Australasian Medical Journal
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Thalidomide for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy
No full textBackgroundAntiemetic guidelines recommend co-administration of agents to maximize the prevention of chemotherapy-induced nausea and vomiting (CINV), however, the control of delayed CINV is still not satisfactory. The purpose of this study was to evaluate the effectiveness and safety of thalidomide in the prevention of CINV.Methods Of 89 patients enrolled, 83 chemotherapy-naïve patients receiving highly emetogenic chemotherapy (cisplatin 70mg/m2) were randomized into two groups: standard therapy group (ondansetron on day 1, metoclopramide and dexamethasone on days one to five) and thalidomide group (in addition to standard emesis prevention, patients received oral 100mg thalidomide on days one to five). Patients recorded nausea and vomiting episodes in a diary. The primary end point was the efficacy of thalidomide in controlling vomiting and nausea on days one to five post cisplatin, and the secondary end point was the safety of the thalidomide. Results No significant differences of complete response rates (no emesis, no use of rescue therapy and no nausea) were observed between the two groups, while the percentages of patients with complete response of delayed vomiting on day four and day five were higher in the thalidomide group, furthermore, the complete response rate of delayed nausea for thalidomide group and standard therapy group showed significant differences. Thalidomide group showed a similar safety profile as standard emesis prevention group.ConclusionAddition of thalidomide was generally well tolerated and improved prevention of CINV in patients receiving cisplatin-based chemotherapy to some degree, especially for delayed nausea
Australian general practitioners’ current practice for chronic kidney disease (CKD) detection and management
No full textBackgroundGuidelines for early detection of chronic kidney disease (CKD) emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care.AimsAssess Australian general practitioners’ (GP) current practice in relation to CKD detection and management.Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent.Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR), blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent) and ‘glycaemic control if diabetes present’ (64 per cent). Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003).ConclusionThe results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas
Socio-economic and Socio-demographic Determinants of BNP values in children with Pneumonia In Benin City
No full textBackgroundThe level of BNP is usually used as a guide to heart failure. However, there is need for the level of this peptide to be known in non-cardiac conditions that may cause inflammation and hypoxia.AimsTo determine socio-demographic determinants of BNP in children with pneumonia. To determine the socio-economic determinants of BNP in children with pneumonia.Methods Over a year, consecutive children diagnosed radiologically with pneumonia were evaluated echocardiographically for CHD. Also, children with heart failure were excluded. Inclusion criteria included all those children with ongoing pneumonia without any evidence of any other co-morbidity whether acute or chronic. Biodata and sociodemographic variables of children with pneumonia that met the inclusion criteria were collected and studied. Results Of the 50 subjects recruited for the study, 26 (52 per cent) were males. The mean age for males 14.27±13.33, females 12.03±11.83, mean height for males 74.00±3.46 and 72.00±0.00 for females, the mean weight range from 8.30±1.87 and 7.08±3.40 for males and females respectively. The mean BNP value for all subjects was 459.55±422.61, of which males had a mean value of 500.33±.399.93 and females 415.38±450.25 with a p value of 0.483. The mean brain natriuretic factor for weight range 1–5.9kg was 203.83±116.04 that of 6–10.9kg was 645.22±314.26, while that of 11–15.9kg was the lowest with 115.85±72.46.ConclusionApart from congenital heart disease and several other morbidities both chronic and acute, sociodemographic characteristics of the patient and some clinical features may also affect BNP levels in the blood. Patients with pneumonia had higher mean values of BNP when compared with normal cut-off
Assessing the knowledge and attitudes of group of mothers living in Saudi Arabia with regards to their children’s oral health
Get PDFBackgroundThe knowledge of mothers with respect to health can affect their children’s health either directly by promoting health practices or indirectly by influencing the health-related attitudes and behaviours of children.AimsThe aim of this study was to assess the knowledge and attitude of a group of mothers living in Saudi Arabia with regard to their children’s oral health.Methods This cross-sectional study involved 614 mothers living across Saudi Arabia. An electronic web-based questionnaire was developed and distributed among the participants using different social media outlets.Results Almost 80 per cent of study participants were knowledgeable regarding their child’s primary and permanent teeth’s eruption time and agreed that their child’s primary teeth were as important as the permanent teeth. The results also indicated that 79 per cent of the participants were aware that bottle feeding during sleep causes tooth decay and 73.7 per cent knew that the frequency of sugar consumption has a greater impact on oral health than the quantity of sugar consumed. Almost all participants (97 per cent) reported that they watch and help their children to brush their teeth. More than half (55.8 per cent) of them reported that they take their children for their first dental check-up when the children are one-year old, and almost three-quarters (73 per cent) reported they take their children to regular dental check-ups.ConclusionMost mothers had a positive attitude toward their children’s oral health and were reasonably knowledgeable about it; however, further health education is required among some groups and in some aspects particularly those concerning oral and systemic health
Comparison of dietetics service delivery (demand and determinants) within two Australian Medical Assessment and Planning Units
No full textAimsAssessment and Planning Units have increased globally however, models of care literature is limited. With high malnutrition prevalence amongst ageing populations, this case report identifies demands for dietetic services. Methods Descriptive data compared and contrasted two service including medical models, eligibility criteria, malnutrition screening, dietetic services, clinical follow-up, and team composition.Results High malnutrition prevalence (17 per cent, 31 per cent) was evident with different screening approaches successfully implemented. Both units favoured rapid assessment and intervention. ConclusionDietetic expertise was required for malnutrition assessment, and ongoing management in acute or community setting as determined by differing health-care system arrangements
The present and future roles of Traditional Health Practitioners within the formal healthcare sector of South Africa, as guided by the Traditional Health Practitioners Act No 22 (2007)
No full textBackgroundThe promulgation of the Traditional Health Practitioners Act No 22 (2007) was seen as the long awaited start-up of the traditional healing profession in South Africa. Act No 22 (2007) was strongly politically driven from the late 1960s onward. Many of these political motivators were based upon outdated cultural ideas, customs and traditions, rooted outside the modern day healthcare needs and demands of the particular population that traditional healing intends to serve.An in-depth needs and skills analysis, to test the viability and sustainability of the South African traditional healers as well as their positions and roles as health practitioners inside the formal healthcare sector, as guided and stipulated by the Traditional Health Practitioners Act No 22 (2007), was lacking in this early development and start-up process. This resulted in the traditional healers’ present and future roles as specific healthcare practitioners being both undefined and insufficiently formulated. In addition their existing education, training, skills and abilities to compete in the formal healthcare sector were ignored. Therefore, since the promulgation of the Act in 2007, there was limited professional-development for traditional healers, to improve their immediate professionalism and thus to promote effective role-playing and management in the formal healthcare sector. The South African traditional healing professional model is still in the foundational stage of its professional development; a stage which the other registered/regulated healthcare practitioners of the country surpassed long ago, making them well-equipped for role-playing and management as health professionals in the formal healthcare sector. The whole venture of the statutory recognition of the traditional health practitioners in 2007 as new healthcare professionals with the promulgation of the Traditional Health Practitioners Act No 22 (2007) seems to increasingly be a failure. There is thus a definite need to establish how the South African traditional healers are equipped to compete independently in the healthcare sector. If this is not possible, what alternatives are available to steer some of them into the country’s healthcare sector and still make them useful as health practitioners. Coupled to this need is the future status and role of the Traditional Health Practitioners Act No 22 (2007), to uphold the roles of traditional healers. AimsThe study aims to determine the present and future roles of the traditional health practitioner in the South African formal healthcare sector, as guided by the Traditional Health Practitioners Act No 22 (2007).Methods This is an exploratory and descriptive study that makes use of a historical approach by means of investigation and a literature review. The emphasis is upon using current documentation such as articles, books and newspapers as primary sources to reflect upon the present and future roles of traditional health practitioners within the regulated healthcare sector of South Africa, as guided by the Traditional Health Practitioners Act No 22 (2007). The findings are offered in narrative form. Results It seems as though the professional position and foundation of the Traditional Health Practitioners Act No 22 (2007) is on a level that is meant for the governing of a healthcare group with a well-established learning and management infrastructure. This is an unfortunate situation wherein the incoming traditional healer unfortunately cannot meet the requirements at the moment. Various negative factors have affected the South African traditional healers’ development and position. These include early political out-casting and discrimination from training facilities and work opportunities in the healthcare sector under White Rule, while poor organization, strategy and future planning and a lack of self-promotion by traditional healers themselves regarding their positions and roles over the years, seem also to have contributed negatively to the situation. The immediate impact is that this predisposition unfortunately places the traditional health practitioners in situations wherein they cannot always take specific roles at present or in the future as healers in the South African healthcare sector, as intended and guided by the Traditional Health Practitioners Act No 22 of 2007.ConclusionTo expect the South African traditional health practitioners to function at present and in future fully within the intentions of the Traditional Health Practitioners Act No 22 (2007), executing certain roles as independent health practitioners in the formal healthcare sector, seems to a great extent impossible. Wherever they are successfully placed in the healthcare sector, their positions and roles seem to be limited. Furthermore, the traditional healers’ places in the formal healthcare sector were already taken by the allied health professions, by such practitioners as homeopaths, naturopaths and ethno-therapists, etc. Thus they are obliged to compete with the already established nursing practitioners, psychiatrists and psychologists, as well as medical doctors, all established in clearly defined and functioning roles. These work inclinations and reservations further minimize their roles dramatically in the formal healthcare sector.To consider the future of the Traditional Health Practitioners Act No 22 (2007) and its two outcomes, namely the Traditional Health Practitioners Council as well as the traditional health practitioner, there are at present three urgent issues. The prominent question is: can the Traditional Health Practitioners Act No 22 (2007) continue in its present form or must it be recalled? In its present manifestation the Act and the traditional healers seem to be ineffective and aimless.It is time to consider alternatives to assure the continuation of the traditional healers as practitioners in the South African healthcare sector. The most obvious and practical one is to accommodate some of the traditional healers, where applicable and possible, in some of the various already established professional Health Councils as healthcare professionals
Healthcare Disparities in the Perioperative Setting: An Analysis of the National Anaesthesia Clinical Outcomes Registry
No full textBackgroundThere are numerous studies which indicate healthcare disparities exist in the United States. AimsThis study aims to investigate healthcare disparities in perioperative setting.Methods The National Anaesthesia Clinical Outcomes Registry (NACOR) was analysed for the impact of socioeconomic status and gender on perioperative adverse outcomes in elective, non-obstetrical cases. Socioeconomic status was initially divided into six income groups using Thompson & Hickey class modifications and subsequently classified into three income group classification (lower, middle, and upper). Three adverse outcomes were studied: intraoperative cardiac arrest, unplanned ICU admissions, and mortality.Results A total of 1,800,506 non-emergency, non-obstetrical cases in NACOR documented the presence or absence of an adverse outcome. In these cases, 43.42 per cent were males and 56.58 per cent were females. The incidences of adverse outcomes per 10,000 were 8.64 for unplanned ICU admissions, 7.86 for intraoperative cardiac arrest not leading to death and 2.37 for intraoperative cardiac arrest leading to death. Patients in the upper socioeconomic group had significantly fewer adverse outcomes than patients in lower group for unplanned ICU admissions (OR 0.41, 95 per cent CI 0.28-0.59), cardiac arrest not leading to death (OR 0.21; 95 per cent CI 0.13–0.33), and cardiac arrest leading to death (OR 0.41 95 per cent CI 0.21–0.79). The lower class group was found to have more intraoperative cardiac arrests not leading to death than the middle class group. There was no statistical significance between the lower and middle income groups when analysing unplanned ICU admissions and mortality.ConclusionOur study has found that healthcare disparities do exist in the perioperative setting
The dietary iron intake and iron status of female university students in Saudi Arabia
No full textBackgroundNo prior research in Saudi Arabia has examined dietary iron intake and its association with iron status in young women. AimsThis study therefore explored the iron intake, dietary iron sources and iron status of female Saudi university students in Tabuk, Saudi Arabia.Methods A cross-sectional study of dietary consumption and iron status used a sample of 200 apparently healthy female students (19–25 years old) on the university campus from February to June 2016.Results Covariance analyses showed that the prevalence of iron deficiency (ferritin < 15ng/ml) and iron deficiency anaemia (ferritin < 15ng/ml with haemoglobin < 12g/dl) were 50.0 per cent and 12.5 per cent respectively. The three groups’ (normal levels of iron; iron deficiency; and iron deficiency anaemia) mean iron intakes fell below recommendations, and the iron deficiency anaemia group’s intake was lowest. Different food groups’ proportional contributions to total iron intakes varied across the groups, with the iron deficiency anaemia group recording a lower mean consumption of meat-derived foods and a higher mean consumption of plant-derived foods than the other two groups. All three had lower Vitamin C consumption than recommended.ConclusionWomen of childbearing age face a higher iron deficiency risk, so there is a need to encourage dietary routes for treating or avoiding iron deficiency by increasing iron intake (particularly heme iron) and iron absorption enhancers such as vitamin C, and decreasing consumption of iron absorption inhibitors, e.g., phytate
Amelioration of quality of life and lung function of chronic obstructive pulmonary disease by pranic healing as adjuvant therapy
Get PDFAimsTo study the effects of Pranic Healing (PH), as a complementary therapy to improve lung function, physiological condition and quality of life of Chronic Obstructive Pulmonary Disease (COPD) patients.MethodsRandomised, double-blind, placebo-controlled, pilot study. 21 males with a mean age of 61.6 years and COPD stage II were randomly allocated to PH and control groups. The PH group received PH sessions thrice weekly during the study. The control group received Sham PH. Data was collected during baseline and four scheduled visits of the participants during six months. The primary outcome of the study was to access the reduction in COPD symptoms and to increase participation in physical and social activities by evaluating Spirometry, St George’s Respiratory Questionnaire (SGRQ), 6 Minute Walk Test (6MWT) and Hamilton Rating Scale for Depression (HRSD).ResultsSignificant improvement for PH group in Forced Expiratory Volume in the first second (p=0.02), SGRQ domains of Activity (p=0.006), Impact (p=0.002), Total (p=0.000), and non-significant change in Symptom domain (p=0.44). PH group showed a positive tendency in 6 MWT and HRSD scores with insignificant difference between the groups. No serious adverse events occurred during the study.ConclusionPH as an adjunct to conventional treatment can improve lung function and quality of life of COPD subjects
The relationship between Computed Tomography and DXA results: A potential bias in Bone Mineral Density assessment
No full textBackgroundIt has been reported that the results of the lumbar spine bone mineral density assessment can be strongly biased by degenerative changes. However, the reported data remains controversial and a potential bias has not been assessed.Aims To evaluate the relationships between the results of DXA and CT with the assessment of potential bias related to the influence of different structures.Methods This is a cross-sectional study and 25 patients were enrolled. Using DXA scan, Bone Mineral density (BMD) (g/cm2) was calculated from 100 vertebra from the lumbar spine. Out of all the CT measurements, a mean radiodensity in HU (Hounsfield Units) for cancellous bone and total vertebra body, a mean square and radiodensity of vertebra pedicles and facet were calculated. Results Linear regression analysis demonstrated a strong correlation between BMD measured by DXA and CT data. Multiple correlation coefficient of model accounts for 0.8093, r2=0.6550, p < 0.0001. Parameters that have significant relationships with the results of DXA were: a product of facet joints radiodensity and mean square on axial images (B= 0.000003379, p < 0.0001) and total vertebral body radiodensity B=0.0016395253, p=0.0201. Beta coefficients for those variables accounted for 0.6729 and 0.3037 respectively.ConclusionThe results of the bone mineral density assessment of the lumbar spine using DXA, can be strongly influenced by facet joints condition, especially in cases of degenerative changes. The results of BMD, provided by DXA, are partly relevant to vertebral body bone quality assessment and irrelevant to the characteristics of bone in pedicles. This means that the prognostic value of the DXA measurement results might be limited in relation to predicting low energy vertebra fracture and implant stability