Australian and New Zealand journal of medicine

Australian and New Zealand Journal of MedicineVolume 30, Issue 1 p. 91-91 Progression to accelerated hypertension in untreated primary aldosteronism F. WU, Corresponding Author F. WU Research Fellow, Department of MedicineDr F. Wu, Department of Endocrinology, Auckland Hospital, Park Road, Grafton, Auckland, New Zealand.Search for more papers by this authorW. BAGG, W. BAGG Lecturer in Medicine, Department of Medicine, University of AucklandSearch for more papers by this authorP. L. DRURY, P. L. DRURY Consultant Endocrinologist, Department of Endocrinology, Auckland Hospital, Auckland, NZ.Search for more papers by this author F. WU, Corresponding Author F. WU Research Fellow, Department of MedicineDr F. Wu, Department of Endocrinology, Auckland Hospital, Park Road, Grafton, Auckland, New Zealand.Search for more papers by this authorW. BAGG, W. BAGG Lecturer in Medicine, Department of Medicine, University of AucklandSearch for more papers by this authorP. L. DRURY, P. L. DRURY Consultant Endocrinologist, Department of Endocrinology, Auckland Hospital, Auckland, NZ.Search for more papers by this author First published: 25 March 2008 https://doi.org/10.1111/j.1445-5994.2000.tb01065.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume30, Issue1February 2000Pages 91-91 RelatedInformation

Australian and New Zealand Journal of MedicineVolume 30, Issue 3 p. 360-366 Advances in echocardiography U. Premawardhana, U. Premawardhana Echocardiography Fellow, Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW.Search for more papers by this authorD. S. Celermajer, D. S. Celermajer Associate Professor of Medicine, Medical Foundation Fellow, Academic Consultant Cardiologist, Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW.Search for more papers by this author U. Premawardhana, U. Premawardhana Echocardiography Fellow, Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW.Search for more papers by this authorD. S. Celermajer, D. S. Celermajer Associate Professor of Medicine, Medical Foundation Fellow, Academic Consultant Cardiologist, Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW.Search for more papers by this author First published: 25 March 2008 https://doi.org/10.1111/j.1445-5994.2000.tb00838.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Main ML, Asher CR, Rubin DN et al. Comparison of tissue harmonic imaging with contrast (sonicated albumin) echocardiography and Doppler myocardial imaging for enhancing endocardial border resolution. Am J Cardiol 1999; 83: 218–22. 2 Thomas JD, Rubin DN. Tissue harmonic imaging. Why does it work J Am Soc Echocardiogr 1998; 11: 803–8. 3 de Jong N, Cornet R, Lancee CT. Higher harmonics of vibrating gas filled microspheres, Il; measurements. Ultrasonics 1994; 32: 455–9. 4 Adler I, Hiederman EA. Determination of the non-linearity parameters B/A for water and m-Xylene. J Acoust Soc Am 1962; 34: 410–2. 5 Rubin DN, Yazbek N, Huma D. Why does tissue harmonic imaging improve image quality?: A quantitative examination demonstrating side-lobe suppression. J Am Coll Cardiol 1998; 32: 127A (Abstr.). 6 Spencer KT, Bednarz J, Rafter PG, Korcaz C, Lang RM. Use of harmonic imaging without echocardiographic contrast to improve two dimensional image quality. Am J Cardiol 1998; 82: 794–9. 7 Mulvagh SL, Foley DA, Belohlavek M, Seward JB. Image enhancement by noncontrast harmonic echocardiography. Part 1. Qualitative assessment of endocardial visualisation. Mayo Clin Proc 1998; 73: 1062–5. 8 Feinstein SB, TenCate F, Werner Z et al. In vitro development and quantitative analysis of echo contrast agents. J Am Coll Cardiol 1984; 3: 14–20. 9 Porter T, Xie F, Kilzer K. Intravenous perfluoropropane-exposed sonicated dextrose albumin produces myocardial contrast which correlates with coronary blood flow. J Am Soc Echocardiogr 1995; 8: 710–8. 10 Quay SC. Microbubble-based ultrasound contrast agents: the role of gas selection in microbubble persistence. J Ultrasound Med 1994; 13: S9 (Abstr.). 11 Marcovitz P, Armstrong W. Accuracy of dobutamin stress echocardiography in detecting coronary artery disease. Am J Cardiol 1992; 69: 1269–73. 12 Kaul S, Pandian NG, Okada RD, Weiman AE. Contrast echocardiography in acute myocardial ischemia: I. In vivo determination of total left ventricular ‘area at risk. J Am Coll Cardiol 1984; 4: 1272–82. 13 Lindner JR, Suad I, William DS, Danny MS, Jayaweera AR, Kaul S. Albumin microbubble persistence during myocardial contrast echocardiography is associated with microvascular endothelial glycocalycx damage. J Am Coll Cardiol 1998; 31: 439A. 14 Porter T, Xie F, Kricsfeld A, Kilzer K. Noninvasive identification of acute myocardial ischaemia and reperfusion with contrast ultrasound using intravenous perfluoropropane-exposed sonicated dextrose albumin. J Am Coll Cardiol 1995; 26: 33–40. 15 Sutherland GR, Stewart MJ, Groundstroem KWE et al. Colour Doppler Myocardial Imaging: A new technique for the assessment of myocardial function. J Am Soc Echocardiogr 1994; 7: 441–58. 16 Fedele F, Trambaiolo P, Magni G, de Castro S, Caccioti L. New modalities of regional and global left ventricular function analysis: State of the art. Am J Cardiol 1998; 81: 49G–57G. 17 Wilkenshoff UM, Sovany A, Wigstrom L et al. Regional mean systolic myocardial velocity estimation by real-time colour Doppler myocardial imaging: a new technique for quantifying regional systolic function. J Am Soc Echocardiogr 1998; 11: 683–92. 18 Yamada E, Garcia M, Thomas JD, Marwick TH. Myocardial Doppler velocity imaging – A quantitative technique for interpretation of dobutamine echocardiography. Am J Cardiol 1998; 82: 806–9. 19 Uematsu M, Miyatake K, Tanaka N et al. Myocardial velocity gradient as a new indicator of regional left ventricular contraction: detection by a two-dimensional tissue Doppler technique. J Am Coll Cardiol 1995; 26: 217–23. 20 Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiography applications for the study of diastolic function. J Am Coll Cardiol 1998; 332: 865–75. 21 Rajagopalan N, Garcia MJ, Rodiguez L, Murray RD, Klein AL. Comparison of Doppler echocardiography methods to differentiate constrictive pericarditis from restrictive cardiomyopathy. J Am Coll Cardiol 1998; 31: 164A. 22 Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a non-invasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 30: 1527–33. 23 Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quinones MA, Zohgbi WA. Doppler estimation of left ventricular filling pressure in sinus tachycardia.: a new application of tissue Doppler imaging. Circulation 1998; 98: 1644–50. 24 Yin LX, Li CM, Fu QG, Lo Y, Huang QH, Cai L, Zheng ZX. Ventricular excitation maps using tissue Doppler acceleration imaging: potential clinical application. J Am Coll Cardiol 1999; 33: 782–7. 25 Mele D, Pedini I, Alboni P, Levine RA. Anatomic M-mode: a new technique for quantitative assessment of left ventricular size and function. Am J Cardiol 1998; 81: 82G–85G. 26 Waner JG, Nomeir AM, Salim M, Kitzman DW. A prospective, randomised, blinded comparison of multiplane and biplane transoesophageal echocardiographic techniques. J Am Soc Echocardiogr 1996; 9: 865–73. 27 Tam JW, Burwash IG, Ascall KJ, Baird MG, Chan KL. Feasibility and complications of single-plane and bi-plane versus multiplane transoesophageal imaging: a review of 2947 consecutive studies. Can J Cardiol 1997; 13: 81–4. 28 de Castro S, Yao J, Pandian N. Three-dimensional echocardiography: clinical relevance and application. Am J Cardiol 1998; 81: 96G–102G. Citing Literature Volume30, Issue3June 2000Pages 360-366 ReferencesRelatedInformation

BACKGROUND:The continuing uncertainty about the silica-systemic sclerosis relationship led to the investigation of its role as a disease determinant in a large population-based study of systemic sclerosis.AIMS:To compare the frequency, socioeconomic and educational status, age-specific prevalence and duration of occupational silica exposure in males with and without systemic sclerosis. To assess the temporal relationship between exposure and disease onset. To estimate disease latency. To compare disease characteristics between silica-exposed and non-silica-exposed male cases.METHODS:The study was case-control in design. The exposure variable was occupational silica exposure as assessed by an occupational health officer blinded to case/control status and the outcome variable was systemic sclerosis. The employed instrument comprised either a standardised telephone questionnaire (interviewed cases and controls) or medical records (deceased or living-status-unknown cases).RESULTS:Sixty of 160 cases (37.5%) and 11 of 83 (13.3%) controls had occupational silica exposure (OR=3.93; 1.84-8.54). Comparison of data between 64 interviewed cases and all controls demonstrated initial occupational silica exposure occurring before age 40, comparable educational status but significantly different cumulative socioeconomic status with cases being over-represented in semi-skilled and unskilled occupations. Cross-sectional 'current' occupational data underestimated cumulative silica exposure by more than 50%. Silica exposure uniformly preceded onset of second disease symptoms and disease diagnosis. In most, it also preceded onset of first disease symptoms. Disease latency approximated two decades. No disease features distinguished silica-associated systemic sclerosis from idiopathic systemic sclerosis. The duration of silica exposure in the interviewed silica-exposed cases did not significantly exceed that of silica-exposed controls.CONCLUSIONS:Male systemic sclerosis displays socioeconomic dependence. Silica is a disease determinant in male systemic sclerosis, with disease features including a long latency and clinical characteristics indistinguishable from idiopathic disease. Cross-sectional 'current' occupational data underestimate cumulative occupational silica exposure.

BACKGROUND:To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the process of ACP and the use of advance care directives (ACD) is suboptimal in residential care institutions. By comparison there are few Australian data.AIM:To study the process of ACP and the prevalence of ACD in residential care.METHODS:Cross-sectional study using a questionnaire in the Hunter area, NSW, Australia.RESULTS:Very low levels of formal advance directives were found (available for only 0.2%). Only 1.1% of residents had 'no-CPR' orders documented in the medical record, while 5.6% had a formal guardian and 2.8% had an enduring guardian. Informal processes of advance planning were much more prevalent. Sixty-five per cent had a 'person responsible' recorded to make decisions for them while in 13% of cases, there was 'staff consensus' as to the optimal care for the patient. However, in 10.6% there was no clear process for medical decision making identified.CONCLUSIONS:Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore current processes of decision making.

Australian and New Zealand Journal of MedicineVolume 30, Issue 6 p. 737-738 Silent myocardial ischaemia following methysergide overdose A. A. FISHER, A. A. FISHER Senior Registrar Department of Clinical Pharmacology and Toxicology, The Canberra Hospital, Canberra, ACTSearch for more papers by this authorD. G. LE COUTEUR, D. G. LE COUTEUR Associate Professor Department of Clinical Pharmacology and Toxicology, The Canberra Hospital, Canberra, ACTSearch for more papers by this author A. A. FISHER, A. A. FISHER Senior Registrar Department of Clinical Pharmacology and Toxicology, The Canberra Hospital, Canberra, ACTSearch for more papers by this authorD. G. LE COUTEUR, D. G. LE COUTEUR Associate Professor Department of Clinical Pharmacology and Toxicology, The Canberra Hospital, Canberra, ACTSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1445-5994.2000.tb04378.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume30, Issue6December 2000Pages 737-738 RelatedInformation

Background : The epidemiology and natural history of recently discovered viruses, which may be responsible for cases of seronegative infectious hepatitis, are currently being investigated. Retrospective studies of stored sera can provide a historical perspective of these infections. Aims : To re-evaluate the serological, demographic and clinical characteristics of patients hospitalised in the early 1970s with acute hepatitis. Methods : The stored sera of 57 patients hospitalised between 1971 and 1974 with acute hepatitis, designated at that time as non-A non-B (NANB) hepatitis, were re-tested using commercially available enzyme-linked immunosorbent assays (ELISAs) for the presence of anti-hepatitis A virus (HAV) IgM, hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV) IgG, and anti-hepatitis E virus (HEV) IgG. Stored sera from a group of 57 patients concurrently hospitalised for other conditions were also tested. Detailed records of the original epidemiological interviews were examined to compare patient demographics, risk factors for infectious hepatitis and clinical data for the NANB hepatitis group and an original control group of 604 hospitalised patients. Results : Serum from 15 of the 57 (26%) previously designated NANB hepatitis cases had elevated anti-HAV IgM and are likely to represent missed cases of hepatitis A. Thirteen (23%) of cases previously designated as NANB hepatitis had positive hepatitis C antibody tests. These patients were younger and significantly more likely to have used intravenous drugs than control patients. Three NANB hepatitis and two hospital control patients were anti-HEV IgG antibody positive. All of these individuals were born in, or had travelled to, developing countries. Serum from 27 (47%) of the NANB hepatitis patients were negative on all tests. These hepatitis non-A-E cases included children and elderly adults, but as a group were significantly more likely to have used intravenous drugs than hospitalised control patients.

Due to rapid industrial changes and increased pressure of people on fragile ecosystems, large-scale environmental perturbations have been occurring on Earth. Major current environmental problems that can be expected to have a substantial effect on human health include human-induced climate change and stratosphere ozone depletion, because they threaten the ecological support systems on which human life depends. The most serious potential consequence of global environmental change is the erosion of Earth's life-support systems. The public health assessments of the present and future anthropogenic damage to the biosphere have important implications for human health and wellbeing. Medical practitioners have an important role to play in this field.

Australian and New Zealand Journal of MedicineVolume 30, Issue 6 p. 731-731 Hypothyroidism - an unusual cause of cardiac tamponade N. SHARMA Assistant Professor, N. SHARMA Assistant Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorS. JAIN Associate Professor, S. JAIN Associate Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorS. KUMARI Additional Professor, S. KUMARI Additional Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorS. VARMA Professor, S. VARMA Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this author N. SHARMA Assistant Professor, N. SHARMA Assistant Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorS. JAIN Associate Professor, S. JAIN Associate Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorS. KUMARI Additional Professor, S. KUMARI Additional Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorS. VARMA Professor, S. VARMA Professor Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1445-5994.2000.tb04374.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Kerber RE, Sherman B. Echocardiographic evaluation of pericardial effusion in myxoedema. Incidence and biochemical and clinical correlations. Circulation 1975; 52: 823–7. 2 Kabadi UM, Kuman SP. Pericardial effusion in primary hypothyroidism. Am Heart J 1990; 120: 1393–5. 3 Parving H., Neilson SV. Mechanisms of oedema formation in myxoedema-increased protein extravasation and relatively slow lymphatic drainage. N Engl J Med 1981; 301: 460–5. 4 Manolis AS, Ostrowski RM. Hypothyroid cardiac tamponade. Arch Intern Med 1987; 147: 1167–9. 5 Jain S., Sharma N., Varma S., Rajwanshi A., Verma JS, Sharma BK. Profile of cardiac tamponade in the medical emergency ward of a North Indian hospital. Can J Cardiol 1999; 15: 671–5. 6 Khaleeli AA, Memon N. Factors affecting resolution of pericardial effusions in primary hypothyroidism: a clinical, biochemical and echocardiographic study. Postgrad Med J 1982; 58: 473–6. Citing Literature Volume30, Issue6December 2000Pages 731-731 ReferencesRelatedInformation

Abstract Background : Endothelial function is known to be abnormal in patients with diabetes and acute hyperglycaemia may play an aetiological role. Aims : The aim of this randomised controlled study was to determine if acute systemic hyperglycaemia impairs endothelial function in normal subjects. Methods : Endothelial function was assessed by the change in brachial artery diameter in response to forearm ischaemia using B-mode ultrasound in ten healthy subjects (eight male) aged 19–35 years. Brachial artery blood flow velocity and diameter were measured before and after five minutes of forearm ischaemia. Measurements were performed in the supine position after an overnight fast, before and after 60 minute infusions of 0.9% saline or 10% dextrose. Measurements were made on two separate occasions at least 24 hours apart, and subjects were randomised to saline first or dextrose first. The largest diameter measured after ischaemia was divided by the resting arterial diameter to calculate percent dilatation of the artery from baseline, and is reported as flow-mediated dilatation (FMD). Results : Dextrose infusion resulted in a significant rise in mean (SD) serum glucose 5.2 (0.1) to 9.2 (0.3) mmol/L and insulin concentration 6.3 (1.4) to 20.6 (3.7) mU/L p <0.002. Brachial artery blood flow velocity and diameter increased significantly from baseline after ischaemia ( p <0.002). Mean FMD (SEM) before and after infusion were not, however, significantly different ( p =0.4) (pre-saline 7.3 [1.0]%, post saline 5.2 [1.5]% and predextrose 8.1 [2.0]%, post dextrose 5.9 [1.7]%). Conclusions : These data suggest that acute hyperglycaemia does not impair FMD in normal subjects.

Julian Savulescu argues that destructive experimentation on human embryos is ethically permissible. He attempts to refute objections to such experimentation, and offers an account of the status of the early human embryo according to which it is the kind of entity upon which it is perfectly permissible to experiment. However, his attempts to refute the objections to destructive experimentation on human embryos are unconvincing, and the consequences of his own view of the status of the embryo are counter-intuitive.

Every day, people die because there are insufficient tissues available for transplantation. The development of cloning and embryonic stem (ES) cell line technologies offers real hope for developing better sources of tissues for transplantation. Moreover, these new technologies may mean that damaged tissue (for example, after a stroke or heart attack) can be replaced with normal functioning tissue rather than scar tissue. Research into 'therapeutic cloning' and the development of ES cell lines is illegal in several States in Australia. It is time to review that legislation in order to allow destructive embryo research. My argument is that at least research should be allowed on spare embryos from assisted reproduction; that it is only one moral view (of several plausible ones) of the status of the embryo which precludes producing embryos for research; that this view is mistaken and so it is morally permissible to produce embryos for research into therapeutic cloning.

Australian and New Zealand Journal of MedicineVolume 30, Issue 3 p. 401-403 Spontaneous pneumomediastinum - ‘ecstasy’: a hard pill to swallow R. HARRIS, Corresponding Author R. HARRIS Staff Specialist, Emergency MedicineCommunications to: Dr Roger Harris, Emergency Medicine, Royal North Shore Hospital, St Leonards, NSW 2065. Email: [email protected]Search for more papers by this authorA. JOSEPH, A. JOSEPH Staff Specialist, Emergency Medicine, Royal North Shore Hospital, Faculty of Medicine, University of Sydney, Sydney, NSW.Search for more papers by this author R. HARRIS, Corresponding Author R. HARRIS Staff Specialist, Emergency MedicineCommunications to: Dr Roger Harris, Emergency Medicine, Royal North Shore Hospital, St Leonards, NSW 2065. Email: [email protected]Search for more papers by this authorA. JOSEPH, A. JOSEPH Staff Specialist, Emergency Medicine, Royal North Shore Hospital, Faculty of Medicine, University of Sydney, Sydney, NSW.Search for more papers by this author First published: 25 March 2008 https://doi.org/10.1111/j.1445-5994.2000.tb00848.xCitations: 13AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume30, Issue3June 2000Pages 401-403 RelatedInformation

BACKGROUND:Gout is a common and challenging problem in South Auckland, New Zealand. Allopurinol is widely used but urate reduction remains unsatisfactory. Allopurinol dosing guidelines and a therapeutic range for plasma oxypurinol levels have been published. AIMS:We aimed to determine the appropriateness of allopurinol dosing according to current guidelines and to assess the relationship between plasma creatinine, oxypurinol and urate. In addition, we assessed the clinical usefulness of the oxypurinol level. METHODS:Thirty-one patients, on a stable dose of allopurinol for at least three weeks, had plasma creatinine, urate and oxypurinol measured as part of routine clinical assessment. Relationships between the various methods were examined using regression analysis. Fisher's exact test was used to test associations with categorical variables. RESULTS:Fifty-five per cent of patients were on higher than recommended doses of allopurinol. There was a statistically significant relationship between calculated creatinine clearance and plasma oxypurinol level. Only 50% of patients with a plasma oxypurinol within the therapeutic range (30-100 micromol/L) had a plasma urate < 0.42 mmol/L and this did not increase significantly in the patients with an oxypurinol level > 100 micromol/L. CONCLUSIONS:There is poor adherence to the current recommended dosing guidelines for allopurinol. Creatinine clearance rather than plasma creatinine needs to be used to predict the dose of allopurinol. The current role of the oxypurinol level is to identify non-compliers with allopurinol therapy. We need further research to clarify whether increasing the dose of allopurinol outside the recommended dose range to reach an oxypurinol level of close to 100 micromol/L may be of benefit in those who have not had sufficient urate reduction.

Australian and New Zealand Journal of MedicineVolume 30, Issue 5 p. 600-607 Atherosclerosis and the vulnerable plaque - pathogenesis: Part I S. G. Worthley, S. G. Worthley Research Cardiologist, Cardiovascular Research Centre, Monash Medical Centre, Melbourne, Vic.Search for more papers by this authorG. Helft, G. Helft Research Fellow, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.Search for more papers by this authorA. G. Zaman, A. G. Zaman Research Fellow, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.Search for more papers by this authorV. Fuster, V. Fuster Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.Search for more papers by this authorJ. J. Badimon, Corresponding Author J. J. Badimon Associate Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA. Juan J. Badimon, Associate Professor of Medicine, Cardiovascular Biology Research Laboratory, Room 24–261, Annenberg Building, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029–6574, USA. E-mail: jbadimo@smtplink.mssm.eduSearch for more papers by this author S. G. Worthley, S. G. Worthley Research Cardiologist, Cardiovascular Research Centre, Monash Medical Centre, Melbourne, Vic.Search for more papers by this authorG. Helft, G. Helft Research Fellow, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.Search for more papers by this authorA. G. Zaman, A. G. Zaman Research Fellow, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.Search for more papers by this authorV. Fuster, V. Fuster Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.Search for more papers by this authorJ. J. Badimon, Corresponding Author J. J. Badimon Associate Professor of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA. Juan J. Badimon, Associate Professor of Medicine, Cardiovascular Biology Research Laboratory, Room 24–261, Annenberg Building, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029–6574, USA. E-mail: jbadimo@smtplink.mssm.eduSearch for more papers by this author First published: 25 March 2008 https://doi.org/10.1111/j.1445-5994.2000.tb00862.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume30, Issue5October 2000Pages 600-607 RelatedInformation

BACKGROUND:There is a controversy regarding the investigation of patients with suspected acute pulmonary embolism (PE).AIMS:To compare the cost-effectiveness of alternative methods of diagnosing acute PE. Chest helical computed tomography (CT) alone and in combination with venous ultrasound (US) of legs and pulmonary angiography (PA) were compared to a conventional algorithm using ventilation-perfusion (V/Q) scintigraphy supplemented in selected cases by US and PA.METHODS:A decision-analytical model was constructed to model the costs and effects of the three diagnostic strategies in a hypothetical cohort of 1000 patients each. Transition probabilities were based on published data. Life years gained by each strategy were estimated from published mortality rates. Schedule fees were used to estimate costs.RESULTS:The V/Q protocol is both more expensive and more effective than CT alone resulting in 20.1 additional lives saved at a (discounted) cost of $940 per life year gained. An additional 2.5 lives can be saved if CT replaces V/Q scintigraphy in the diagnostic algorithm but at a cost of $23,905 per life year saved.CONCLUSIONS:The more effective diagnostic strategies are also more expensive. In patients with suspected PE, the incremental cost-effectiveness of the V/Q based strategy over CT alone is reasonable in comparison with other health interventions. The cost-effectiveness of the supplemented CT strategy is more questionable.

BACKGROUND Information is lacking about the extent to which Australasian physicians apply methods of evidence-based medicine (EBM) in routine practice. AIMS To assess the frequency and predictors of use of EBM methods in a sample of consultant physicians in adult medicine. METHODS Self-administered questionnaires were distributed to a convenience sample of 545 physicians from October 1998 to January 1999. RESULTS One hundred and eleven questionnaires were returned (20% response rate). Ninety-eight (88%) respondents formulated five or less clinical questions per week; 69 (62%) undertook five or more evidence searches per week, the majority as MEDLINE searches involving therapeutic topics. Respondents identified insufficient time (74%), limited search skills (41%), and limited access to evidence (43%) as search impediments. In determining evidence quality, 37% frequently relied on global impressions, while 22% frequently applied explicit critical appraisal (p=0.008). Efficiency of literature searches was rated on average as good/very good by 18%, fair by 52% and poor by 30%. As a result of EBM, 47% frequently had confidence in pre-existing decisions increased, 39% gained improved knowledge, and 5% altered clinical decisions. Frequently encountered inhibitors to changing practice were personal conservatism (40%), organisational constraints (40%), and interdisciplinary tensions (39%). Perceived weaknesses of EBM included: limited applicability to individual patients (26%); evidence deficiencies (25%); and too time consuming (13%). In making EBM more attractive, one third requested reliable evidence sources at the point of care. CONCLUSIONS The application of EBM to routine practice by physicians is constrained by deficient EBM skills, limited access to evidence, lack of time, and cognitive and environmental factors. Targeted education in EBM and systems that quickly deliver high-quality evidence at the point of care are needed in realising the full potential of EBM to improve care.

Australian and New Zealand Journal of MedicineVolume 30, Issue 2 p. 272-274 Medical services in China Ian Brand, Ian Brand Medical Adviser, The Northern Hospital, Melbourne, Vic.Search for more papers by this author Ian Brand, Ian Brand Medical Adviser, The Northern Hospital, Melbourne, Vic.Search for more papers by this author First published: 25 March 2008 https://doi.org/10.1111/j.1445-5994.2000.tb00820.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume30, Issue2April 2000Pages 272-274 RelatedInformation

Background: A recent review of international literature concludes that there is a relative absence of social class differentials in health in early youth. There is an absence of Australian studies on the effect of social class on the health of this age group.Aims: To examine the association between social class and health among 16-year-old Australians.Methods: The data on 1048 16-year-olds came from the fifth wave (1993) of the Australian Youth Survey conducted by the former Department of Employment, Education and Training. Outcome measures were self-rated general health and psychological health (GHQ-12). Binary logistic regression was used to analyse data.Results: Neither social class of origin nor current social class was associated with self-rated general health or psychological health.Conclusion: The argument that social class inequalities in health exist in childhood, disappear during early youth, and reappear later appears to hold ground within the Australian context.