Australasian Medical Journal
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Rituximab Causing Posterior Reversible Encephalopathy Syndrome
No full textA 66-year-old woman presented with new onset generalised tonic-clonic seizures following her first dose of chemotherapy comprising Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisolone (R-CHOP) 10 days earlier for non-Hodgkin’s lymphoma. On admission, computed tomography (CT) scan of the cranium showed no abnormality. The CT was repeated within 48 hours as the patient developed status epilepticus and papilledema; the repeat scan showed characteristics of posterior reversible encephalopathy syndrome (PRES). Association of rituximab with this condition was suspected as there was no recurrence of PRES after receiving two more cycles of CHOP without rituximab. Contrary to previously published case reports, this patient had a delayed clinical presentatio
A Tool to Predict Surgical Outcomes
No full textBackgroundIncreased scrutiny and the need to institute a truly patient centered approach to surgical care has motivated the growing interest in measuring the quality of surgical care through comparative surgical audit. This study aimed to assess the validity of the POSSUM (Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) and P-POSSUM (Portsmouth-POSSUM) score in predicting the risk of morbidity and mortality respectively in general surgical patients presenting with conditions of various operative severities at a tertiary care centre in Haryana, a northern state of India.Method A prospective study was performed in 100 general surgical patients including an equal number of patients in each of the four groups of operative severity i.e. minor, moderate, major, major plus. The risks of mortality and morbidity were calculated by using the POSSUM equation for morbidity and the P-POSSUM equation for mortality in each patient. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.ResultsThe difference in p value of predicted risk of morbidity by POSSUM equation and observed morbidity; calculated by chi square test was 0.756 which was not statistically significant. The difference in p value of predicted mortality by P-POSSUM equation and observed mortality; calculated by chi square test was 0.472 which was also not statistically significant.ConclusionPOSSUM and P-POSSUM appear to be good and valid indices for use in the risk prediction of morbidity and mortality in the north Indian population
Prescription Writing at a Tertiary Hospital in India
No full textBackgroundPrescription is a written order from physician to pharmacist which contains name of drug, its dose and its method of dispensing and advice over consuming it. The frequency of drug prescription errors is high. Prescribing error contributes significantly towards adverse drug events. The present study was undertaken to understand the current prescription writing practices and to detect the common errors in them at a tertiary health care centre situated in a rural area of Western Maharashtra, India. Method A cross sectional study was conducted at a tertiary level hospital located at a rural area of Maharashtra state, India during October 2009-March 2010. 499 prescriptions coming to medical store during period of one month were considered for data analysis. Important information regarding the patient, doctor, drug and the general description of the prescription were obtained.ResultsAll the prescriptions were on the hospital pad. A significant number of the prescriptions (n=88, 17.6%) were written in illegible handwriting and not easily readable. The name, age and sex of the patient were mentioned is majority of the prescriptions. All the prescriptions (100%) failed to demonstrate the presence of address, height and weight of the patient. Only the brand name of the drugs was mentioned in all the prescriptions with none of them having the generic name. The strength, quantity and route of administration of the drug were found on 73.1%, 65.3% and 75.2% prescriptions.ConclusionThere are widespread errors in prescription writing by the doctors. Educational intervention programs and use of computer can substantially contribute in the lowering of such errors. A short course on prescription writing before the medical student enters the clinical field and strict monitoring by the administrative authorities may also help alleviate the problem
Lymphatic Filariasis and Mass Drug Administration
Get PDFBackgroundA third of world’s filariasis cases occur in India. As a result Mass Drug Administration (MDA) was commenced in 1997 with the aim of eliminating this disease by 2015. However the coverage of MDA was not satisfactory. The underlying reasons for the poor coverage need to be identified. This study was conducted to assess the awareness of health personnel of lymphatic filariasis and the MDA programme.Method This cross-sectional study was conducted in Kundapura taluk of Karnataka state in India during the 6th round of the MDA which was held between December 11 to 13, 2009. 78 health personnel who were posted for drug distribution were selected by convenience sampling. After obtaining informed consent health personnel were interviewed individually using a semi-structured questionnaire. Performance of health personnel was assessed according to points scored for their responses.ResultsThe mean age of all participants were 22.7± 8.9 years, 74(94.1%) were females and 58(74.4%) were nursing students. Only 17 (21.8%) participants had prior experience before taking part in this round of MDA. Only 4 (5.1%) participants achieved good scores while 45 (57.7%) got average scores. Performance scores were significantly better among paramedical workers (
Aetiology of Chronic Suppurative Otitis Media
No full textBackgroundChronic suppurative otitis media (CSOM) is assumed to be a complication of acute otitis media (AOM), but the risk factors for CSOM are not clear. Objectives 1. To study the aetiological organisms for CSOM. 2. To identify the effect of demographic factors on disease manifestation.Method This retrospective study included a case series of 234 patients who had been admitted to National Hospital of Sri Lanka (NHSL), with the complaint of ear discharge and from whom the specimens were sent for microscopy and culture at Department Of Microbiology, NHSL. The period of analysis was 1 year extending from 1 January 2009 to 31 December 2009.Consecutive patients who fulfilled the inclusion criteria were recruited to the retrospective analysis.ResultsAmong 234 patients studied, 129 (55.1%) were male and 150 (64.1%) were under 40 yrs old. The mean age was 39.5 yrs (range 12 to 60 yrs, SD = 22.6). The mean duration of ear discharge was 1.2 yrs. (range 6 weeks to 20 yrs.)Pseudomonas species (29.5%) was the commonest microbial organism to cause ear discharge, followed by staphylococcus (20.5%) and coliform (16.7%) species. Among the fungal agents identified, candida was the most common. 23.1% of the cultures did not reveal any microbiological agent. Eighteen patients (8%) had a prior history of trauma to affected ear and 51 patients (21.8%) were diagnosed with diabetes mellitus. ConclusionThe commonest microbial agent impicated in CSOM was pseudomonas species followed by staphylococci and coliforms. Demographic variables such as gender or age did not seem to affect the disease manifestation significantly, though CSOM was less common among older people and women
Cytology or Histopathology for Cervical Lymphadenopathy?
No full textBackgroundLymphadenopathies are the most common form of extrapulmonary tuberculosis and tuberculous lymphadenitis is the most common cause of peripheral lymphadenopathy in a developing country like Nepal. The objective of this study was to compare the findings of fine needle aspiration cytology to histopathology in diagnosing cervical lymphadenopathies.Method This is a prospective, longitudinal, comparative study was performed in the Department of ENT and Head and Neck Surgery, TU Teaching Hospital, Kathmandu between August 2007 and January 2009. Patients 13 years of age or older were included. There were 55 patients with cervical lymphadenopathies subjected to both fine needle aspiration cytology (FNAC) and histopathology (HPE). The sensitivity, specificity, false positive, false negative, positive predictive value and negative predictive value were calculated.ResultsOf 55 patients, 48 patients had lymphadenopathies of infective origin while 7 patients had metastatic disease. Majority of patients (n=20) were in age group 23-32 years and males outnumbered females. The sensitivity, specificity, false positive, false negative, positive predictive value and negative predictive value of FNAC of lymphadenopathies to diagnose tubercular lymphadenopathies were 80.0%, 100.0%, 0.0%, 20.0%, 100.0% and 82.14% respectively. Similarly, sensitivity, specificity of FNAC of lymphadenopathies to differentiate benign and malignant lesion were 100% each. False positive, false negative, positive predictive value and negative predictive value were 0.0%, 0.0%, 100.0% and 100.0% respectively. Overall correlation of FNAC and HPE was 90.9%.ConclusionFNAC can distinguish tubercular lymphadenitis from reactive and granulomatous lymphadenitis in majority of cases. Similarly, it can distinguish well between benign and malignant lymphadenopathies. It can be used as an initial investigation for routine screening of cervical lymphadenopathies where facilities of histopathology are not available
Role of Community Pharmacists in Asthma
Get PDFAsthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS), a comprehensive disease management model. There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management. Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care
The Tobacco Industry and Youth Smoking
Get PDF Background This paper provides a comprehensive account of how the tobacco industry, over time, has promoted its products to young people. Method A comprehensive search of tobacco industry documents relating to youth smoking was conducted using documents available on the World Wide Web through the Master Settlement Agreement. Results The documents provide evidence that the industry invested great time and resources in developing strategies to attract young people through Youth Smoking Prevention strategies (including education strategies) and marketing to youth. The results include information from published literature and direct excerpts from the tobacco industry documents. Conclusion The tobacco industry documents confirm that the tobacco industry has promoted and supported strategies that are ineffective in reducing smoking by youth, and opposed strategies that have proven to be effective. It is clear from the documents reviewed that the industry values the youth market and through a number of measures continues to promote its products to young people.
Resources Promoting the Regular Consumption of Seafood
No full textBackground General practitioners (GPs) are considered a trusted and reliable source of health-related information including nutritional advice. Preliminary investigation found that GPs wanted evidence-based nutrition resources that could be used within a 10 minute consultation. Aim The aim of the study was to identify and critically review current resources available to GPs that promote seafood consumption within a healthy diet, as a preventative or treatment measure for common lifestyle or medical conditions. Methods English language resources currently available to GPs in 2008 were sourced through multiple avenues including: individual organisations; medical service networks; health information services and internet search engines. Assessment included critical review of: format; appropriateness for target groups; reference to seafood and supporting evidence; credibility; readability; and suitability for use by practitioners in a short consultation. Results One hundred and twenty resources were identified. The majority (88.4%, n=106) of identified resource were available Electronically. Just over half (57.5%, n=69) of the resources were targeted at specific audiences. All of the resources made reference to the health benefits of regular consumption of fish (100%, n=120), 22.5% (n=27) made reference to seafood in general and 5% (n=6) made reference to fish oil. Only 15% (n=18) of the identified resources were suitable for use with the general Australian population at or below the recommended reading level of Year Eight. The majority (87.5%, n=105) of the identified resources were associated with credible sources of information about the health benefits of regular consumption of seafood. Conclusions This study found that the majority of resources available to GPs were not suitable for use with the general Australian population at the recommended reading level of Year 8 or lower. Whilst it is acknowledged that written health information alone cannot change health behaviours, it can provide accurate information to assist in making changes to behaviours with support from appropriate health care professionals.