Tinzaparin reduces health care resource use for anticoagulation in hemodialysis.

Anticoagulation is required during hemodialysis to prevent thrombus formation within the extracorporeal circuit. The low-molecular-weight heparin tinzaparin is more expensive than unfractionated heparin (UFH) in Canada but more convenient to administer. We conducted a time-and-motion study to test the hypothesis that tinzaparin may reduce nursing time and total health care costs compared with UFH. Data on health care resource use associated with anticoagulation during hemodialysis for chronic renal failure were collected at an academic hospital in Quebec. Nursing time was recorded for 8 nurses performing 16 dialysis sessions for 4 patients receiving tinzaparin and 4 receiving UFH (2 dialysis sessions per patient). Nurses had ≥ 1 year of experience supervising hemodialysis. We estimated total annual costs of nursing time and health care resources (anticoagulants, medical supplies, and laboratory testing) associated with anticoagulation. In sensitivity analyses, drug costs were varied ± 30% of their base-case values. Estimated annual nursing times per patient were 0.8 vs. 11.5 hours in the first year and 0.6 vs. 10.2 hours in subsequent years for tinzaparin vs. UFH, respectively. Annual drug costs per patient were CAD 898.56 for tinzaparin and 546.75 for UFH. Estimated total annual costs were CAD 1061.03 vs. 1012.71 in the first year and CAD 917.75 vs. 895.23 in subsequent years for tinzaparin vs. UFH, respectively. Use of tinzaparin was cost saving relative to UFH if tinzaparin price was reduced 30%. Most of the price differential between tinzaparin and UFH is offset by substantial time savings to nephrology nurses.

Multimedia article. Laparoscopic Ladd's procedure in two adults: malrotation and the minimally invasive approach.

Malrotation is an intestinal rotation anomaly rarely diagnosed in adults. In the adult patient, obstructing peritoneal bands may lead to nausea and abdominal distention. Familiarity with this presentation as well as the aberrant anatomy associated with the unusual problem facilitates surgical treatment. While the minimally invasive approach requires meticulous dissection due to this abnormal anatomy, laparoscopic treatment does provide the advantages of short convalescence and low morbidity. This video briefly reviews embryologic intestinal development, rotational anomalies and two laparoscopic Ladd's procedures.

The Healthline pilot: call centre triage in New Zealand.

AIMS: To acquaint New Zealand doctorsabout nurse telephone triage using call centre technology, and to report the activities of Healthline, a pilot call centre telephone triage project in New Zealand. METHODS: Data for the second quarter of Healthline's activities are reported. RESULTS: Healthline received about 100 calls a day, mostly after hours, and typically from symptomatic patients seeking health advice. Women and children were the most frequent users; Maori used the service in proportion to their representation in the population. Common symptoms were to those encountered in primary medical care. Requests for specific health information were usually about the health issues of the day Callers were more often directed to contact general practitioners than any other careproviders. The triage advice provided was often different from the caller's original intention about the timing and and ofcare they would have sought. Satisfaction with the service among Maori and non-Maori callers was high. CONCLUSIONS: Healthline is providing a safe and acceptable primary care triage service in its pilot regions and appears to be meeting its first objective of providing timely and appropriate access to health advice and services.

Did Cook's sailors have Tapanui 'flu? --chronic fatigue syndrome on the Resolution.

The 1982 publication of the Resolution journal of Johann George Reinhold Forster provided justification for his recognition as a scientist, and gave a remarkable insight into his character. It also included an account of an illness suffered by many of the sloop's crew, including Forster, after a period ashore at Queen Charlotte Sound. The symptoms of the illness were remarkably similar to those now clustered as the chronic fatigue syndrome.

Predicting resting blood pressure at eighteen years: the Dunedin Study.

PURPOSE: To examine the value of repeated blood pressure screening during childhood, and exercise testing in adolescence, for predicting resting blood pressure at eighteen years. METHOD: Regular measures of blood pressure and other variables in a birth cohort from 7 to 18 years. Cardiovascular responses to exercise testing at 15 and 18 years. RESULTS: The best predictors of resting blood pressure at 18 years were body size at 18 years and resting blood pressure at 15 years. Neither exercise and recovery blood pressures at 15 years, nor the way blood pressure had tracked through childhood, added importantly to the prediction. CONCLUSION: We question the value of screening for hypertension during childhood, either by regular resting measures or by exercise testing in adolescence.

Body size and the menarche: the Dunedin Study.

PURPOSE: We wished to elucidate the relationships among body size variables and age of menarche for New Zealand girls. METHODS: Body size variables were measured repeatedly over eighteen years and age of menarche recorded for 415 girls enrolled in the Dunedin Multidisciplinary Health and Development Study. RESULTS: Girls who were taller and heavier with a higher body mass index than their peers from 7 years of age reached menarche early: height was the most important determinant. Early maturing girls were overtaken in height by the later-maturing girls by fifteen but remained heavier even at eighteen. The daughters of tall mothers matured later. The mean weight at menarche was 41.4 kg, height 149.4 cm, body mass index 18.4, and age 12.9 years. CONCLUSIONS: The daughters of short women matured early and continued growing heavier, but they stopped growing taller and were overtaken in height by the later-maturing daughters of tall women.

Intrauterine growth retardation and blood pressure at age seven and eighteen.

The association between intrauterine growth retardation and blood pressure in middle childhood and early adulthood was examined. At age 7, after adjusting for sex and weight, the differences between normal children and those who had experienced intrauterine growth delay were 0.9 mmHg (95% CI -0.1 to 2.2) for systolic and 0 mmHg (-1.7 to 2.0) for diastolic blood pressure respectively. The differences between the blood pressures of intrauterine growth retarded infants with an appropriate ponderal index and those with a low ponderal index were 4.4 mmHg (-0.9 to 7.9) for systolic, and 3.8 mmHg (0.2 to 7.3) for diastolic blood pressure respectively. At age 18 the differences were much less pronounced. The association between blood pressure and the placental weight was also examined. The evidence from this sample lends weak support to the findings of other studies which suggest that there is an association between factors occurring before or around the time of birth and blood pressure in later life.

The role of the liver in the production of free radicals during halothane anaesthesia in the rat. Quantification of N-tert-butyl-alpha-(4- nitrophenyl)nitrone (PBN)-trapped adducts in bile from halothane as compared with carbon tetrachloride.

Halothane or CCl4 was co-administered with the spin trap N-tert-butyl-alpha-(4-nitrophenyl)nitrone (PBN) to rats fitted with bile duct cannuli or to isolated perfused liver preparations. Rats maintained under halothane anaesthesia generated significant amounts of free radicals, and 5-9 nmol was excreted in bile over 1 h. No adducts were detected in urine or plasma. The hepatic origin of these free radicals was confirmed by studies on isolated perfused livers where the addition of halothane to the perfusate resulted in the biliary elimination of the same PBN-trapped radical adducts. Similarly, following CCl4 administration, the same radical species were eliminated in bile in the whole animal and the perfused liver preparation. In the perfused liver, over 3 h the total biliary elimination of radicals derived from halothane or CCl4 (administered at equimolar concentrations) was approximately the same (5-7 nmol); however, the elimination of halothane-derived radicals was more rapid over the first 1 h.

Blood pressure level, trend, and variability in Dunedin children. An 8-year study of a single birth cohort.

In a birth cohort of children in the Dunedin Multidisciplinary Health and Development Study in New Zealand, resting blood pressures were recorded biennially five times from age 7 to 15 years. Using previously described methods, we examined the level, trend, and variability of blood pressures in those children with at least three readings. The level, trend, and variability of height, weight, and body mass index were compared among six separate groups of children. Two groups were categorized on the basis of high systolic pressure levels, one with low variability and the other with high variability, which was thought to resemble adult labile hypertension. Two additional groups were categorized on the basis of increasing and decreasing blood pressure trends; the fifth group had consistently low blood pressures, and the sixth group consisted of the remaining children. There were significant differences among the groups for the level of all the physical measurements and for the trend of body mass index. No significant differences were found among the groups for gender or socioeconomic status. A parental history of high blood pressure, stroke, or heart attack was significantly more common in the first two groups.

Should family doctors screen asymptomatic children for high blood pressure?

Whereas the United States Task Forces on Blood Pressure Control in Children have recommended annual blood pressure screening in all children, a working party of the British Hypertension Society has formed the opposite opinion. Relevant literature is reviewed here, and the conclusion reached that on epidemiological and ethical grounds, screening children for hypertension cannot at present be justified.

The stability of high blood pressure in Dunedin children: an eight year longitudinal study.

Resting blood pressures were recorded for children in the Dunedin Multidisciplinary Health and Development Study at two year intervals five times from age seven to fifteen. Correlations between pairs of readings were modest but significant, and higher for systolic (0.39 to 0.62) than for diastolic blood pressure. However, although children with normal blood pressure were likely to continue to have normal blood pressure, high blood pressures at age seven, nine, eleven and thirteen were not stable--only 28% of those whose systolic blood pressure at age seven was in the highest 5% had two subsequent readings in the highest 5%. On the other hand 56% of those in the highest 20% had two subsequent readings in the highest 20%, and 9% had all subsequent readings in the highest 20%. We do not believe that adult essential hypertensives can be recognised early by annual blood pressure measurement in childhood and the assignation of blood pressure rank according to a set of normal values.

Patient education leaflet for hypertension: a controlled study.

THIS STUDY ATTEMPTS TO ANSWER THE QUESTION: is a leaflet, designed according to criteria of likely effectiveness, actually more effective in practice than a standard patient education leaflet? A new leaflet was designed, its content determined by the responses of a sample of New Zealand general practitioners. Four matched groups of hypertensive patients were used to compare gain from an old leaflet (group 1), a new leaflet (group 2), a tape-slide programme plus a new leaflet (group 3); group 4 were controls. Group 3 showed the only significant educational gain.

What do trainee interns see in general practice?

From diaries kept by trainee interns during their three week general practice attachment, it was found that the average clinical experience of students closely matches standard figures from general practice with respect to age, sex, and morbidity of patients consulting. Most students record high levels of satisfaction with their attachment.