Outpatient deep vein thrombosis treatment models.

Approximately 9000 patients are admitted annually to Canadian hospitals with a primary diagnosis of deep vein thrombosis (DVT). Although this is a serious medical condition, potentially more than 40% of all patients with uncomplicated DVT, or 3600 Canadian patients/year, may be safely treated as outpatients with low-molecular-weight heparin. Outpatient treatment avoids costly hospitalization that is required for the standard 5-10 days of intravenous unfractionated heparin therapy. Although institutions vary widely in the available resources, five core models can assist with successful implementation of an outpatient DVT treatment program while providing optimum use of each site's resources and clinical expertise. These models are as follows: anticoagulation clinic (thromboembolic clinic-service), medical day care clinic, emergency department fast-track, one visit and self-injection, and physician-office follow-up. A program was implemented at Burnaby Hospital in May 1996 using the medical day care clinic model as a pilot. Formal evaluation of the program is still in progress but interim evaluation demonstrated overwhelming success.

A retrospective evaluation of imipenem use in bone marrow transplant patients.

A retrospective, open, 3-year trend analysis of imipenem use in bone marrow transplant (BMT) patients was conducted at a 1000-bed tertiary care hospital. Broad-spectrum antibacterial drugs are routinely used to treat infections in the febrile neutropenic host. The antibacterial activity and acceptable tolerance profile of imipenem makes this agent a potentially useful addition to the traditional armamentarium which includes aminoglycosides, cephalosporins, and glycopeptides. Some authorities recommend imipenem as monotherapy in the treatment of fever of unknown origin in this select patient population. Eighty-three treatment courses (one treatment course per patient) were evaluated. The major indications for initiating therapy were fever of neutropenia (28%), suspected infection in the absence of fever (55%), and documented infection (17%). Imipenem was used as a first-line agent in 42% of patients, although imipenem monotherapy was not common. Concurrent antibacterials were usually vancomycin and tobramycin. Seventeen patients required modification of the initial regimen with vancomycin and/or tobramycin for additional coverage after an average of 8 days of imipenem therapy. Forty-eight bacterial isolates were obtained in cultures from 35 patients during the study, with gram-positive organisms predominating (in particular, staphylococci and streptococci). Pretherapy and superinfecting organisms were primarily gram-positive. Overall clinical success or improvement occurred in 42% of patients. Microbiologic outcome was indeterminate in 89% of patients, microbiologic eradication occurred in 1%, and superinfection occurred in 6%. Imipenem was relatively well tolerated. Rash and nausea/vomiting were reported most often; 29% of those patients who had adverse reactions discontinued therapy.

Acute non-haemorrhagic conjunctivitis due to coxsackievirus A24.

Two cases of acute non-haemorrhagic conjunctivitis due to coxsackievirus A24 (CA24) are described. These are the first Australian isolates. The presentation was as a severe conjunctivitis in otherwise healthy adults who had not travelled outside Australia. The course was of short duration and self-limiting with no long-term sequelae. The isolates could not be neutralised by antiserum prepared against prototype CA24 but were identified by immune electron microscopy and complement fixation.

Neutralization kinetic analysis of echovirus 30 and coxsackievirus B4 strains revealed little antigenic variation amongst the echovirus strains.

An antigenic analysis was made of echovirus 30 and coxsackievirus B4 isolates by determining neutralization rate constants in neutralization kinetic tests. The seven echovirus 30 isolates included the prototype strain and six others isolated in Melbourne, Australia, between 1959 and 1982. Little antigenic heterogeneity was observed in contrast to the evidence of antigenic variation recorded in similar tests on seven coxsackievirus B4 isolates. These isolates also included the prototype strain, as well as six others isolated in Melbourne between 1958 and 1973. The results obtained with the coxsackievirus B4 isolates were in keeping with those observed particularly with the polioviruses and also coxsackievirus B4 by other workers. Those obtained with the echovirus 30 isolates were unexpected, as this virus is also a member of the enterovirus group.