Australian and New Zealand journal of medicine
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Severe heat-related illness can result in hospitalisation and possibly death. These illnesses are potentially preventable; in Australia high environmental temperatures are common. ⋯ Problems were identified in accuracy of diagnosis and appropriate intervention. Awareness of the risk factor profile is needed among health workers, to ensure early preventative strategies. Populations to target for future prevention include elderly people (including those in institutional care), patients with cognitive impairment and patients taking diuretics, multiple medication and/or with other severe co-existing illnesses. Treatment could be more standardised.
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At fibreoptic bronchoscopy the potential exists for contamination of bronchoscopes and microbiological specimens. Patients may also be cross infected with acid fast bacilli (AFB). During a five month period, 12 bronchial wash specimens of 65 patients undergoing bronchoscopy, one bronchoscope and an autocleaner, were contaminated with the AFB, Mycobacterium chelonae (MCH). ⋯ To avoid contamination of bronchoscopy specimens with MCH, use of autoclearners should be discouraged and sterile water and containers used in cleaning procedures. If MCH contamination occurs in this setting, the bronchoscope and dismantled valve mechanism should undergo ethylene oxide sterilisation.
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Hypothermia occurs within domestic and non-residential settings. Most epidemiological data originate from the northern hemisphere, with little data being generally available concerning cases from New Zealand and Australia. ⋯ The two main non-neonatal groups contributing to cases of hypothermia were males aged 13-65 years, and the elderly. In the aged, the proportion of hypothermia-related deaths was no different from that associated with other disorders, however, the case-fatality ratio was three times greater, highlighting the need for improving prevention and management strategies.
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The incidence of acute rheumatic fever in New Zealand remains relatively high. Reliable early diagnosis of carditis is difficult and important in management. ⋯ Doppler echocardiography is more sensitive than clinical assessment in the detection of carditis in acute rheumatic fever, and can contribute to earlier diagnosis.
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Comparative Study
Accuracy of reported family history of heart disease: the impact of 'don't know' responses.
Usual 'Yes/No' definitions of a family history of heart disease do not allow for 'Don't know' responses. In some families, misclassification of family history may result if these are not considered. ⋯ For first degree relatives, sensitivity of reporting was 81% for CHD, 86% for any heart disease and 60% for cancer, while for second degree relatives, sensitivity was 73%, 69% and 90%, respectively. When 'Don't know' responses were classified as 'No', sensitivity in first degree relatives was not affected, but in second degree relatives, it fell to 49%, 41% and 60%, respectively. Specificities were unchanged. These data show that in families where information beyond first degree relatives is considered, failing to account for 'Don't know' responses is likely to lead to misclassification of family history of CHD.