. Teamwork and the conditions of employment were felt to be the biggest advantages of CHC practice, while difficulties with management and the perceived loss of professional ownership and control were the commonest disadvantages. None reported interference from the CHC management in their clinical practice. Nearly a quarter of full-time CHC general practitioners do not undertake any formal community health promotion activities. Forty-five per cent of respondents intended to leave their CHC within the next five years. Universal health insurance has diminished the impact of CHC general practice. The philosophy of CHCs and the salaried nature of the employment continues to attract general practitioners. High staff turnover is a feature of CHC general practice, in part related to young doctors making an initial, but not long-term commitment to CHC practice. However, the loss of professional control and management difficulties should be addressed, as these may contribute to the high turnover.

Adult↗
PubMed1994

The use of inpatient admission privileges by members of a division of general practice.

OBJECTIVE: The Mornington Peninsula Hospital (MPH) in Victoria has a Division of General Practice whose members retain admission privileges. We will describe the use of general practitioner inpatient admitting rights at Mornington Peninsula Hospital. METHOD: The study will be a retrospective review of existing hospital databases. RESULTS: From 1980 until July 1992 the rate of general practitioner admissions is decreasing at one per cent per annum. Comparative data shows an increase of 0.7 per cent in admissions per annum by medical specialists. Between 1988 and 1991 general practitioner admissions have been equally divided between obstetrics and general medicine. The proportion of long stay general practitioner inpatients is below one per cent of all general practitioner admissions, and the average length of stay for general practitioner inpatients approximates that of MPH in general. Most general practitioner inpatients are discharged home, and 3.1 per cent are transferred to other units or hospitals. Neoplastic disease accounts for 40 per cent of all the deaths within the general practitioner inpatient group. DISCUSSION: This study shows that, in selected areas, the care of inpatients is still a valid role for some general practitioners.

Family Practice↗
PubMed1994

Impact of general practitioners' referral letters to an emergency department.

INTRODUCTION: We sought to determine the impact of general practitioner communication on the efficient management of patients who present to the emergency department. Casemix, severity, time of presentation, the quality of the letter and the reception of a telephone call were considered. METHOD: All consecutive patients presenting to the emergency department of Mornington Peninsula Hospital (Frankston) for one month in 1992 were included in this survey. The methodology is summarised in Figure 1. RESULTS: The referral letter made no difference to patients' waiting time and time spent in the department and a non significant difference in communication back to the general practitioner. This was found despite the quality of the referral letter, the time of presentation, and the diagnosis. The general practitioners' telephone call, however, decreased significantly the patient's waiting time. Investigations that were reported in the general practitioners' letters and not repeated by the emergency department resulted in a direct saving of $2604 for the month of the study. High interrater reliability was discovered in the rating of letters by six general practitioners. DISCUSSION: Despite the ability of general practitioners to select appropriate cases for referral, only the telephone call results in a quantifiable benefit for patients who attend their general practitioner. The high inter-rater reliability affirms the use of referral letters as audit tools in general practice. Better practical use could be made of general practitioners' referral communication to the emergency department.

Communication↗
PubMed1993

Delivery of traditional hospital services to patients at home.

The high cost of traditional inpatient care, advances in the delivery of depot antibiotics and narcotics, and the demands of patients for realistic alternatives to frequent hospitalisation have led to programs for the provision of acute hospital care in the home. We review the progress of overseas hospital-in-the-home programs and the issues that such service delivery has raised for clinicians and administrators. The potential application in Australia is examined and priorities for preparative research are suggested. It seems inevitable that for a select number of conditions in a select group of patients, home hospital services will become a reality in this country.

Australia↗
PubMed1993

Color Doppler ultrasound in prenatal diagnosis of umbilical cord angiomyxoma. Case report.

A pregnant woman, at 28 weeks' gestation, has been observed ultrasonographically. A complex mass arising from the umbilical cord was detected. Color Doppler imaging demonstrated the vascular nature of the mass and the strictly connection with the three umbilical vessels. Color Doppler ultrasound provides useful informations for a correct assessment of the masses arising from the umbilical cord.

Adult↗
PubMed1993

Survey of Australian emergency physicians' expectations of general practitioner referrals.

This paper reports the first study of Australian emergency physicians which concentrates on their relationship with general practitioners. A self-administered questionnaire was mailed to every known fellow and senior trainee of the Australasian College of Emergency Medicine working in Victoria, Australia. Good response rates were achieved (97% from fellows, 78% from trainees). Referral letters from general practitioners were always read by 99% of respondents. Telephone calls from general practitioners were found to be desirable for imparting details of social history or other qualitative information and for determining the appropriateness of the referral. The list of patients' current medication and the details of any emergency treatment administered by the general practitioner were almost universally considered essential inclusions in all urgent referral letters. Other items of information were considered to be influenced by the particular patient presentation. The majority of respondents (87%) felt that a written management plan had some influence on the patient's management in their emergency department. Eighty nine per cent of respondents stated that they always or usually responded to general practitioners' communications. The outcome for patients attending emergency departments with referral letters warrants study. If a good referral letter is seen to be of value in terms of more accurate diagnosis, quicker patient processing, less investigations and better responses, then general practitioners will be encouraged to write better letters. The results of this study offer a useful definition of inappropriate referral to the emergency department and it may now be possible to investigate any link between poor referral letters and inappropriate referrals.

Australia↗
PubMed1991

Letters to go: general practitioners' referral letters to an accident and emergency department.

OBJECTIVE: To investigate the content of general practitioners' referral letters to the Accident and Emergency (A&E) Department of a large regional hospital. METHOD: Two hundred and fourteen consecutive identifiable letters from general practitioners presented by patients over a four week period were reviewed. The accuracy and content of the letters was measured by the presence of 10 key items, and checked against the A&E notes when necessary. A further nine items were examined to discover whether the context of the referral had any influence on letter content. RESULTS: Information that was relatively poorly represented in the letters included social and personal background details, vital signs, regional examination findings, a management plan, and investigation results. The presence in the letter of a management plan or a clear presenting problem was found to be significantly associated with appropriate referrals. CONCLUSIONS: Poor referral letters may reflect a professional distance between the general practitioner and A&E staff that is stretched by the anonymity of the relationship, increasing A&E specialisation, or lack of feedback to the general practitioner. Specific information standards for A&E referrals should be developed to ease contact and to establish criteria for referral.

Correspondence as Topic↗
PubMedDate not supplied

Association of myasthenia gravis and antisynthetase syndrome: a case report.

Myasthenia gravis is a chronic disease of neuromuscular transmission caused by loss of acetylcholine receptors. It can be found in association with other autoimmune disorders. We report the case of a 47-yr-old woman affected by Myasthenia gravis who complained of fever, progressive weakness of proximal limb muscle, arthritis and Raynauds phenomenon and dyspnea. Chest X-rays and CT scan showed an interstitial lung disease; laboratory data indicated an inflammatory picture and increased serum muscle enzymes. Evaluation for infectious, metabolic, iatrogenic and neoplastic aetiologies was unrevealing. The patients clinical condition together with positive results on antisynthetase antibody assay lead to the diagnosis of antisynthetase syndrome. To our knowledge, this is the first report on the association of Myasthenia gravis with antisynthetase syndrome.

Anti-Inflammatory Agents↗