Improving access to health information for older migrants by using grounded theory and social network analysis to understand their information behaviour and digital technology use.

Migrant well-being can be strongly influenced by the migration experience and subsequent degree of mainstream language acquisition. There is little research on how older Culturally And Linguistically Diverse (CALD) migrants who have 'aged in place' find health information, and the role which digital technology plays in this. Although the research for this paper was not focused on cancer, we draw out implications for providing cancer-related information to this group. We interviewed 54 participants (14 men and 40 women) aged 63-94 years, who were born in Italy or Greece, and who migrated to Australia mostly as young adults after World War II. Constructivist grounded theory and social network analysis were used for data analysis. Participants identified doctors, adult children, local television, spouse, local newspaper and radio as the most important information sources. They did not generally use computers, the Internet or mobile phones to access information. Literacy in their birth language, and the degree of proficiency in understanding and using English, influenced the range of information sources accessed and the means used. The ways in which older CALD migrants seek and access information has important implications for how professionals and policymakers deliver relevant information to them about cancer prevention, screening, support and treatment, particularly as information and resources are moved online as part of e-health.

The relative contributions of antithrombin III during heparin treatment, and of clinically recognisable risk factors, to early recurrence of venous thromboembolism.

The influence of antithrombin III (ATIII) level and ATIII activity, measured during intravenous heparin treatment for venous thromboembolism (VTE), on 'heparin requirement' (the heparin dose required to prolong the activated partial thromboplastin time (APTT) into its designated therapeutic range), and on the likelihood of recurrent VTE during the first month of anticoagulant therapy, were examined in a prospective study of 232 patients with VTE treated according to a standard protocol. 15 patients with recurrent VTE (6.5%) had a lower mean APTT during heparin treatment than patients without recurrence; a finding due partly to their heparin requirement. However, there was no measurable relationship between ATIII level or ATIII activity and either heparin requirement or recurrence of VTE. By contrast, both the presence of disseminated malignancy and the development of heparin induced thrombocytopenia were powerful, clinically recognisable, risk factors for recurrence during or soon after heparin therapy.

Oral contraceptives and surgery: reduced antithrombin and antifactor Xa levels without postoperative venous thrombosis in low-risk patients.

The effect of preoperative treatment with an estrogen containing oral contraceptive on the incidence of postoperative thrombosis (detected with 125I-fibrinogen leg scanning) was examined in 221 patients aged 18-49 years who had elective or emergency general intra-abdominal or gynecologic surgery, 99 of whom were taking an oral contraceptive before their operation. Eighty-five percent of the contraceptive treated patients had taken their preparation until 1-7 days before surgery and the rest until within a month of surgery; 81% were taking preparations containing 30 or 50 micrograms estrogen. Postoperative thrombosis developed in 1 of the 122 patients who were not taking a contraceptive and in none of the 99 contraceptive treated patients. As the 95% confidence limits for the 0% thrombosis rate observed in the contraceptive treated patients are 0-3.7%, the added risk of postoperative thrombosis attributable to oral contraceptive treatment before surgery is very small in young women who are otherwise at low risk of thrombosis. Plasma antithrombin level (by immunoassay), antithrombin activity (by chromogenic substrate assay), and antifactor Xa activity (by clotting assay), were measured before surgery in 81 patients, 42 of whom had been taking an oral contraceptive. Contraceptive treatment significantly reduced all 3 assay results. Its most marked effect was on antifactor Xa activity, which was reduced by contraceptive treatment from 103 +/- 24% (range 68 - 172%) to 81 +/- 27% (range 24 - 155%; with less than 80% activity in 54%, and less than 50% activity in 15% of patients). These results suggest that reduced preoperative antifactor Xa activity has a low specificity for thrombosis after moderately extensive surgery in young, otherwise fit, oral contraceptive treated women. This test is therefore unlikely to be a clinically useful predictor for postoperative thrombosis in this group of patients.

PIP: The effect of preoperative treatment with an estrogen containing oral contraceptive (OC) on the incidence of postoperative thrombosis (detected with 125 I-fibrinogen leg scanning) was examined in 221 patients ages 18-49 who had elective or emergency general intraabdominal or gynecologic surgery, 99 of whom were taking an OC before their operation. 85% of the contraceptive treated patients had taken their preparation until 1-7 days before surgery and the rest until within a month of surgery; 81% were taking preparations containing 30 or 50 mcg estrogen. Postoperative thrombosis developed in 1 of the 122 patients who were not taking a contraceptive and in none of the 99 contraceptive treated patients. As the 95% confidence limits for the 0% thrombosis rate observed in the contraceptive treated patients are 0-3.7%, the added risk of postoperative thrombosis attributable to OC treatment before surgery is very small in young women who are otherwise at low risk of thrombosis. Plasma antithrombin level (by immunoassay), antithrombin activity (by chromogenic substrate assay), and antifactor xa activity (by clotting assay), were measured before surgery in 81 patients, 42 of whom had been taking an OC. Contraceptive treatment significantly reduced all 3 assay results. Its most marked effect was on antifactor Xa activity, which was reduced by contraceptive treatment from 103 +or- 24% (range 68-172%) to 81 +or-27% (range 24-155%) with 80% activity in 54%, and 50% activity in 15% of patients. These results suggest that reduced preoperative antifactor Xa activity has low specificity for thrombosis after moderately extensive surgery in young, otherwise fit, OC treated women. This test is therefore unlikely to be a clinically useful predictor for postoperative thrombosis in this group of patients.

Heparin stability: effects of diluent, heparin activity, container, and pH.

The effects have been studied of diluent, heparin activity after dilution, container, and pH on the stability of heparin solutions stored under conditions resembling those present during heparin infusion by intravenous drip or syringe pump. Heparin activity was measured by activated partial thromboplastin time and thrombin clotting time (and, in one set of studies, also by factor Xa inhibitor assay and protamine sulphate neutralisation). Heparin activity was stable for 6 hours regardless of storage conditions. After 24 hours heparin activity was stable when the drug was diluted in 0.9% saline and stored in plastic, but a small loss of activity was observed in several studies after dilution in 5% dextrose or storage in glass. A more extensive comparison confirmed a 3-5% loss in heparin activity over 24 hours after dilution in 5% dextrose. Changing the pH to 3.5 or 10.0 had little effect on storage stability. We conclude that heparin activity in vitro remains stable during short infusions but recommend dilution in 0.9% saline and a plastic container when a heparin solution is infused over 24 hours.

Heparin-associated thrombocytopenia: case report and prospective study.

After observing a patient with heparin-induced thrombocytopenia we prospectively recorded the incidence of thrombocytopenia associated with heparin treatment by measuring the platelet count every second day in 166 patients given therapeutic heparin for various thromboembolic disorders, and 51 patients given low-dose heparin prophylaxis. A platelet count below 100 x 10(9)/litre developed in nine patients (5.4%) during or soon after full-dose heparin therapy, and in one patient given low-dose heparin. Careful clinical review suggested that heparin was either the most likely cause of a contributing cause of thrombocytopenia in 5/166 patients (3.0%) receiving therapeutic heparin and none of the patients who received prophylactic heparin. Associated laboratory studies suggest that heparin-initiated platelet aggregation in vivo is a useful marker for heparin-induced thrombocytopenia.