 |
|
|
|
|
|
|
 |
||||||
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
||||
|
|
|||||||||||||||||||||||||
|
|
Am J Med 2003 Mar;114(4):339
Is the Geneva rule usable outside of Geneva?
Iles S, Hodges A, Frampton C, Town I.
Canterbury Respiratory
Research Group,Christchurch School of Medicine and Health
Sciences, Christchurch Hospital, New Zealand
N Z Med J 2001 Nov 9;114(1143):488-92
Community-acquired
pneumonia in Christchurch and Waikato 1999-2000: microbiology
and epidemiology.
Laing R, Slater W,
Coles C, Chambers S, Frampton C, Jackson R, Jennings L,
Karalus N, Mills G, Murdoch D, Town I.
Canterbury Respiratory
Research Group, Christchurch School of Medicine and
Health Sciences, University of Otago.
AIMS: To prospectively
record current epidemiology and microbiology of
community-acquired pneumonia in two New Zealand centres. METHODS: Between
July
1999 and 2000 all adults admitted to Christchurch and Waikato Hospitals with
community-acquired pneumonia were screened for study inclusion. All those
enrolled had their medical history, clinical variables, inpatient management
and
clinical outcomes recorded and standardised microbial diagnostic testing carried
out. RESULTS: 474 participants were enrolled with a mean age of 64 years and
a
microbial diagnosis was made in 197 cases (42%). Streptococcus pneumoniae
(14%),
Haemophilus influenzae (10%) and Influenza A virus (7%), Legionella spp (4%)
and
Mycoplasma pneumoniae (3%) were the most commonly isolated organisms. An
'atypical' organism was diagnosed in 8% of cases compared to 30% and 23% in
previous Christchurch and Waikato studies respectively. Fourteen of the 67
S
pneumoniae isolates (21%) had reduced susceptibility to penicillin, all with
a
MIC < or = 2 microg/mL, a level of reduced susceptibility not associated
with
worse patient outcomes. Clinical outcome included a mean hospital stay of
6.7
days and a 6 week mortality of 6%. CONCLUSION: Although S pneumoniae was the
most commonly isolated organism in this study there have been significant
changes in the prevalence of atypical organisms since previous surveys. Ongoing
surveillance of antibiotic resistance and variations in the prevalence of
organisms causing community-acquired pneumonia is required to guide clinicians'
empiric antibiotic use.
The use of the Hospital
Anxiety and Depression Scale (HADS) in patients with
chronic obstructive pulmonary disease: a pilot study.
Dowson C, Laing R, Barraclough R, Town I, Mulder R, Norris K, Drennan C.
Canterbury Respiratory
Services, Canterbury Health Limited, Christchurch.
claire.dowson@chmeds.ac.nz
AIMS: To investigate
the use of the Hospital Anxiety and Depression Scale (HADS)
with recuperating chronic obstructive pulmonary disease (COPD) patients. To
study prevalence rates and changes in clinically relevant anxiety and depression
during rehabilitation. METHODS: Consecutive patients admitted to a non acute
respiratory ward over a twelve week period were asked to complete a HADS
questionnaire on three occasions. Nurses recorded basic demographic information
on admission. Additional demographic, medical and psychiatric data were obtained
by retrospective review of medical records. RESULTS: Of 93 consecutive
inpatients, 79 (85%) completed the admission HADS. 72 patients were eligible
to
complete the day three HADS and 60 the discharge HADS. Clinically relevant
anxiety (HADS score of > or =8) was indicated in 39 patients (50%) and
depression in 22 (28%). HADS anxiety (p=0.05) and total scores
(anxiety+depression) (p=0.03) decreased between admission and discharge. A
larger proportion of patients scored within the normal or mild psychopathology
range by discharge. More severe COPD (FEV1% predicted) correlated with higher
HADS anxiety scores (r=-0.39, p<0.001) and HADS depression scores (r=-0.34,
p<0.005). Patients with a recorded history of anxiety (p<0.0001) and
depression
(p<0.02) had higher WADS scores. Females (n=37) when compared to males
(n=42),
recorded significantly higher HADS anxiety scores throughout (p<0.005).
CONCLUSIONS: Clinically relevant anxiety, indicated by higher HADS scores,
was
more common in patients with severe COPD, a past history of anxiety or
depression and females. Anxiety and total mood improved during inpatient
rehabilitation. The use of this instrument with New Zealand COPD patients
may
improve identification and treatment of anxious and depressed patients.
The prevalence of
asthma symptoms, bronchial hyperresponsiveness and atopy in
New Zealand adults.
D'Souza W, Lewis S,
Cheng S, McMillan D, Pearce N, Town I, Rigby S, Skidmore C,
Armstrong R, Rutherford R.
Wellington Asthma Research Group, Wellington School of Medicine.
AIMS: To examine the
prevalence of asthma symptoms, bronchial
hyperresponsiveness (BHR) and atopy in a random population sample of New Zealand
adults. METHODS: A random sample of 2004 adults, aged 20-44 years, in Hawkes
Bay, Wellington and Christchurch, were selected from respondents to a one-page
respiratory screening questionnaire and invited to take part in further testing.
Subjects attending the testing centres' laboratories underwent a detailed
respiratory symptom questionnaire, Phazet testing to eleven common allergens,
blood samples for total and specific IgE, and measurement of bronchial
hyperresponsiveness. Subjects who did not wish to participate were encouraged
to
complete the questionnaire by telephone. RESULTS: A participation rate of
67%
(1257 of 1877 eligibles) was achieved. We found a high prevalence for all
measures of asthma in the previous 12 months: wheezing was reported by 28.5%,
waking with shortness of breath by 7.7%, a physician diagnosis of asthma by
15.9% and asthma medications were used by 8.5%. Bronchial hyperresponsiveness
was found in 24.9%, atopy in 34.8% and elevated serum IgE levels in 30.5%.
Asthma symptoms (in the past 12 months) and atopy decreased with increasing
age,
whereas bronchial hyperresponsiveness increased with age. Females reported
higher prevalences of waking with coughing (45.9%), nasal allergies (43.5%)
and
skin allergies (48.8%) compared to males (30.5%, 31.9% and 37.0%, respectively).
There were no significant regional differences. CONCLUSIONS: Asthma symptoms,
bronchial hyperresponsiveness and atopy are all common in adult New Zealanders.
Their prevalence is associated with age, gender and current smoking but there
are no significant regional differences between Hawkes Bay, Wellington and
Christchurch.
Crit Care Med 1998 Oct;26(10):1690-7
Extreme hypoventilation
reduces ventilator-induced lung injury during ventilation
with low positive end-expiratory pressure in saline-lavaged rabbits.
Hickling KG, Wright
T, Laubscher K, Town IG, Tie A, Graham P, Monteath J,
A'Court G.
Department of Intensive Care, Christchurch Hospital, New Zealand.
OBJECTIVE: To compare
the degrees of ventilator-induced lung injury caused by
two ventilation protocols. DESIGN: Randomized trial. SETTING: University animal
laboratory. SUBJECTS: Sixteen New Zealand white rabbits. INTERVENTIONS: After
five sequential saline lung lavages, eight pairs of anesthetized rabbits were
allocated randomly to receive either of two ventilation protocols for 4 hrs
during neuromuscular blockade. Both groups received 3 cm H2O of positive
end-expiratory pressure and 100% oxygen. Control group animals received an
estimated tidal volume of 12 mL/kg, an inspiratory time of 0.7 sec, and a
ventilatory rate adjusted for a PaCO2 of 35 to 45 torr (4.7 to 6 kPa). Study
group animals were ventilated through an intratracheal catheter, with
inspiratory time of 1.5 secs, ventilatory rate of 20 breaths/min, and peak
inspiratory pressure of 4 to 8 cm H2O, adjusted to maintain PaCO2 at 150 to
250
torr (20 to 33 kPa). MEASUREMENTS AND MAIN RESULTS: Arterial blood gases were
measured every 30 mins. After 4 hrs, a final lung lavage was performed.
Physiologic parameters, cell counts and protein concentration in the final
lavage, and lung histology were compared between groups. The alveolar-arterial
oxygen tension gradient was higher in the study group over the first 1.5 hrs,
but the time profile showed significantly (p = .001) greater improvement in
the
study group. After 4 hrs, the mean alveolar-arterial oxygen tension gradient
was
lower in the study group (94 torr [12.5 kPa] vs. 201 torr [26.8 kPa]). The
increase in neutrophil count from the initial to the final lung lavage was
lower
in the study group (0.27 x 10(7) cells/L vs. 2.01 x 10(7) cells/L, p = .037),
as
was the absolute value of the neutrophil count in the final lavage (1.33 x
10(7)
cells/L vs. 3.02 x 10(7) cells/L, p = .04). The median hyaline membrane score
was lower in the study group (0.5 vs. 3.0) but the difference was not
statistically significant. CONCLUSION: These findings suggest that a very
low
tidal volume reduces ventilator-induced lung injury in saline-lavaged rabbits
during ventilation at low lung volume.
Am J Respir Crit Care Med 1997 Nov;156(5):1440-6
Chronic bronchitis,
shortness of breath, and airway obstruction by occupation in
New Zealand.
Fishwick D, Bradshaw LM, D'Souza W, Town I, Armstrong R, Pearce N, Crane J.
Wellington Asthma Research Group, Wellington School of Medicine, New Zealand.
The objectives of
this study were to measure the population prevalence of
symptoms of chronic obstructive lung disease and mild airway obstruction and
to
compare these between occupational groups. There were 1,609 subjects (63.9%
response rate) who completed a respiratory questionnaire. Of these, 1,132
(70.4%) underwent pulmonary function testing (FEV1 and FVC). Twenty-one
categories of current occupation were used for analysis. Four definitions
of
chronic obstructive pulmonary disease (COPD) were used: (1) chronic bronchitis,
(2) chronic bronchitis with airway obstruction, (3) shortness of breath, and
(4)
shortness of breath with airway obstruction. For chronic bronchitis, adjusted
prevalence odds ratios were significantly elevated for food processors other
than bakers (OR = 2.83; 95% CI, 1.27 to 6.29) and chemical processors (OR
=
18.84; 3.71 to 95.64). The combination of chronic bronchitis and mild airway
obstruction (FEV1/FVC < 0.75) was associated with bakers (OR = 25.5; 3.86
to
168.53) and spray painters (OR = 14.40; 2.85-72.69). Shortness of breath was
associated with hairdressers (OR = 2.75; 0.80 to 9.42) and bakers (OR = 6.72;
0.57 to 79.66), and nursing was associated with lower levels of shortness
of
breath (OR = 0.42; 0.16 to 1.15). Working ever with vapors, gases, dust, or
fumes was significantly associated with chronic bronchitis and airway
obstruction (OR = 3.13; 1.07 to 9.12). This population-based study has
identified certain occupations with increased prevalence of chronic bronchitis
and COPD.
Occup Environ Med 1997 May;54(5):301-6
Occupational asthma in New Zealanders: a population based study.
Fishwick D, Pearce
N, D'Souza W, Lewis S, Town I, Armstrong R, Kogevinas M,
Crane J.
Wellington Asthma Research Group, Wellington School of Medicine, New Zealand.
OBJECTIVES: To examine
the effect of occupation on respiratory symptoms in a
randomly selected adult population aged 20-44 years. METHODS: It is based
on the
phase II sampling of the New Zealand part of the European Community respiratory
health survey. 1609 people (63.9% response rate) completed a detailed
respiratory questionnaire. Of those responding, 1174 (73%) underwent skin
tests
and 1126 (70%) attended to undergo methacholine bronchial challenge. Current
occupation was recorded and a previous occupation was also recorded if it
had
led to respiratory problems. 21 occupational groups were used for analysis
for
the five definitions of asthma wheezing in the previous 12 months; symptoms
related to asthma; bronchial hyperresponsiveness (BHR); BHR with wheezing
in the
previous 12 months; and BHR with symptoms related to asthma. RESULTS: Prevalence
odds ratios (ORs) were significantly increased for farmers and farm workers
(OR
4.16, 95% confidence interval (95% CI) 1.33 to 13.1 for the combination
of
wheezing and BHR). Increased risks of prevalence of asthma were also found
for
laboratory technicians, food processors (other than bakers), chemical workers,
and plastic and rubber workers. Workers had also been divided into high
and low
risk exposure categories according to relevant publications. The prevalence
of
wheezing was greater in the high risk group (OR 1.57, 95% CI 0.83 to 2.95)
than
in the low risk group. Atopy was associated with asthma, but the prevalence
of
atopy did not differ significantly between occupational exposure groups.
The
attributable risk of wheezing that occurred after the age of 15 years and
that
was estimated to be due to occupational exposure (based on the defined high
risk
group) was 1.9%, but this increased to 3.1% when farmers and food processors
(other than bakers) were also included in the high risk group. CONCLUSIONS:
This
population based study has identified certain occupations significantly
associated with combinations of asthmatic symptoms and BHR.
J Allergy Clin Immunol 1997 May;99(5):587-93
House dust mite allergen levels in public places in New Zealand.
Wickens K, Martin
I, Pearce N, Fitzharris P, Kent R, Holbrook N, Siebers R,
Smith S, Trethowen H, Lewis S, Town I, Crane J.
Wellington Asthma Research Group, Wellington School of Medicine, New Zealand.
BACKGROUND: House
dust mite allergens are a risk factor for asthma in New
Zealand, and levels in domestic dwellings have been found to be high compared
with levels in most other countries. Studies in other countries have
demonstrated lower levels of Dermatophagoides pteronyssinus allergens in
public
places compared with levels in domestic dwellings. OBJECTIVES: The purpose
of
this study was to measure reservoir Der p 1 levels in public places in New
Zealand and to examine determinants of these levels. METHODS: Reservoir
dust was
obtained in the two centers (Christchurch and Wellington) from hotels,
hospitals, rest homes, churches, primary schools, childcare centers, cinemas,
bank head offices, and airplanes; samples were also obtained from ski lodges.
Single measurements of temperature and relative humidity were taken with
thermohygrometers and an average humidity over 2 weeks was estimated with
use of
waxed wooden sticks. Information was collected on building construction,
type of
heating, and frequency of cleaning. Der p 1 levels (micrograms per gram
of fine
dust) for floor (n = 202), bed (n = 65), and seat (n = 24) samples in public
places were expressed as geometric means (95% confidence intervals). RESULTS:
Der p 1 levels in public places were significantly lower than domestic levels
in
both Wellington and Christchurch. Both floor and bed levels were higher
in
hotels than in other public places. After controlling for potential confounders,
floor Der p 1 levels were higher with carpeted floors (p < 0.0001) and
lower
with recent cleaning (p = 0.02) and bed Der p 1 levels were higher with
timber
wall construction (p = 0.03). Other building, heating, or cleaning
characteristics did not show significant association with allergen levels.
CONCLUSION: Der p 1 levels were much lower in public places than in domestic
dwellings with floor levels primarily affected by floor covering.
N Z Med J 1997 Mar 14;110(1039):71-4
Rapid assay of plasma
brain natriuretic peptide in the assessment of acute
dyspnoea.
Fleischer D, Espiner EA, Yandle TG, Livesey JH, Billings J, Town I, Richards AM.
Department of Endocrinology,
Christchurch School of Medicine and Radiology,
Christchurch Hospital.
AIM: Recognition
of heart failure may be difficult in patients presenting with
acute dyspnoea, particularly in the presence of chronic airways obstruction
or
obesity. In a previous study of patients with acute dyspnoea, we showed
that the
measurement of plasma brain natriuretic peptide (BNP)-a hormone secreted
in
increased amounts by the failing heart-accurately distinguishes heart failure
from primary lung disorder. The aim of the present study was to develop
a rapid
assay for BNP and evaluate its diagnostic use in patients acutely hospitalised
for increasing dyspnoea of any cause. METHODS: A rapid assay for plasma
BNP,
providing results within 24 h of blood collection, was developed without
loss of
precision. The results of the rapid and previously established BNP assays
were
highly correlated (r = 0.9). To determine the diagnostic value of the rapid
assay, measurements were undertaken on the day of admission in 123 breathless
patients (mean age 68.3, range 23 to 90 years) and related to conventional
diagnostic assessments and final outcome. RESULTS: In patients diagnosed
and
treated urgently for clinical heart failure, plasma BNP was significantly
higher
(115 (SE 13) pmol/L, n = 39) than in those without clinical heart failure
(33
(5) pmol/L, n = 84, p < 0.001). Using a cut-off of 50 pmol/L for the
presence of
heart failure, there was discordance between BNP level and clinical diagnosis
in
21 of 123 cases. Reassessment after independent analysis of discordant cases
increased the difference in BNP level in the presence (123 (13) pmol/L,
n = 43)
or absence (24 (1.5) pmol/L, n = 80) of heart failure. Using two way analysis
of
variance, no further improvement in discrimination was found when chest
radiographs were used together with the BNP data. CONCLUSION: Rapid BNP
assays
are practicable and provide accurate information on cardiac status-superior
to
chest radiographs in many cases-early in the course of the patient's
presentation with acute dyspnoea.
Intensive Care Med 1996 Dec;22(12):1445-52
Pressure-limited
ventilation with permissive hypercapnia and minimum PEEP in
saline-lavaged rabbits allows progressive improvement in oxygenation, but
does
not avoid ventilator-induced lung injury.
Hickling KG, Town
IG, Epton M, Neill A, Tie A, Whitehead M, Graham P, Everest E,
A'Court G, Darlow B, Laubscher K.
Department of Intensive Care, Christchurch Hospital, New Zealand.
OBJECTIVE: To determine
whether pressure-limited intermittent mandatory
ventilation with permissive hypercapnia and positive end-expiratory pressure
(PEEP) titrated to arterial oxygen tension (PaO2) prevents or reduces acute
lung
injury, compared to conventional ventilation, in saline-lavaged rabbits.
DESIGN:
Prospective randomised trial. SETTING: University animal laboratory. SUBJECTS:
18 New Zealand White rabbits. INTERVENTIONS: Following five sequential saline
lung lavages, anaesthetised rabbits were randomly allocated in pairs to
receive
either of two ventilation protocols using intermittent mandatory ventilation.
The study group had peak inspiratory pressure limited to 15 cm H2O and arterial
partial pressure of carbon dioxide (PaCO2) was allowed to rise. The control
group received 12 ml/kg tidal volume with rate adjusted for normocarbia.
PEEP
and fractional inspired oxygen (FIO2) were adjusted to maintain, PaO2 between
8
and 13.3 kPa (60 and 100 mm Hg) using a predetermined protocol. At 10 h
or
following death, lung lavage was repeated and lung histology evaluated.
MEASUREMENTS AND MAIN RESULTS: The mean increase in lavage cell counts and
protein concentration and hyaline membrane scores were not significantly
different between the groups. Oxygenation progressively improved more in
the
study group (p = 0.01 vs control for PaO2/FIO2 ratio and alveolar-arterial
oxygen tension gradient (AaDO2)). PEEP was similar and the mean airway pressure
higher in the control group, suggesting that this probably resulted from
less
ventilator-induced injury in the study group. Four deaths occurred in the
control group (three due to pneumothorax and one to hypoxaemia) and none
in the
study group (p = 0.08). CONCLUSIONS: This ventilatory protocol may have
failed
to prevent lung overdistension or it may have provided insufficient PEEP
to
prevent injury in this model; PEEP greater than the lower inflection point
of
the pressure-volume curve has been shown to prevent injury almost entirely.
© 2003, Alpha One International Registry. All rights reserved.
