Vascular Malformation of Hypothalamus: A Cause of Isolated Growth Hormone Deficiency

The etiology of pituitary dwarfism is varied.1 The majority of cases are idiopathic (with an observed increase in history of birth trauma), and approximately one third are associated with radiologic changes of craniopharyngioma or pituitary tumor. A number are associated with midline embryonal defects, histiocytosis, basilar meningitis, and sarcoidosis. An increasingly reported cause is craniospinal irradiation for oncologic disease. An unusual, and previously unreported, cause is described. CASE REPORT A male child, born Aug 8, 1961, was investigated at the Royal Adelaide Hospital for shortness of stature. He was the second of four siblings; gestation and delivery were normal with a birth weight of 2.6 kg.</jats:p

Disparities in acute in-hospital cardiovascular care for Aboriginal and non-Aboriginal South Australians

Objectives: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non-Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences. Design: Analysis of administrative data with logistic regression modelling to assess the relationship between Aboriginal status and the decision to undertake diagnostic angiography. A detailed medical record review of Aboriginal admissions was subsequently undertaken. Setting: Emergency ACS admissions to SA cardiac catheterisation hospitals, 2007-2012. Participants: 13 701 admissions of patients with an ACS, including 274 Aboriginal patients (2.1%) Major outcome measures: .Rates of coronary angiography and revascularisation; documentation of justification for non-invasive management. Results: After adjustment for age, comorbidities and remoteness, Aboriginal patients presenting with an ACS were significantly less likely than non-Aboriginal patients to undergo angiography (odds ratio [OR], 0.4; 95% CI, 0.3-0.5; P < 0.001). There was no significant difference in the rates of revascularisation for Aboriginal and non-Aboriginal patients who had undergone angiography. Reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non-cardiac (16%), non-invasive test performed (8%), and discharge against medical advice (11%); the reasons were unclear for 36% of Aboriginal patients. Conclusions: After controlling for age and other factors, the rate of coronary angiography was lower among Aboriginal patients with an ACS in SA. The reasons for this disparity are complex, including patient-related factors and their preferences, as well as the appropriateness of the intervention. Improved consideration of the hospital experience of Aboriginal patients must be a priority for reducing health care disparities.Rosanna Tavella, Katharine McBride, Wendy Keech, Janet Kelly, Amanda Rischbieth, Christopher Zeitz, John F Beltrame, Philip A Tideman, Alex Brow

Enrollment of intensive care unit patients into clinical studies: A trinational survey of researchers' experiences, beliefs, and practices

BackgroundAs critical care practice increases in scope, size, and complexity, enrollment of critically ill patients into clinical studies is increasing.ObjectiveTo understand the experiences, beliefs, and practices of the Canadian Critical Care Trials Group and Australian and New Zealand Intensive Care Society Clinical Trials Group regarding enrollment of critically ill children and adults into clinical studies.MethodsSurvey items generated by the research team were formatted in four domains: experiences, beliefs, practices, and demographics. Five research coordinators and five physicians pretested the survey, providing feedback on clarity and completeness. Intrarater reliability (16 participants, 2 wks apart) was very good.ResultsThe response rate was 284 of 322 (88.2%). Respondents worked in intensive care units with a mean of 20.5 (SD 10) beds, caring for adults (72.2%), pediatric (18.8%), and both groups (9%) of critically ill patients. Clinical research was considered key to the future of improved clinical care. To enhance recruitment efficiency, respondents widely endorsed the effectiveness of increasing participating centers, after-hours, and weekend enrollment (all 3 scores 7 [6-7[sqb], reflecting median [interquartile range] on 1-7 scale). Overall, the effectiveness (6 [4-7]), feasibility (5 [4-6]) and ethics (5 [4-7]) of coenrollment into more than one randomized trial was endorsed. Half of respondents have adopted coenrollment with scientific and psychosocial provisos. Alternative designs, such as factorial and cluster randomized trials, were considered when suitable. Modifications to consent approaches (deferred consent (7 [6-7]), waived consent (7 [6-7]), or consent from two physicians in the absence of a substitute decision maker (6 [5-7])) were considered effective, but beliefs about the feasibility and ethics of some of these approaches varied.ConclusionsClinical research is highly valued by these intensive care unit communities. Strategies to increase capacity involve enhancing recruitment efficiencies, considering alternative study designs and expanding consent procedures. Thoughtfully implementing these strategies may advance the care of critically ill adults and children.Deborah J. Cook, David Blythe, Amanda Rischbieth, Paul C. Hebert, Nicole Zytaruk, Kusum Menon, Simon Erikson, Robert Fowler, Diane Heels-Ansdell, Maureen O. Mead