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Biomedical subjects

C Guest

Publications and source records attributed to C Guest.

At least 19 recordsLinked to original sources
PubMed2003

Perioperative headache and day case surgery.

BACKGROUND AND OBJECTIVE: Headache is a common and distressing morbidity associated with day case surgery. We undertook a prospective, observational study to identify risk factors associated with perioperative headache in a modern, day case surgery setting. METHODS: Two hundred-and-thirty consecutive patients presenting for day case surgery were invited to complete a questionnaire about their previous experience of headache and various associated risk factors. Questionnaires were completed by 90% of patients. The presence of headache in the pre- or postoperative period was also documented. We used multivariate logistic regression to model perioperative headache. RESULTS: Increased frequency of previous headache, odds ratio (95% confidence interval) 1.9 (1.2-2.8) (P = 0.004) and low alcohol consumption 0.90 (0.87-0.98) (P = 0.019) were significant predictors. A history of migraine showed a trend towards being predictive 1.9 (0.9-4.0) (P = 0.055). Some risk factors thought to be important such as caffeine withdrawal and duration of starvation and fluid deprivation were not associated with perioperative headache in this setting. CONCLUSIONS: In this study of risk factors associated with perioperative headache in day case surgery, increased frequency of headache and low alcohol consumption were independent risk factors.

Adult↗
PubMed2001

Comparison of the effects of intravenous alfentanil and esmolol on the cardiovascular response to double-lumen endobronchial intubation.

We compared the effect of alfentanil 10 microg.kg-1 and esmolol 1.5 mg.kg-1 on the cardiovascular responses to laryngoscopy and double-lumen endobronchial intubation in two groups of 20 ASA 2-3 patients undergoing pulmonary surgery, in a randomised double-blind study. Arterial pressure and heart rate decreased after induction of anaesthesia and increased after intubation in both groups (p < 0.05) but remained at or below baseline values, and changes were comparable in both groups. Plasma catecholamine concentrations decreased after induction of anaesthesia in both groups (p < 0.05). Epinephrine concentrations increased in the esmolol group after intubation (p < 0.05) but remained below baseline in the alfentanil group (p < 0.05). Norepinephrine concentrations increased significantly in both groups after intubation but were higher in the esmolol group (p < 0.05). Although both esmolol 1.5 mg.kg-1 and alfentanil 10 microg.kg-1 similarly attenuated the arterial pressure and heart rate response to endobronchial intubation, plasma catecholamine concentrations increased in the esmolol group to values greater than previously reported after tracheal intubation.

Adrenergic beta-Antagonists↗
PubMed2001

A comparison of the prevalence of respiratory illness and non-specific health symptoms in two Victorian cities.

OBJECTIVE: To compare the prevalence of respiratory illness and non-specific health symptoms among adults and children aged 4-15 years living in Portland and Warrnambool, Victoria. METHODS: A postal survey of 3,903 adults in Portland and Warrnambool systematically selected from the electoral roll was undertaken. Both an adults and children's questionnaire were enclosed in the mailing to each adult. If there were children aged 4-15 years in the household, an adult was asked to complete a questionnaire for the child who would next celebrate a birthday. Questionnaires were returned by 2,111 adults (54%) and for 585 children. RESULTS: No significant differences in the prevalence of self-reported asthma or wheeze were observed among adults or children residing in Portland and Warrnambool. The likelihood of itchy eyes, skin rash and stuffy nose was significantly higher in Portland adults and children compared with those in Warrnambool. Dry cough at night was increased among Portland children, but not significantly so. CONCLUSIONS: Higher rates of non-specific symptoms were observed in Portland but from a cross-sectional survey such as this, it is not possible to identify the cause of these higher rates. They may be related to environmental factors such as pollens or emissions from aluminium production, fertiliser production or bulk handling activities on the wharf, or they may be attributable to other factors such as response or recall bias.

Adolescent↗
PubMed1999

Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study.

OBJECTIVE: To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae. DESIGN: A retrospective (1980-1986) and prospective (1987-1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time. SETTING: Obstetric units in two counties (three health districts) with similar annual numbers of maternities and the Regional Blood Transfusion Service antenatal serology laboratory. PARTICIPANTS: Non-sensitised Rhesus D negative pregnant nulliparae. INTERVENTIONS: Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county. MAIN OUTCOME MEASURES: 1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme. RESULTS: Prophylaxis significantly reduced iso-immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0.14-0.53; P < 0.0001) and contemporary controls (OR 0.43, CI 0.22-0.86; P = 0.02). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty-two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill-health that result from very preterm birth should be considerable. CONCLUSION: Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.

Female↗
PubMed1996

Coronary artery disease following repair of tetralogy of Fallot: implications and management.

A 62-year-old man underwent successful coronary artery bypass for unstable angina 34 years after a complete repair of tetralogy of Fallot. Coronary risk factors were hypertension and a positive family history. While coronary disease was the presenting complaint, he had evidence of widespread atherosclerosis. He is the first patient reported to undergo coronary artery bypass following repair of tetralogy of Fallot. Coronary artery disease complicating tetralogy of Fallot has been mentioned five times in the literature. As the population of patients who have undergone tetralogy of Fallot ages, the number showing signs of coronary disease will likely rise. Thus, vigilance regarding risk factor modification must encompass these patients as they age.

Aged↗
PubMed1996

Epidemiology and detection of cervical cancer. Implementing the national screening policy.

The epidemiological bases of primary prevention and early detection of cancer of the uterine cervix are presented with emphasis on recent developments that are important for clinical practice. The progress of the implementation of the Australian cervical cancer screening policy is also discussed. A Medline search on cervical cancer, 1991-1996, was supplemented by material from international and local authorities, including reports on all aspects of cervical screening in Australia. National and international patterns of risk factors, predictors of progression and regression of precancerous lesions, cervical cancer incidence and mortality are summarised, with emphasis on the most recent and local research. Human papilloma virus (HPV) types are important causes of cervical intra-epithelial neoplasia (CIN) and squamous cell carcinoma. Most cervical screening is performed during medical consultations; additional financial incentives to promote correct targeting of this screening test should be explored. The Commonwealth Government is developing a national policy for the training of persons to provide cervical screening to supplement that provided by medical practitioners. The improvements in the national application of cervical screening should continue with the development of quality assurance at all stages of the screening pathway.

Australia↗
PubMed1995

Tropospheric ozone: respiratory effects and Australian air quality goals.

OBJECTIVE: To review the health effects of tropospheric ozone and discuss the implications for public health policy. DESIGN: Literature review and consultation with scientists in Australia and overseas. Papers in English or with English language abstracts were identified by Medline search from the international peer reviewed published reports. Those from the period 1980-93 were read systematically but selected earlier papers were also considered. Reports on ozone exposures were obtained from environmental agencies in the region. RESULTS: Exposure to ozone at concentrations below the current Australian air quality goal (0.12 ppm averaged over one hour) may cause impaired respiratory function. Inflammatory changes in the small airways and respiratory symptoms result from moderate to heavy exercise in the presence of ozone at levels of 0.08-0.12 ppm. The changes in respiratory function due to ozone are short lived, vary with the duration of exposure, may be modified by levels of other pollutants (such as sulphur dioxide and particulates), and differ appreciably between individuals. Bronchial lavage studies indicate that inflammation and other pathological changes may occur in the airways before reductions in air flow are detectable, and persist after respiratory function has returned to normal. It is not known whether exposures to ozone at low levels (0.08-0.12 ppm) cause lasting damage to the lung or, if such damage does occur, whether it is functionally significant. At present, it is not possible to identify confidently population subgroups with heightened susceptibility to ozone. People with asthma may be more susceptible to the effects of ozone than the general population but the evidence is not consistent. Recent reports suggest that ozone increases airway reactivity on subsequent challenge with allergens and other irritants. Animal studies are consistent with the findings in human populations. CONCLUSION: A new one hour air quality ozone goal of 0.08 ppm for Australia, and the introduction of a four hour goal of 0.06 ppm are recommended on health grounds.

Adaptation, Physiological↗
PubMed1995

Case report: anti-Cra in pregnancy.

A 39-year-old Grenadian multiparous patient presented in the 12th week of pregnancy. Her red cells were found to have the rare Cr(a-) (ISBT Number 202001) phenotype within the Cromer complex, and her serum contained anti-Cra. To date, anti-Cra has not been implicated in hemolytic disease of the newborn (HDN), but there are very few published reports on this topic. This case provided an excellent opportunity for study. The patient's serum showed no detectable functional activity in in vitro antibody-dependent, cell-mediated cytotoxicity assays, and no increase in the strength of the antibody during the pregnancy. The newborn infant showed no clinical signs of HDN, and was of normal weight. This case study suggests that anti- Cra is not implicated in HDN.

Journal Article↗
PubMed1995

High prevalence of Helicobacter pylori antibodies in an institutionalized population: evidence for person-to-person transmission.

OBJECTIVE: To evaluate the prevalence of H. pylori antibodies in mentally and physically handicapped adults living together in a long-term care facility. METHODS: One hundred twenty-two institutionalized subjects from six living areas were compared to a normal representative Caucasian population obtained by random sampling from the urban population area of Melbourne. Serum samples from 1977 and 1989 from 122 subjects were tested for H. pylori antibody by an ELISA technique. The data were analyzed by Student's t test, chi 2 test and logistic regression. RESULTS: Ninety-two of the 122 subjects (75%) from whom sera was collected in 1989 were seropositive for H. pylori, compared with only 23% in age- and sex-matched control subjects (p < 0.0001). The prevalence of H. pylori antibodies in 1977 was 34% (42/122). Of the remaining 80 seronegative subjects, 51 (61.4%) converted to became positive in the 12-yr interval. The annual seroconversion rate was 7.4%, with an average of 4.25 newly positive subjects each year. The prevalence of H. pylori in 1989 was significantly higher than in 1977 after adjustment for age (odds ratio 2.39, 95% CI 1.1-5.3, p = 0.03). CONCLUSIONS: H. pylori antibodies are significantly more prevalent in institutionalized adults compared with controls from the general population. These data support the hypothesis that H. pylori is acquired by either fecal-oral or oral-oral transmission.

Adult↗
PubMed1993

Paraspinal soft-tissue sarcoma. Classification of 14 cases.

Fourteen patients were treated surgically for soft-tissue sarcoma arising in the paraspinal muscles. Eleven patients received adjuvant irradiation administered before or after resection. In describing the treatment and outcomes of these patients, a new classification of paraspinal soft-tissue sarcoma is introduced that is based on the anatomic relationship of the tumor to the spinal lamina and the epidural space. This classification can be used in planning combined modality treatment for paravertebral sarcomas. Lesions that extend through the lamina into the epidural space present an unanswered problem for local control.

Adult↗
PubMed1992

A comparison of the impact of institutionalization on spouse and nonspouse caregivers.

We report on a study of 106 spouse and nonspouse primary caregivers of cognitively impaired older people. Half of these caregivers cared for someone in a community setting, half cared for someone in an institution (a nursing home or hospital). The study used the multidimensional Caregiver Burden Inventory (CBI) to measure the burden that these caregivers felt. A 2 x 2 multivariate analysis of variance found an effect of the interaction of relationship and living arrangement on two CBI subscales: Time Dependence Burden and Developmental Burden. Spouses showed a significantly greater difference in Time Dependence Burden scores than did nonspouses in both living arrangement groups, and nonspouses showed a significantly greater difference in Developmental Burden than did spouses in both groups. We conclude with a discussion of how programs can help different types of caregivers cope with feelings of burden.

Analysis of Variance↗
PubMed1990

Cancer of the uterine cervix and screening of Aboriginal women.

Carcinoma of the cervix has not been widely reported as an important health problem for Aboriginal women. From four sources, we have studied cervical cancer death rates, abnormalities detected by cervical cytology screening, and the proportion of women who had been screened. First, from the Northern Territory for the years 1979-1983, we present a relative risk of 6.3 (95% confidence interval, 3.0-11.6) for cervical cancer deaths in Aboriginal women compared with all Australian women. Second, the screening and disease rates in Aboriginal women were profiled within a large laboratory in Victoria. Since 1984, a fourfold increase in the number of smears taken at Aboriginal health services is apparent. In women attending these services, a high rate of significantly abnormal smears is evident. Third, to study the extent of screening, we interviewed Aboriginal women in a Victorian country setting and fourth, we examined a random sample of medical records from an Aboriginal Health Service. The proportion screened at least once rose from 5/47 (11%) among women whose most recent consultation with the Health Service was during the years 1974-1980 to 51/170 (31%) women who attended from 1981-1987 (p less than 0.01). Aboriginal communities may interpret these trends favourably as they encourage their women to be screened regularly to reduce cervical cancer mortality.

Adolescent↗
PubMed1989

AIDS and its metaphors.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Application of a multidimensional caregiver burden inventory.

Multidimensional measures of caregiver burden give a sensitive reading of caregivers' feelings and a sophisticated picture of caregivers' responses to the demands of care. This paper reports on the development of a 24-item, five-subscale Caregiver Burden Inventory (CBI) and demonstrates its use as a diagnostic tool for professional caregivers. It concludes with a discussion of several ways that professional caregivers can use this multidimensional measure of caregiver burden.

Alzheimer Disease↗