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Biomedical subjects

J F Cade

Publications and source records attributed to J F Cade.

At least 19 recordsLinked to original sources
PubMed2003

Helicobacter pylori infection in the Australian community: current prevalence and lack of association with ABO blood groups.

AIMS: To assess the current prevalence of Helicobacter pylori infection in an Australian urban population sample and to relate this to age, gender and ABO and Rhesus blood groups. METHODS: We performed a prospective epidemiological survey of H. pylori serological status in 500 consecutive voluntary blood donors who presented for the purpose of blood donation at the central -Melbourne branch of the Australian Red Cross Blood Service, Victoria, Australia, and gave a Melbourne suburban home address. RESULTS: The overall prevalence of specific anti-H. pylori IgG antibodies in this cohort was 32% (95% confidence interval = 28-36%) and H. pylori sero-positivity increased with age. The rate of H. pylori infection was not significantly different in men and women, with anti-H. pylori IgG anti-bodies detected in 35% (97/277) of men compared with 28% (63/233) of women (P = 0.12). Similarly, H. pylori serological status was not significantly different between subjects of different ABO (P = 0.18) or Rhesus blood groups (P = 0.55). CONCLUSION: This study showed that, contrary to expectation, the updated prevalence of H. pylori seropositivity (32%) in this Melbourne sample is at least as high as that found in previous Australian studies over the past 19 years. Seropositivity increased with age, and was not related to gender, confirming the infection pattern seen in other developed nations. Despite epidemiological evidence of increased peptic ulcer disease in ABO blood group O subjects, and recent evidence that H. pylori adhesion to gastric epithelial cells is mediated by blood group epitopes, no significant association between blood groups and H. pylori serological status was detected.

ABO Blood-Group System↗
PubMed2002

Chest physiotherapy for the prevention of ventilator-associated pneumonia.

OBJECTIVE: Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. DESIGN: Prospective controlled systematic allocation trial. SETTING: Tertiary teaching hospital ICU. PATIENTS AND PARTICIPANTS: Sixty adult patients intubated and mechanically ventilated for at least 48 h. INTERVENTIONS: Chest physiotherapy (intervention group) or sham physiotherapy (control group). MEASUREMENTS AND RESULTS: Control and intervention groups were well matched for age, sex, and admission PaO(2)/FiO(2) ratio, APACHE II score, and Glasgow Coma Score. There were no differences in the duration of mechanical ventilation, length of stay in ICU or mortality. VAP was assessed daily by combined clinical assessment and the clinical pulmonary infection score (CPIS). VAP occurred in 39% (14/36) of the control group and 8% (2/24) of the intervention group (OR = 0.14, 95% CI 0.03 to 0.56, P = 0.02). After adjustment was made by logistic regression for other important variables (APACHE II score, duration of mechanical ventilation, presence of tracheostomy, and GCS score), chest physiotherapy was independently associated with a reduced occurrence of VAP (adjusted OR = 0.16, 95% CI 0.03 to 0.94, P = 0.02). CONCLUSIONS: In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.

Aged↗
PubMed2001

Prospective randomised open-label comparison of danaparoid with dextran 70 in the treatment of heparin-induced thrombocytopaenia with thrombosis: a clinical outcome study.

AIM: To compare clinical outcomes in a randomised comparison of treatment with danaparoid sodium (a heparinoid), or dextran 70, for heparin-induced thrombocytopaenia (HIT) plus thrombosis. METHODS: Forty-two patients with recent thrombosis and a clinical diagnosis of probable HIT who presented at ten Australian hospitals during a study period of six and one half years were randomly assigned to open-label treatment with intravenous danaparoid or dextran 70, each combined with oral warfarin. Thirty-four patients (83%) had a positive platelet aggregation or 14C-serotonin release test for HIT antibody. Twenty-five received danaparoid as a bolus injection of 2400 anti-Xa units followed by 400 units per hour for 2 h, 300 units per hour for 2 h, and then 200 units per hour for five days. Seventeen received 1000 mL dextran 70 on day one and then 500 mL on days 2-5. Patients were reviewed daily for clinical evidence of thrombus progression or resolution, fresh thrombosis or embolism, bleeding or other complications. The primary trial endpoint was the proportion of thromboembolic events with complete clinical resolution by the time of discharge from hospital. RESULTS: With danaparoid, there was complete clinical recovery from 56% of thromboembolic events compared to 14% after dextran 70 (Odds Ratio 10.53, 95% Confidence Interval 1.6-71.4; p = 0.02). Clinical recovery with danaparoid was complete or partial in 86% of thromboembolic events compared with 53% after dextran 70 (Odds Ratio 4.55, 95% Confidence Interval 1.2-16.7; p = 0.03). Overall clinical effectiveness of danaparoid was rated as high or moderate in 88% of patients compared with 47% for dextran 70 (p = 0.01). One patient given danaparoid died of thrombosis compared with three patients given dextran 70. The platelet count returned to normal after a mean of 6.7 days with danaparoid and 7.3 days with dextran 70. There was no major bleeding with either treatment. CONCLUSION: danaparoid plus warfarin treatment for HIT with thrombosis is effective, safe, and superior to dextran 70 plus warfarin.

Aged↗
PubMed2000

Plasma granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor levels in critical illness including sepsis and septic shock: relation to disease severity, multiple organ dysfunction, and mortality.

OBJECTIVE: To define the circulating levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) during critical illness and to determine their relationship to the severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the development of multiple organ dysfunction, or mortality. DESIGN: Prospective cohort study. SETTING: University hospital intensive care unit. PATIENTS: A total of 82 critically ill adult patients in four clinically defined groups, namely septic shock (n = 29), sepsis without shock (n = 17), shock without sepsis (n = 22), and nonseptic, nonshock controls (n = 14). INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: During day 1 of septic shock, peak plasma levels of G-CSF, interleukin (IL)-6, and leukemia inhibitory factor (LIF), but not GM-CSF, were greater than in sepsis or shock alone (p < .001), and were correlated among themselves (rs = 0.44-0.77; p < .02) and with the APACHE II score (rs = 0.25-0.40; p = .03 to .18). G-CSF, IL-6, and UF, and sepsis, shock, septic shock, and APACHE II scores were strongly associated with organ dysfunction or 5-day mortality by univariate analysis. However, multiple logistic regression analysis showed that only septic shock remained significantly associated with organ dysfunction and only APACHE II scores and shock with 5-day mortality. Similarly, peak G-CSF, IL-6, and LIF were poorly predictive of 30-day mortality. CONCLUSIONS: Plasma levels of G-CSF, IL-6, and LIF are greatly elevated in critical illness, including septic shock, and are correlated with one another and with the severity of illness. However, they are not independently predictive of mortality, or the development of multiple organ dysfunction. GM-CSF was rarely elevated, suggesting different roles for G-CSF and GM-CSF in human septic shock.

APACHE↗
PubMed1999

Helicobacter pylori infection in intensive care: increased prevalence and a new nosocomial infection.

OBJECTIVE: The pathogenesis of acute gastric stress ulceration in the seriously ill is uncertain, and any role of Helicobacter pylori infection is unknown. We aimed to assess the relationship between H. pylori serological status and stress ulceration in seriously ill patients, as well as H. pylori serological status in intensive care nurses as a marker for nosocomial infection. DESIGN: Prospective epidemiologic survey. SETTING: Adult intensive care unit in a university teaching hospital. PATIENTS: One hundred patients, 100 nurses, and 500 blood donors as community controls. INTERVENTIONS: H. pylori serological status was measured in patients, staff, and controls using a rapid whole blood test. Upper gastrointestinal bleeding and risk factors for acute stress ulceration were recorded. MEASUREMENTS AND MAIN RESULTS: In seriously ill patients, H. pylori seropositivity (67%) was significantly higher than in the control group (39%) (p < .001). In patients, seropositivity was not related to age, country of birth, diagnostic category, severity of illness, or risk score for stress ulceration. There was a trend toward increased macroscopic gastric bleeding in seropositive patients. In intensive care nurses, H. pylori seropositivity (40%) was significantly higher than in age-matched controls (19%) (p < .001). Only duration of intensive care nursing was significantly associated with seropositivity (p = .02). CONCLUSIONS: The unexpectedly high H. pylori seropositivity rate in this seriously ill cohort raises the possibility that under intensive care conditions, H. pylori infection may modulate responses to illness and injury, with consequent clinical implications. Furthermore, the elevated seropositivity rate in intensive care nurses suggests that H. pylori can be nosocomially transmitted.

Adult↗
PubMed1999

Pain relief using smart technology: an overview of a new patient-controlled analgesia device.

A new adaptive patient-controlled analgesia (PCA) system designed to improve PCA through the use of a variable bolus dose and a variable background infusion is outlined here. The handset allows patients to rate their pain on a scale of 1-10. Data derived from the handset signals are used by an expert algorithm to repeatedly adapt the drug dosage of the bolus and the background infusion according to both pain intensity and patient response to previous dosages. A feasibility study of the system consisted of a small number of randomized, double-blind, crossover clinical trials. The new system was alternated with a conventional system every 12 h. When the new system was active, 12-h questionnaire pain scores were significantly lower and a trend toward fewer bolus requests was found in alternating intervals. In addition, when the new system was used to commence trials, the number of bolus requests were significantly lower and there was a trend toward lower handset scores, lower questionnaire pain scores, and lower verbal pain scores over the entire trial period. The new adaptive PCA system was well accepted by both patients and clinical staff. The trials successfully established the feasibility of the new system. Further development is being carried out as a result.

Analgesia, Patient-Controlled↗
PubMed1999

Smart technology improves patient-controlled analgesia: a preliminary report.

UNLABELLED: A new adaptive system has been designed to improve patient-controlled analgesia through the use of a variable bolus dose and a variable background infusion of analgesic. A novel hand set allows patients to rate their own pain on a linear scale of 1 to 10. Data derived from the hand set signals are used by an expert algorithm to repeatedly adapt the drug dosage of the bolus and of the background infusion according to both current pain intensity and the patient's response to previous dosage. To test the system, we performed a small pilot clinical study, using a randomized, double-blinded, cross-over design. The new system was alternated with a conventional system every 12 h. Use of the new system was associated with significantly lower pain scores and fewer bolus requests but more analgesic administration, though without increased adverse effects. It was very well accepted by both patients and clinical staff. IMPLICATIONS: Pain relief after surgery is often best provided by patient-controlled analgesia, which uses an IV infusion pump and a patient-activated switch. We have developed a new computer-controlled or "smart" patient-controlled analgesia that rapidly learns a patient's individual needs and provides continuously tailored pain relief.

Adolescent↗
PubMed1993

The optimal dosage of ceftazidime for severe lower respiratory tract infections.

The optimal dosage of antibiotics for the treatment of patients with severe lower respiratory tract infections (LRTI) has not been determined but may be lower than is commonly administered at present. We have compared the efficacy of a low dosage of ceftazidime (1 g tds) with the more usual dosage (2 g tds) in a prospective, randomized study of the treatment of LRTI in seriously ill patients. Fifty patients on an Intensive Care Unit received one or the other regimen for 5 days; the demographic characteristics of the two groups were comparable. There was no significant difference in terms of clinical and microbiological response rates between the two regimens. Overall, clinical resolution was documented for 86% of patients, there was no change in 8% and 6% deteriorated. Microbiological eradication was achieved in 52% of patients from whom a pathogen was isolated (46% of all patients). We conclude that ceftazidime 1 g tds is effective treatment for severe LRTI in hospitalized patients.

Adult↗
PubMed1992

Apparent lack of synergism between heparin and dihydroergotamine in prevention of deep vein thrombosis after elective hip replacement: a randomised double-blind trial reported in conjunction with an overview of previous results.

We report the results of a double-blind, randomised trial of venous thrombosis (VT) prevention in 117 patients having elective hip replacement where low dose heparin alone (5,000 IU sodium heparin given subcutaneously [sc] 8 hourly until the seventh postoperative day) was compared with low dose heparin plus dihydroergotamine (DHE; 0.5 mg, given 8 hourly by sc injection). The trial end point consisted of VT discovered through bilateral ascending venography done routinely on the seventh postoperative day. VT developed in 34% of patients given heparin/DHE (95% confidence interval = 22% - 47%) compared with 24% in those given low dose heparin alone (95% confidence interval = 14% - 37%; p = 0.34), difference = 10% (95% confidence interval = -7% to +26%). Corresponding figures for the incidence of proximal (above-knee) thrombosis were 17% and 14% (95% confidence intervals = 8% - 29% and 6% - 25% respectively). These results are discussed in the context of a detailed overview of published evidence concerning VT prevention with heparin/DHE after hip replacement and we conclude it is unlikely that heparin/DHE is markedly superior to low dose heparin alone in this clinical setting.

Aged↗
PubMed1992

Uncertain relevance of gastric colonization in the seriously ill.

We have studied the temporal relationship for the same micro-organisms between gastric colonization and both nasopharyngeal colonization and major clinical infections in 100 consecutive, long-stay, intensive care patients. 67% of patients developed positive gastric cultures, mainly with aerobic Gram-negative bacilli and C. albicans; 33% developed positive nasopharyngeal cultures with similar organisms, but in only 8% was the same organism previously cultured from the stomach; 48% of patients developed infections, mainly respiratory, but commonly with different organisms. The presence of a positive gastric culture was not associated with gastric pH, bleeding, severity of illness, or mortality. The results fail to confirm that an ascending migration of organisms from the stomach is.frequent or that there is a relationship between gastric colonization and clinical infections. Firm therapeutic recommendation in these areas may be premature.

Adolescent↗
PubMed1992

Oxygen dissociation curve in the adult respiratory distress syndrome.

The oxygen tension for half saturation (P50) was determined for venous blood in thirteen patients with the adult respiratory distress syndrome undergoing intensive therapy. The mean value for P50 was found to be significantly lower than the value found in ten normal control subjects (22.9 mmHg and 26.7 mmHg respectively; t = 3.03, P < 0.01). The extent of reduction in P50 was not related to serum phosphate level nor was it a predictor of short-term outcome. It is unlikely that the slight left-shifted oxygen-haemoglobin dissociation curve contributes in a major way to an oxygen delivery deficiency and its cause is unexplained.

Adult↗
PubMed1992

Efficacy of a low dose of cefotaxime in serious chest infections.

The optimal antibiotic dosage in serious chest infections is not established and commonly used regimens may well be excessive. We have compared the efficacy of a low dose of cefotaxime (2 g every 12 h) with a more usual dose (2 g every 8 h) in a prospective, randomized study of the treatment of chest infections in the seriously ill. Fifty intensive care unit patients received either regimen for five days. The two groups appeared demographically comparable. Clinical resolution occurred in 86 percent, no change occurred in 4 percent, and deterioration occurred in 10 percent. Microbiologic clearance occurred in 52 percent of those in whom a pathogen was isolated (46 percent of patients). There was no significant difference in clinical or microbiologic response between the two regimens. It is concluded that cefotaxime in a dose of 2 g twice daily is effective in the treatment of serious chest infections.

Adult↗
PubMed1991

Clinical evaluation of closed-loop control of blood pressure in seriously ill patients.

OBJECTIVE: To compare the effectiveness of a new method of closed-loop (automatic) control of BP with usual manual control. DESIGN: Within-subject crossover trial. SETTING: General and open heart ICUs in a university teaching hospital. PATIENTS: Convenience sample of 74 seriously ill patients aged 17 to 88 yr. Twenty had hypertension: postoperative (n = 7), neurologic damage (n = 6), miscellaneous (n = 7), and were prescribed nitroprusside (n = 11) or nitroglycerin (n = 9). Fifty-four had hypotension: septic (n = 33), other (n = 21), and were prescribed norepinephrine (n = 30), dopamine (n = 11), epinephrine (n = 8), or dobutamine (n = 5). An additional 21 trials were omitted from analysis because of technical (n = 7), clinical (n = 1), or drug-related problems (n = 13). INTERVENTION: Closed-loop and manual drug administrations 1-hr were studied during periods in each patient. The target and observed mean arterial pressure (MAP) and drug infusion rate were recorded electronically every 30 sec. MAIN OUTCOME MEASUREMENTS: Time taken to achieve initial control (min); fidelity of control (the integral of size and duration of error from target MAP +/- 10% in mm Hg.hr/hr); and average drug dose administered (microgram/min as % maximum possible per drug). RESULTS: Compared with manual control, closed-loop achieved faster initial control (log-rank chi 1 = 5.04, p less than .05) and greater fidelity (mean 1.37 vs. 2.36; F = 7.15, p less than .01). There was no difference in average drug dose administered. There was uniformity in the efficacy advantage of closed-loop drug administration across drugs and patient classifications. CONCLUSION: The new closed-loop system is more effective than the usual manual control in managing acute BP disturbances in the seriously ill patient.

Adolescent↗
PubMed1989

Fluid management of shock in critically-ill patients.

This article summarizes the theoretical basis and practical applications of the fluid management of shock in critically-ill patients. It also draws attention to the differences in the aetiology and management of fluid disturbances in adult and paediatric practice. Some evidence suggests that colloidal solutions alone may be superior to crystalloid solutions alone in the resuscitation of patients with shock, but in most situations a combination of both types of fluid is more logical.

Adult↗
PubMed1989

Thrombolytic therapy.

The accepted role for thrombolytic therapy has until recently been limited because of its complexity and side-effects. It has generally been reserved for use systemically in a limited number of patients with acute, major pulmonary embolism or iliofemoral venous thrombosis, and locally in some patients with acute, peripheral arterial occlusion. Its indications have now been greatly expanded by the confirmation from large, multicentre trials completed within the last year that it is also effective in acute myocardial infarction, with a reduction in acute mortality of 20-25%. Moreover, administration has become greatly simplified as dosage regimens have been standardised and the need for laboratory monitoring eliminated. The standard thrombolytic agent used for nearly 3 decades has been streptokinase but within the last year recombinant, human, tissue-type plasminogen activator (the first 'third generation' thrombolytic agent) has become clinically available. This protein is the body's own chief plasminogen activator and has been produced by recombinant DNA technology. Compared with streptokinase, it appears to be both somewhat more effective and also safer (less bleeding and probably no allergic reactions). Other new thrombolytic agents are also being developed but the cost-effectiveness of the newer agents in relation to streptokinase will be for many the main practical issue.

Fibrinolytic Agents↗