Australasian Medical Journal
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What does an intern doctor actually do? A quantification of time on work activities
Get PDFBackgroundInterns, or first year junior doctors, have traditionally been used as an adaptable frontline solution to many of the changes in healthcare, utilising their broad skill sets for both direct patient care and administrative burdens. While there are studies that focus on the total hours junior doctors work, there are few that analyse the specific tasks they do and how they dedicate their work time.AimsWe aim to quantify the amount of time intern doctors spent on specific tasks during a shift. Methods This is a multi-centred, retrospective, self-reported study that was carried out in a public tertiary hospital network in Western Australia, comprising one tertiary, two metropolitan, and three regional hospitals. 68 individual shifts were reported, accounting for 605.72 hours. Participants reported time spent, in fifteen minute segments, on categories grossly defined as clerical tasks, clinical tasks, teaching, and personal time. Participants were also asked about their satisfaction with the amount of clinical exposure during the reported shift. Results Direct patient care accounted for 22 per cent of total shift time, indirect care 74 per cent, and personal time 4 per cent. Discharge summaries accounted for the most time-per-shift at 26 per cent, followed by medical note documentation at 14 per cent, with the least being teaching at 2 per cent. Direct patient contact by interns during a shift was on average 12 per cent (SD 14 per cent). 12 interns or 18 per cent of all responses reported no direct patient contact (0 per cent) during a shift. Interns working in emergency medicine spent 44 per cent of their shift on direct patient contact, significantly more compared to their medicine and surgical colleagues.ConclusionIndirect care activities consume almost three times as much time as direct care activities. Interns are mostly unsatisfied with their amount of clinical exposure per shift. The results concur with the current literature of increasing levels of clerical and administrative burden, and decreasing relevant clinical exposure in doctors’ work
Evaluating antimicrobial resistance patterns of the etiological agents of urinary tract infections
Get PDFBackgroundAntimicrobial resistance has been presented as a highly prevailing condition.AimsTo evaluate antimicrobial resistance patterns of the etiological agents of urinary tract infection among children in Saudi Arabia.Methods A retrospective population-based epidemiological study has been conducted at King Abdulaziz University Hospital, Saudi Arabia, from the year 2016–2017. It has recruited individuals with clinical diagnosis of urinary tract infection, particularly.Results The study has recruited 63 participants on the basis of inclusion criteria. Among these, majority were males with the prevalence of 54 per cent (n=34); while females were 46 per cent (n=29). Most of the participants were under the age of two years with the prevalence of 50.8 per cent (n=32), then children of 2 years with 34.9 per cent (n=22); and older than two years with 14.3 per cent (n=9). Resistance to ampicillin was observed in 12.7 per cent cases; resistance to ciprofloxacin was observed in 1.6 per cent; resistance to cotrimoxazole was witnessed in 3.2 per cent; and multidrug resistance was observed in 30.2 per cent of the patients.ConclusionClinical management of urinary tract infections is a challenge that mainly presents antimicrobial resistance as the point of concern
Effect of self-assessment training in preclinical endodontic courses on the clinical performance of undergraduate dental students
Get PDFBackgroundRoot canal treatment (RCT) of molar teeth is very challenging to undergraduate dental students. Well-structured self-assessment was shown to be the key for improving quality of dental education so that graduates could be properly prepared to act independently in dental practice.AimsTo observe the effect of rubric self-assessment teaching during the preclinical stage on the performance of undergraduate students in treating patients’ molars. Methods An improved rubric was introduced to the endodontic preclinical stage through which 128 students were trained on self-assessing their practical work over an entire year (Group A). While 149 students (Group B) were taught without self-assessment. The following year, during the clinical stage, both groups were asked to treat single rooted teeth only, after they finish at least ten teeth, students who feel confident enough were allowed to do simple molar cases. The effect of new system on the ability of undergraduate students to perform root canal treatment on patients’ molars was studied.Results All students taught on self-assessment where able to perform RCT on patients’ on molars before graduation (100 per cent) in comparison to 73.83 per cent for the students of the previous groups. There was statistically significant difference for the average number of molars treated per student: 6.06 for Group A in comparison to 3.00 for Group B. All analysis was performed with 0.05 level of set significance using the statistical software SPSS 16.0 for Windows.ConclusionWhen cases are properly selected, ttechnical part of root canal treatment must not be time consuming if the student is properly trained on how to assess his own work
Differentiating case-based learning from problem-based learning after a two-day introductory workshop on case-based learning
Get PDFBackgroundConsiderable overlap exists between case-based learning (CBL) and problem-based learning (PBL) and differentiating between the two can be difficult for a lot of the academicians.AimsThis study gauged the ability of members of medical school, familiar with a problem-based learning (PBL) curriculum, to differentiate between case-based learning (CBL) and PBL after a two-day workshop on CBL.MethodsA questionnaire was distributed to all participants, attending the introductory course on CBL. It was designed to document the basic characteristics of the respondents, their preference for either CBL or PBL, their ability to recognize differences between CBL and PBL, and their overall perception of the course.ResultsOf the total workshop participants, 80.5 per cent returned the completed questionnaire. The mean age of the respondents was 44.12±12.31 years and women made up a slight majority. Majority favoured CBL over PBL and felt it was more clinical, emphasizes on self-directed learning, provides more opportunities for learning, permits in-depth exploration of cases, has structured environment and encourages the use of all learning resources. On the respondents’ ability to discriminate CBL from PBL, a weighted score of 39.9 per cent indicated a failure on the part of the respondents to correctly identify differences between CBL and PBL. Less than half opined that CBL was a worthwhile progression from PBL and about third would recommend CBL over PBL.ConclusionIt seems that majority of the respondents failed to adequately differentiate between CBL and PBL and didn’t favour CBL over PBL
Anaphylaxis to Moringa oleifera: First description
Get PDFWe describe the first reported case of repeated anaphylaxis after ingestion of Moringa oleifera, causing significant hypotension, angioedema and elevation of serum tryptase. Moringa oleifera seedpod was confirmed as the causative allergen by skin testing with the fresh pod. Moringa oleifera is widely consumed, both as a vegetable and in herbal medicines
Successful haemofiltration therapy in severe phenobarbital overdose
Get PDFIn the 19th century, barbiturates were first-line treatment as hypnotic and anticonvulsants, then gradually replaced by agents with a safer clinical profile. However, its ongoing use in Australian veterinary medicine and steadfast prescriptions in developing countries/our migrant population, still contributes to overdoses.We present a case of a middle-aged man with a life-threatening phenobarbital overdose. Haemofiltration was trialled, causing a rapid fall in phenobarbital levels and a speedy recovery. Through a review of the literature, treatment options of barbiturate overdose presentations will be discussed. It is imperative clinicians are aware of barbiturate’s mechanism and its enhanced elimination through extracorporeal treatment
The use of traditional medicines to lower blood pressure: A survey in rural areas in Yogyakarta
Get PDFBackgroundDespite common usage of traditional medicines in rural populations, information about their use along with anti-hypertensive medications is limited.AimsTo quantify the use of traditional medicines and to identify factors associated with their use among people with hypertension in a low-resource setting in Indonesia.Methods Data were collected using a researcher-administered questionnaire from people with hypertension in rural villages in Yogyakarta, Indonesia.Results Two hundred sixty-three of 384 participants (68.5 per cent) used traditional medicines to help lower their blood pressure; about half (n=134) used only traditional medicines, and the other half (n=129) also took anti-hypertensive medications. Seventy-four participants (19.2 per cent) took only anti-hypertensive medications, and 47 (12.2 per cent) used neither traditional medicines nor anti-hypertensive medications. Herbal medicines were the most frequent products used, mainly herbs and herbal materials, which were obtained from traditional markets (n=169, 44 per cent), family members (n=100, 26 per cent) or their own garden (n=88, 23 per cent). The use of traditional medicines was not associated with any specific sociodemographic variables. However, among traditional medicines users, participants with a lower level of formal education were twice as likely to not take anti-hypertensive medications compared with those with a higher level of education.ConclusionTo treat their hypertension, these rural villagers used traditional medicines more often than anti-hypertensive medications. Health professionals in rural areas should be aware of how the use of traditional medicine might affect hypertension management
General medical practitioners’ knowledge and management of oral and dental problems
Get PDFBackgroundMany patients with oral and dental problems seek help from medical practitioners rather than from dentists. Little is known about why this occurs in Australia and how medical practitioners manage these problems.AimsThe aims were to: 1) provide insight into why patients seek treatment for oral and dental problems from medical practitioners, 2) assess how these patients were managed by medical practitioners, and 3) assess medical practitioners’ perception of their knowledge of oral and dental problems.Methods An electronically distributed survey was completed by general medical practitioners who were members of the Australian Medical Association in Western Australia. The survey had 19 questions with a combination of both quantitative and qualitative responses. All responses were anonymous.Results From 130 responses, the most common reasons for patients to present with dental-related issues to general medical practitioners included: cost of dental consults, perceived need for antibiotics, ease of access and immediate relief of pain. Respondents reported that 68 per cent of presentations were during typical business hours. Antibiotic (83 per cent) and analgesic (91 per cent) prescriptions followed by referral to dentists (76 per cent) were the most frequently reported managements. About half the respondents felt their knowledge of oral and dental problems was adequate while 35 per cent felt it was inadequate and 16 per cent felt it was deficient in some areas.ConclusionPatients present to medical practitioners mainly for pain relief or antibiotic prescription. Most practitioners manage these cases with antibiotic and analgesic prescriptions. Practitioners’ knowledge of dental-related problems varies with about half feeling it could be improved
Modification of intubation techniques during ERCP in patients with Zenker’s diverticulum
Get PDFPerforming endoscopic retrograde cholangiopancreatography (ERCP) in patients with Zenker’s diverticulum can be technically difficult and is associated with the risk of oesophageal perforation with subsequent mediastinitis. Therefore, resistance is felt during oesophageal intubation with a duodenoscope, the operator should use a gastroscope to visualize any obstruction. If the existence of an oesophageal pouch is recognised, intubation can be safely performed using a guide-wire over tube technique. However, in specific situations (e.g., narrow oesophageal orifices in patients with low body mass index (BMI)) despite use of guide-wire technique, intubation can still be difficult. Therefore we present a modified guide-wire technique involving rotation of the duodenoscope under fluoroscopy, which opens the entrance to the oesophagus and enables safe intubation
Does compulsory vaccination limit personal freedom? Ethical issues
Get PDFBackgroundDespite vaccinations are scientifically proven to be safe and effective public controversies limit their application in many countries.AimsAim of this review is to provide an overview of biological effects of vaccination and a picture of the ethical dilemmas about compulsory vaccination.Methods We conducted a review on the literature about the subject. Recent news were also included.Results Vaccines are the best weapon against many infectious diseases. The spread of false beliefs among people have led the government authorities to increase compulsory vaccination in order to embank new outbreaks of preventable infectious diseases.ConclusionEven if compulsory is quite drastic approach it could be the on only way to reach an adequate coverage and protect immunoexpressed subjects