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Biomedical subjects

I A Scott

Publications and source records attributed to I A Scott.

24 records · Page 2Linked to original sources
PubMed1997

Fatal human melioidosis in south-eastern Queensland.

Two simultaneous human cases of fatal melioidosis in temperate south-eastern Queensland involved patients who had had pre-existing multisystem illnesses, had sustained cutaneous lesions before illness onset, and died from overwhelming sepsis. Onset of disease was preceded by unseasonably heavy rainfall. These and other features of these cases suggest that the source of infection was local, in which case the endemicity of Burkholderia pseudomallei in temperate regional Australia may be broader than is currently recognised, and melioidosis may need to be considered in at-risk patients in these areas, as well as in tropical and subtropical areas, who present with severe pneumonia and septicaemia.

Acute Disease↗
PubMed1993

Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.

All patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. There was an increase in survivors from 4%, prior to OH-DEFIB, to 9% of all cardiac arrests, but this was not statistically significant (P = 0.3). However, long term survival amongst immediate survivors was associated with a statistically significant improvement following the introduction of OH-DEFIB (15 of 30 (50%) vs. 2 of 19 (10.5%), P < 0.01). Mean call-out, at-scene and transfer times did not significantly vary between survivors and non-survivors. A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witnessed arrests, only 46 (34%) underwent bystander-initiated cardiopulmonary resuscitation (CPR). A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.

Adult↗
PubMed1987

Hypothalamic/pituitary sarcoidosis.

A patient is described with combined pulmonary and central nervous system sarcoidosis, including hypothalamic/pituitary involvement. Formal pituitary challenge testing was performed before steroid treatment and again eight months later. Diabetes insipidus, hyperprolactinemia, and anterior pituitary hormone deficiencies were demonstrated and did not improve significantly in response to steroids. Hypothalamic/pituitary involvement is a rare complication of sarcoidosis, the incidence of which may be under-reported.

Adult↗
PubMed1986

Sneddon's syndrome.

A 24 year old woman presented with generalised livedo reticularis and progressive intellectual decline. A CT scan of her head showed multifocal low density areas, consistent with cerebral infarction. Cerebral angiography revealed occlusive disease of major vessels, an arteriovenous malformation, and moya-moya type anastomoses. There was no other associated systemic illness. Sneddon's syndrome was the provisional diagnosis. Her older brother had the same skin condition and was also shown to have occlusive cerebrovascular disease. The pathogenesis and natural history of this uncommon disease are highlighted.

Adult↗
PubMedDate not supplied

Audit of consultant physicians' reply letters for referrals to clinics in a tertiary teaching hospital.

BACKGROUND: Doctors referring patients to consultant physicians seek reply letters which both educate and assist in ongoing patient management. Highly desirable attributes in specialist letters include clearly stated and justified: (i) diagnostic formulations, (ii) management regimens, (iii) use of clinical investigations, (iv) prognostic statements, (v) contingency plans and (vi) follow-up arrangements. AIM: To explicitly evaluate the quality of reply letters for new patients referred to clinics at a tertiary teaching hospital. METHODS: Letters were sampled from outpatient clinics of 10 different medical specialties at Princess Alexandra Hospital in Brisbane, Australia. Reply letters for new patient referrals between 1 August 2000 and 31 October 2000 were retrieved, from which data were abstracted to calculate the proportion of letters satisfying prespecified quality attributes. RESULTS: Of 297 new patient referrals, reply letters were retrieved for 204 (69%). Of these, 147 (72%) referrals were accompanied by a referral letter, mostly (113/147; 77%) from general practitioners. For 120 referrals involving diagnostic issues, 69 (56%) letters stated a diagnostic formulation. Of 114 letters recommending further clinical investigations, 61 (53%) described a rationale for such testing. In 125 cases where therapy was a key issue, 83 (66%) letters recommended changes to current treatment for which reasons were specified in 46 (55%) cases, and contingency plans provided in 13 (16%). Prognosis was mentioned in only 18 (9%) cases. Follow-up arrangements were detailed in 123 (60%) letters. Assessments of patient understanding and likely adherence to therapy were stated in less than 15% of -letters. CONCLUSIONS: Opportunities exist for improving quality of consultant physicians' reply letters in terms of greater use of problem lists, contingency plans, prognostic statements and patient-centred assessments, as well as more frequent enunciation of consultants' reasoning behind requests for further tests and changes to current management. Use of structured letter templates may facilitate more consistent inclusion of key information to referring doctors.

Australia↗