Measures of blood loss and red cell transfusion targets for caesarean delivery complicated by placenta praevia.

OBJECTIVE: The objective of this study was to assess the association between transfusion, per cent drop in haemoglobin (Hb), and estimated blood loss during the delivery and the first postoperative week following caesarean delivery for placenta praevia. Clinical data predictive of an objective laboratory test for risk of haemorrhage and the need for transfusion were investigated. Transfusions outside national Guidelines were noted. DESIGN: Retrospective observational study of patients with placenta praevia, who were delivered consecutively by caesarean section at Royal Brisbane and Women's Hospital from 1999 to 2005. SETTING: University-affiliated tertiary hospital. All caesareans were performed by one or more consultant obstetricians, gynaecology oncology surgeons and registrar assistants. RESULTS: Seventy-one (28.9%) of 246 patients with placenta praevia were transfused, with 45 of these receiving three or more red cell units. The antenatal Hb fell by a mean of 20.2% (SD 13.5). The average operative haemorrhage was estimated as 1225 mL (SD 996). No patient or surgical factors were significantly associated with changes in Hb. There was a significant association between per cent fall in antenatal Hb and both transfusion P < 0.001 and estimated loss P = 0.002. After transfusion, the Hb of 19 patients was higher than that recommended by Guidelines. CONCLUSIONS: Whether transfusion is necessary, but not the number of red cell units, can be planned by the effect of haemorrhage on antenatal Hb during delivery by caesarean section complicated by placenta praevia.

Opportunities for health promotion in the Queensland women's prison system.

OBJECTIVE: To compare the health of Queensland women prisoners with that of community women using the target areas of public health promotion identified by Health Determinants Queensland as a framework. METHODS: Data from the Queensland Women Prisoners' Health Survey was compared with published community data in each of the target areas. RESULTS: Queensland women prisoners had poorer nutrition, did less exercise, had higher rates of smoking and had a greater prevalence of asthma and diabetes than women in the community. They seemed to have a greater prevalence of mental health disorders. CONCLUSIONS: Within the framework, women prisoners had significantly poorer measured outcomes than community women in all areas except cervical screening, breast cancer screening and overweight and obesity. IMPLICATIONS: The Health Determinants Queensland target areas for Queensland women are of even greater priority in the subgroup of women prisoners. Benefits for the health of prisoners, and therefore the community, could be gained by expanding existing community health promotion activities to prisons through collaboration and partnerships.

Effects of formal education for patients with inflammatory bowel disease: a randomized controlled trial.

BACKGROUND: Patients with inflammatory bowel disease (IBD) suffer physical dysfunction and impaired quality of life (QOL), and need frequent health care. They often lack knowledge about their disease and desire more education. Educational interventions for other chronic diseases have demonstrated reduced health care use and increased knowledge, medication adherence and QOL. METHOD: Sixty-nine participants were randomly assigned to formal IBD education and standard of care (pamphlets and ad hoc physician education) or standard of care alone. Assessment of IBD knowledge and QOL occurred at baseline, immediately posteducation and eight weeks posteducation. Participants documented medication adherence and health care use in diaries. Patient satisfaction was assessed at the end of the study. RESULTS: The education group had higher knowledge scores (P=0.000), perceived knowledge ratings (P=0.01) and patient satisfaction (P=0.001). There was a lower rate of medication nonadherence and health care use for the education group, but the differences were not significant. QOL indices did not change. Significant correlations were found for increased health care use in patients with poorer medication adherence (P=0.01) and lower perceived health (P=0.05). CONCLUSION: Formal IBD patient education improves knowledge, perceived knowledge and patient satisfaction. Further study of long-term effects may better demonstrate potential benefits for QOL, medication adherence and health care use.

Identifying protein kinase inhibitors using an assay based on inhibition of aerial hyphae formation in Streptomyces.

We have identified a strain of Streptomyces in which aerial hyphae formation appears to be especially sensitive to inhibition by protein kinase inhibitors. Using this assay, a number of bacterial cultures have been screened and novel inhibitors of eukaryotic protein kinases have been identified. Since M. tuberculosis possesses multiple eukaryotic-like protein kinase genes, we tested the active kinase inhibitors for the inhibition of mycobacterial growth and obtained several potent compounds. This identifies a new biochemical class of antimycobacterial agents.