Long-term sequelae of electrical injury.

Objective: To summarize the current evidence-based knowledge about the long-term sequelae of injuries from electrical current.

Quality Of Evidence: MEDLINE was searched for English-language articles published in the past 20 years using the following search terms: electrical, injuries, wound, trauma, accident, sequelae, long-term, follow-up, and aftereffects. For obvious reasons, it is unethical to randomly study electrical injury in controlled clinical trials.

Interprofessional education in a midwifery curriculum: the learning through the exploration of the professional task project (LEAPT).

Objective: to develop interprofessional education for students of midwifery, nursing and medicine. To foster collaborative working and learning between students of midwifery, nursing and medicine.

Design: a quasi-experimental method to evaluate the outcomes of an intervention (a problem-based learning (PBL) scenario) with interprofessional students and facilitators.

Fifty years of medical specialisation: from foundation to fragmentation.

The past 50 years of medicine have been dominated by revolutions in biological sciences and clinical therapeutics. No less dramatic have been changes in our healthcare systems, with medical specialisation playing a leading role. The middle of the century saw the rapid development of the teaching hospital as the centre of professional education, collegiate identity, medical specialisation and clinical research.

Clinical representation in the development of casemix: measures and applications in Australia.

The Australian Casemix Clinical Committee coordinated the clinical evaluation of inpatient casemix classifications leading to the development of Australian national diagnosis-related groups 1, 2 and 3. It has provided and will continue to provide advice on clinical matters associated with casemix activities to the Commonwealth and State health authorities, public and private hospital associations, insurers and the clinical professions. In future, all clinicians will be expected to understand casemix, diagnosis-related groups and cost weights, especially those relevant to their speciality.

Success of a new health administration strategy. The patient-focused institute with a tripartite management.

As the result of the restructuring and decentralisation of the administration of St Vincent's Hospital, Sydney, I was Clinical Chief of a pilot "institute" for three years operating within a "patient-focused model" in hospital management. By the end of the trial, we had improved performance despite reductions in hospital and unit budgets.

Arrhythmogenic right ventricular dysplasia.

A 23-year-old man presented with recurrent exercise-induced ventricular tachycardia (VT), complicated by systemic embolisation. Catecholamine--sensitive VT was reproduced on exercise testing and programmed electrical stimulation, displaying features suggestive of enhanced automaticity as well as re-entry. Both 2D-echocardiography and gated heart pool scan showed localised dyskinetic bulging in the right ventricle.

High density lipoproteins, genetic polymorphism for apo A-I and coronary artery disease.

HDL cholesterol and apolipoprotein A-I are associated with the development of coronary artery disease (CAD). The presence of a PstI site polymorphism adjacent to the gene encoding apo A-I (known as P2) has also been shown to be associated with CAD but this relationship is controversial. A case control study was conducted in an Australian population to re-examine whether the rare P2 allele is associated with CAD.

Increased plasma beta-thromboglobulin in patients with coronary artery vein graft occlusion: response to low dose aspirin.

The therapeutic effect of aspirin on vein graft patency was studied in patients undergoing coronary artery bypass graft surgery. The study design enabled the prospective evaluation of the relation of platelet activation, as measured by plasma beta-thromboglobulin concentration, to subsequent coronary vein graft occlusion. Serial beta-thromboglobulin levels were measured in 105 patients randomized to receive aspirin (324 mg/day) or placebo beginning within 1 h after surgery.

Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation.

In an attempt to identify which parameters predict survival in advanced dilated cardiomyopathy, 232 patients presenting for assessment for cardiac transplantation were investigated and followed for 10 +/- 12 months (range 2 weeks to 5 years). Etiology of dilated cardiomyopathy included ischemic heart disease (33%), idiopathic (42%) and miscellaneous (25%). In each patient, 26 parameters were recorded.

Reproducibility of radionuclide left ventricular ejection fraction in patients awaiting cardiac transplantation.

Radionuclide-derived left ventricular ejection fraction (LVEF) is used to assess LV systolic function, to follow trends in the natural history of dilated cardiomyopathy, and to prioritize patients waiting for cardiac transplantation. Reproducibility of LVEF at extremely low levels has not, however, been reported. To assess the reproducibility of radionuclide LVEF at levels below 0.

The effects of adrenergic blockade on lipoproteins using the rat as an experimental model.

Adrenergic blocking drugs are known to have adverse effects on lipids and lipoproteins in man, although the mechanisms underlying these effects are unclear. In order to see whether the rat might be a suitable model to explore this issue, adrenergic blockers having differing properties with respect to receptor interaction were administered to rats orally over seven days, followed by measurement of plasma lipids and lipoproteins. Total plasma cholesterol was not significantly influenced by any of the drugs used, while triglycerides were reduced by 20% and 31% respectively with pindolol and prazosin.

Cadmium levels in Ontario moose and deer in relation to soil sensitivity to acid precipitation.

This study examines the influence of buffering capacity of the soil on the levels of cadmium in the kidney, liver and muscle of moose and white-tailed deer from nine sampling sites (four buffered and five non-buffered) in Ontario, Canada. Tissues collected from hunter-killed moose and deer during 1984 and 1985 were analysed for cadmium. Tissue from moose in the non-buffered Algonquin Park site (21.

Hyperlipidemia after heart transplantation.

Because hyperlipidemia may be a factor in the development of late graft atherosclerosis after heart transplantation, we have studied serum lipid levels in patients during the first year after transplantation. Serum cholesterol and triglyceride levels were measured in the preoperative period and at regular intervals up to 12 months after transplantation in 22 consecutive heart transplant recipients. Patients were divided into two groups: group 1 included 10 patients with underlying ischemic heart disease, and group 2 had 12 patients with underlying idiopathic dilated or valvular cardiomyopathy.

Timing of cardiac transplantation in idiopathic dilated cardiomyopathy.

Seventy-nine patients with idiopathic dilated cardiomyopathy were assessed and followed up to evaluate 9 variables that might predict duration of survival after assessment for cardiac transplantation. Patients with ischemic heart disease, alcoholic and peripartum cardiomyopathy were excluded. There were 38 deaths (48%) during the 18-month (mean) follow-up.

Risk of infective endocarditis in mitral valve prolapse with and without precordial systolic murmurs.

The risk of infective endocarditis (IE) associated with a systolic murmur in patients with mitral valve prolapse (MVP) was investigated in a case-control study. The case group comprised all patients with MVP (n = 19) from a series of 136 consecutive adult admissions for IE. Three matched control subjects were chosen for each case from a series of 144 MVP patients without IE.

Coronary artery bypass graft failure--an autoimmune phenomenon?

Plasma anticardiolipin antibody (ACA) was measured in 83 patients having coronary artery bypass graft surgery and results were correlated with the incidence of early (1-2 weeks) and late (12 months) graft occlusion, as judged by angiography. There was an association between preoperative ACA level and the incidence of late graft occlusion in relation to both number of patients with an occlusion and number of distal anastomoses occluded. 8 of 15 patients (53.

The prevalence of arrhythmias in hypertrophic cardiomyopathy: role of ambulatory monitoring and signal-averaged electrocardiography.

Hypertrophic cardiomyopathy (HCM) is associated with a high incidence of supraventricular and ventricular arrhythmias. The presence of ventricular tachycardia (VT) in patients with HCM has been associated with a high risk of sudden death. Forty-seven patients with HCM (31 male, 16 female, mean age 47 years) underwent continuous 24-hour ambulatory electrocardiographic (ECG) monitoring.

Patient selection for cardiac transplantation.

Since February 1984, 27 isotopic cardiac transplants have been performed in 25 patients. These 25 patients were from a pool of 45 patients who were accepted into the Programme. Sixteen patients have died awaiting a transplant, and four patients are presently on the waiting list.

Reduction in plasma cholesterol and increase in biliary cholesterol by a diet rich in n-3 fatty acids in the rat.

Cholesterol and lipoprotein metabolism were investigated in a group of rats fed a fish oil-supplemented diet, a rich source of n-3 fatty acids. For comparison purposes, other groups of rats were fed either safflower oil (n-6 fatty acids) or coconut oil (saturated fatty acids). Diets were isocaloric and contained identical amounts of cholesterol.