Australasian Medical Journal
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Pathogens and Public Swimming Pools
Get PDFSwimming pools are increasingly recognised as an important transmission route of cryptosporidiosis. Swimmers are infected through ingestion of waterborne faecal matter. The infective oocycts resulting from one Accidental Faecal Release (AFR) may be prolific. A swimmer swallowing just 10 ml of water would ingest an average of 200 oocysts, which is well above the dose capable of causing infection.
Clinical Presentation of “Rove Beetle Dermatitis”
Get PDFObjectives: This case series describes new clinical features of Rove beetle dermatitis Methods: Interviews were conducted with four students at University Sains Malaysia with current or past Rove beetle skin infections. Information on the onset of symptoms, complication, treatment and duration of symptoms were recorded. A physician at a local clinic was also interview to describe the challenges in diagnosis and therapy for this condition. Results: This case series describes new features of Rove beetle dermatitis. Redness, swelling, fatigue and localised stretching of the skin were the commonly reported symptoms. However, vibrations, twitching of the skin and difficulty in breathing were new features observed in this study. Three of the four patients were not aware of the aetiology of the condition, antibiotics and topical steroids were prescribed for the management and prevention of secondary infection. Conclusion: Rove beetle dermatitis is a common seasonal endemic in Malaysia, with a higher incidence in the month of September and March. This case series highlights the need for a health literacy program, aimed at informing the public and medical practitioners about the aetiology, symptoms and complications of this infection.
Designing Better Medicines Delivery
Get PDFBackgroundPrescribed medicines are delivered through a variety of routes to patients in the UK National Health Service (NHS) and are regulated by a host of health and trade related policy and law. These ensure the efficient and safe supply of medicines of appropriate quality from the pharmaceutical manufacturer through to the end-user, the patient. However, persisting medication errors and the recent discovery of counterfeit medicines in the bona fide supply chain have meant there are growing concerns about the timely, accurate and safe supply of medicines in the NHS. MethodsThis study undertakes a systems design approach to process modelling and understanding three key supply routes from the manufacturer through to the patient, across both primary and secondary care. A systems design approach was deployed to investigate complex interactions between professionals, products and processes to improve patient safety in collaboration with twenty five clinical and non-clinical stakeholders across the supply chain and six end-user patients. ResultsSeveral system process models were developed from the literature, field observations and alongside the interviewees. The results reveal that risk to medication safety is perceived as occurring most at the patient-end of the medicines supply chain: the pharmacy and the ward. There are differences observed in the responses of interviewees when they engage with system models. Conclusions This paper reflects on the use of a systems design, a mainly engineering approach, to understanding a health care domain problem of medication errors. The approach provided an enhanced insight into the complex set of system factors and interactions involved in generating medication errors. This study is among the first to develop a systems-wide view of the medicines supply process ‘as-is’ and identify opportunities for re-design to improve patient safety.
Comparative Healthcare: Diabetes Mellitus
Get PDFIn the third in this series of ‘comparative healthcare’ medical practitioners explore the approach to diabetes in Bangaldesh and Australia respectively. The social and medical consequences of this chronic condition are highlighted through the approach to patients at various stages of the disease from two national perspectives. An astonishing 7% of the 153 million people are reported to have diabetes in Bangladesh. Many remain undiagnosed. Delays in diagnosis or management of diabetes have life limiting consequences for those who can ill afford private health care in the poorer nation. Screening and early intervention appear to be denied to many in the developing country. The context is very different with Australians very fortunate to have a coordinated primary health care sector. The outlook for Bangladeshis with uncontrolled diabetes or with treatable sequela would be unacceptable in Australia. At every stage in the disease trajectory the doctors emphasise the importance of life style modification, a particular challenge in affluent Australia with its growing incidence of life style related pre morbid conditions in an increasingly sedentary population. A corner stone of the support of people with diabetes is the role of nurses and allied health professionals. With a funded commitment to multidisciplinary care in the community people with diabetes in Australia have access to support closer to home whereas those in Bangladesh remain heavily dependent on specialist, hospital based services. One can only speculate how Bangladesh will cope as its population ages and there are an ever increasing proportion of people who require urgent and expensive medical interventions. At the very least there is a strong case for greater investment in primary care especially to limit the economic consequences of diabetes and other chronic conditions. Finally as in other articles in this series we would like to emphasise that, the views expressed are those of the authors and do not necessarily reflect health policy or practice in their respective countries. Nonetheless we believe they offer a valuable perspective on common health care issues and commend the article to our readers
Comparative Healthcare: Mental Health
Get PDFAbstractIn the fourth in this series of ‘comparative healthcare’ medical practitioners explore the approach to mental illness in Bangladesh and the UK respectively. Differences and similarities in treatment regimens are illustrated with reference to patients with varying degrees of mental illness. Mental illness poses the greatest challenge in health care as national investment in services often reflects cultural attitudes and norms. While the authors describe very similar approaches to the diagnosis and management of severe psychotic illness there are striking differences in the availability of support services for people with substance abuse and those with relapsing conditions. The involvement and co-operation of the family is particularly important in Bangladesh where comprehensive access to mental health services is very limited. Private alcohol and drug detoxification centres are available although many are expensive and such treatment may effectively be denied to all but the wealthiest people. In the UK all people with serious and enduring mental illness are entered onto a register and therefore flagged for follow up at least once a year. General Practitioners, working within the nationally funded health service have been remunerated since 2003 for maintaining the register. In contrast in the absence of a case-management based psychiatric follow-up framework in Bangladesh, a general practitioner and treating psychiatrist would need to formulate a management plan involving recognition of clinical warning signs by the family. Indeed the co-operation and support of the patient’s family is of paramount importance in maintaining outpatient appointments when supporting people with mental health problems in Bangladesh. Finally we emphasise that the views expressed are those of the authors and do not necessarily reflect health policy or practice in their respective countries. Nonetheless we believe they offer a valuable perspective on mental health issues and commend the article to our readers
Management of Sepsis
Get PDFThis study aims to document the microbial profile and pattern of use of antibiotics in the government hospital of Penang state, Malaysia. A retrospective study was conducted in 2007 in the general medical ward of Hospital Pulau Pinang, Malaysia. The mortality rate was 54.22% with severe sepsis or septicemia. Mithicillin resistant staphylococcus aureus caused 37% of deaths, while 33% of deaths involved Klebsiella Spp. Commonly prescribed antibiotics included; cloxacillin 500mg (qid) 20%, tazocin 2gm (bid) 1.1%, and vancomycin 1gm (od) 27%. We report the use of high doses of antibiotics in the six months prior to a notable rise in resistant infections
