Older medical patients often experience a decline in function associated with hospitalization. Some of this is already established at hospital admission, whereas some occurs during Objectives study were to separately describe pre-hospital and in-hospital functional changes older Australian identify risk factors these changes.Secondary analysis data from prospective controlled trial conducted general units an tertiary teaching hospital. Participants 615 consecutive aged 65 years or admitted...

Caffeine is metabolized extensively (on average 80%) to paraxanthine. With regular caffeine consumption, serum levels of paraxanthine are two thirds those caffeine. Both and competitively nonselectively inhibit adenosine receptors in vitro. To examine the contribution pharmacologic activity caffeine, we administered 12 subjects a crossover design oral (2 or 4 mg/kg) versus placebo (same dose as caffeine) placebo, each after 3 days methylxanthine abstinence. significantly increased diastolic...

The stable isotope-labeled compound 3', 3'-dideuteronicotine was used to investigate the disposition kinetics of nicotine in smokers, systemic absorption from cigarette smoke, and bioavailability ingested as oral capsules. Blood levels labeled could be measured for 9 hours after a 30-minute intravenous infusion. Analysis 10 healthy men revealed multiexponential decline end an infusion, with elimination half-life averaging 203 minutes. This longer than that previously reported, indicating...

Some recent epidemiologic studies have reported a nonlinear dose-response in the relationship between coffee consumption and health risks, such that risks increase disproportionately to dose. Assuming caffeine contributes adverse effects of coffee, possible explanation for is dose-dependent metabolism caffeine. We examined hypothesis under chronic dosing conditions dose-dependent. Nine healthy subjects were given, randomized 5-day treatment blocks, placebo, 4.2 (low) 12 (high) mg/kg/day...

We propose a parametric pharmacokinetic-pharmacodynamic model for caffeine that quantifies the development of tolerance to pressor effect drug and characterizes mean behavior inter-individual variation both pharmacokinetics effect. Our study in small group subjects indicates acute develops occur after some time delay relative changes plasma concentration. The half-life equilibration with concentration is about 20 minutes. regression estimated be 1 hour, suggests tolerance, at its fullest,...

<h3>Objective</h3> Cardiac magnetic resonance (CMR) has the potential to provide early detection of cardiac involvement in Fabry disease. We aimed gain further insight into this by assessing a cohort patients using CMR. <h3>Methods/results</h3> Fifty genotype-positive subjects (age 45±2 years; 50% male) referred for CMR and 39 matched controls 40±2 59% were recruited. Patients had mean Mainz severity score index 15±2 (range 0–46), reflecting an overall mild degree disease severity. Compared...

A stable isotope-labeled drug method was used to determine the absolute bioavailability and absorption kinetics of a transdermal nicotine-delivery system (TTS). TTSs are being developed as an adjunct smoking-cessation therapy. Deuterium-labeled nicotine infused for 24 hours simultaneously TTS application in cigarette-abstinent smokers. In 11 subjects with good patch adhesion, average systemic dose 19 mg delivered, 82%. The rate maximal between 6 12 after declined thereafter, plateauing 16 at...

Abstract Background Clinical practice guidelines have been developed to improve screening, prevention and management of delirium. Aims To implement delirium in general medical patients reduce incidence duration outcomes delirious patients. Methods Implementation was led by a multidisciplinary team clinicians project staff on one ward. Evaluation undertaken as controlled trial aged 65 years or older with/at risk delirium, compared with control Interventions included detection, education, ward...

Abstract Background: Acute hospital general medicine services care for ageing complex patients, using the skills of a range health‐care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency outcomes in older medical patients. Aim: To enhance assessment, communication, by restructuring consistent, patient‐centred multidisciplinary teams service. Methods: Prospective controlled trial enrolling 1538 consecutive inpatients. Intervention...

In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital after-hospital care, patient self-care, hospital–community integration. A multidisciplinary quality improvement program was designed instigated in Brisbane October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 ACS 904 CHF. Quality interventions were...

Abstract Background Prevalence of Fabry disease amongst Chronic Kidney Disease (CKD) patients on haemodialysis has been shown to be approximately 0.2%. Methods We undertook a cross-sectional study employing cascade screening strategy for 3000 adult, male and female affected by CKD stage 1-5D/T at public, specialty renal practices within participating Queensland Hospital Health Services from October 2017 August 2019. A multi-tiered FD strategy, utilising combination dried blood spot (DBS)...

Abstract BACKGROUND: Congestive heart failure (CHF) is an increasingly common condition associated with significant hospital resource utilization. Initiating better disease management at the time of initial admission has potential to reduce readmissions. OBJECTIVE: To evaluate impact a multifaceted quality improvement program on 12‐month utilization in patients admitted CHF. DESIGN: Prospective longitudinal study comparing baseline and intervention cohorts. PARTICIPANTS: All consecutive CHF...

Objectives A number of caffeine metabolite ratios have been proposed to measure CYP1A2 activity in vivo. The data validate these are scanty. objective this study was urine versus stable isotope-labeled clearance under different dosing conditions. Study design Two experiments, one with nine nonsmoking subjects and the other 12 cigarette smokers, were performed. We explored relationship between clearance, measured by means intravenous infusions caffeine, a during administration single or...

Background: residents of aged care are old, frail and frequently require hospital management intercurrent illness, but outcomes poor. Objective: to identify the impact an interdisciplinary model on medical inpatients admitted from residential (RAC). Design: pre-planned subgroup analysis controlled trial. Setting: general units a teaching in Brisbane, Australia. Subjects: consecutive patients over 65 RAC (n = 189) or community 815). Methods: all were allocated by existing cyclical roster...

Abstract Background Fabry disease (FD) is a rare, lysosomal storage disorder caused by the absence or deficiency of enzyme alpha-galactosidase A (α-Gal A) that leads to abnormal accumulation lipid globotriaosylceramide (GB3) in variety cell types and tissues throughout body. FD has an x-linked inheritance pattern. Previously thought be only carriers, females can also experience symptomatology. Symptoms vary type severity from patient tend increase with age. symptoms are non-specific may...

Abstract Objective National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final stratify these into low (negative testing) or high (positive suggestive unstable angina). Adults less than 40 years have a pretest probability syndrome. The utility exercise stress young adults chest pain syndrome who Heart Foundation features was evaluated. Methods A retrospective analysis performed...