The Medical journal of Australia
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To compare clinical outcomes between patients with ST-elevation myocardial infarction (STEMI) presenting to a hospital with facilities for primary percutaneous coronary intervention (PCI) and patients transferred from a non-PCI-capable unit, and to determine the success rate of meeting clinical guidelines for management of STEMI. ⋯ Our study demonstrates that transfer for PCI is feasible and safe in selected patients, with outcomes comparable to those of patients presenting to a PCI-capable unit. However, the CSANZ/NHFA targets, predicated by symptom-to-first-door time, are not being met and have not improved over time, which suggests that strategies to improve symptom-to-first-door, first-door-to-balloon and transfer times need to be addressed.
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Recognising that brain and spinal cord injuries result in significant health and economic burdens for the affected individual and the community, the Victorian government committed $63 million towards neurotrauma research beginning in 2005. A survey of Victorian neurotrauma research units conducted in 2008 showed substantial increases in workforce capacity, collaborative activity and research output during the first 3 years of the funding program. Changes in economic and commercial activity, and research translation activity were also observed. The activity and output of the Victorian brain and spinal cord injury research sector increased substantially during a period coinciding with increased funding.
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To assess women's compliance with different Australian guidelines on alcohol intake during pregnancy and examine factors that might influence compliance. ⋯ The October 2001 change in alcohol guidelines does not appear to have changed behaviour. Risks associated with different levels of alcohol intake during pregnancy need to be clearly established and communicated.
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Recent National Heart Foundation of Australia (NHFA) guidelines for management of acute coronary syndromes (ACS) recommend increasing the rates of early invasive management of ACS and providing equal access for all Australians to percutaneous coronary intervention (PCI) facilities. For patients with ACS managed in regional hospitals without PCI facilities, review of the evidence does not show unequivocal benefit of early routine PCI over selective PCI for patients with non-ST-segment-elevation ACS or ST-elevation myocardial infarction. The current pattern of transfer based on the NHFA guidelines is expensive and disruptive of patient care, as well as undermining regional health care services. Further increase in transfer rates and increases in PCI facilities would divert resources away from supporting the regional infrastructure needed to provide evidence-based therapies, without any evidence that lives would be saved.