Australasian Medical Journal
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The overcoming of the outdated idea of traditional dentistry as a necessary step towards the new generation of highly skilled dentists
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Pink urine syndrome
No full textIn the present images we allude to a syndrome of low incidence, characterized by pink urine, being related to factors such as obesity, and being triggered by abdominal surgeries, use of propofol, among others. Being favoured by the presence of abundant crystals of uric acid in the urine confers the typical pink coloration
Severe leptospirosis and secondary hemophagocytic syndrome: A rare case from Indian subcontinent
No full textHemophagocytic syndrome (HPS) is a rare clinicopathological condition resulting from dysregulation of the immune system. This unusual clinical syndrome is characterized by fever, cytopenia, liver dysfunction, increased ferritin level and hemophagocytosis of bone marrow. We report a case of a 40 year old male with severe leptospirosis and secondary hemophagocytosis who presented to us with high grade fever and jaundice and later was complicated by multi organ dysfunction and death despite aggressive management. Our case highlights leptospirosis as a rare cause of HPS. A high index of clinical suspicion and prompt treatment for HPS in patients with severe leptospirosis with progressive multi-organ dysfunction despite antimicrobial therapy, is very important as the condition otherwise carries a very high mortality
Design and implementation of pay-for-quality in primary healthcare
Get PDFBackgroundThe common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q) programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria.AimsThis study describes the design and implementation of a P4Q program in the primary healthcare (PHc) in East Azerbaijan Province, Iran.Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD), final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program.Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. 'Improvement' and 'absolute level of measures' were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences.ConclusionDesigning and implementing the P4Q program led to a shift in paying the incentives to healthcare providers from passiveness and subjective judgment to rational and quality based payment. Linking the incentive payment to individual, team, and organizational performance, the P4Q program will lead to an increased capacity of staff morale to improve teamwork and integrated health care
Foreign body ingestion in an adolescent – A case report and literature review
No full textForeign body ingestion (FBI) more commonly occurs in paediatric, psychiatric and intellectually impaired patients. Current guidelines primarily focus on paediatrics and adults with less emphasis on the adolescent population.We present a case of a 16-year-old male with autism spectrum disorder (ASD), who presented with generalised abdominal tenderness. Abdominal X-Ray showed a radio-opaque sharp object in the right upper quadrant. Subsequent CT revealed a needle-like object in the proximal small bowel. Clinically, his symptoms continued to worsen despite no radiographic evidence of complications. However, his symptoms markedly improved without intervention and he was managed conservatively. This patient subsequently passed a 5cm needle three days after presentation. This article discusses the challenges involved in managing and communicating with intellectually impaired patients who present with foreign body ingestion. Guidelines from the most recent literature on managing adolescents with foreign body ingestion, particularly sharp object ingestion, are also discussed
Estimated annual incomes of South African traditional healers as generated by their practices and sales of their pre-modern traditional health products for 2015/2016
No full textBackgroundIn South Africa, it is an accepted fact that the main role players in the manufacturing and selling of so called traditional medicine (TAM) are traditional healers. The Traditional Health Practitioners Act No 22 not only strengthened this perception in 2007 by giving statutory recognition to traditional healers as traditional health practitioners, but also with its various definitions as they are reflected in the Act.There is an estimation that South African research on traditional healing that TAM, specifically under the guardianship of the traditional healers, generates in excess of R2 billion (R2,000 million) annually. The idea also exists that the traditional healers offer a widespread indispensable medical service, specifically through their medical and health products, which contributes to a further R1 billion (R1,000 million) or more in income.AimsThe study aims to estimate the annual income generated by South African traditional healers in their practices and with the manufacturing, prescription and selling of their traditional health products for the period 2015/2016. Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the South African traditional healers’ estimated annual incomes as generated by their practices and the manufacturing, prescription and selling of their health and medical products for the period 2015/2016. The findings are offered in narrative form.Results Over the years, it seems that a misconception was established in South Africa about what traditional medicines really are and who the specific manufacturers and sellers are. There is no differentiation between the traditional medicines offered and marketed in the South African retail and commercial market, and those prepared by traditional healers. Some traditional medicines are available from well-established outlets like pharmacies, modern-day health-shops and allied-traditional healthcare professionals like the statutory recognised homeopaths, naturopaths, phytopaths and ethnopaths. These medicines have to adhere to a formal manufacturing and scientific foundation, while traditional healers rely on self-made, pre-modern and untested indigenous mixtures. This lack in differentiation and scientific foundation has clouded the true ownership of traditional health and medical products as viewed and understood under the definition Traditional African Medicines (TAM). This vagueness also obstructs the compilation of a profile of the incomes generated by the various role players in their practices and by manufacturing and selling of traditional medical and health products. The end result is a misrepresentation of sales statistics in South African literature on traditional healers and their self-made health products and untested mixtures.ConclusionThe present-day statistics cited in literature of annual incomes of between R2 billion (R2,000 million) and R3.4 billion (R3,400 million), roughly an average of R2.7 billion (R2,700 million), from the sales of traditional health products and mixtures by South African traditional healers, are false. What is more, South African literature generally reflects an erroneous classification of who the true manufacturers and sellers of traditional health and medical products are, and what “traditional medicines” really mean. This has led to an acceptance of South African traditional healers and their untested and risky health products and mixtures based on a misconception that they are the true manufacturers, sellers and owners of TAM.The most prominent role player in the manufacturing and selling of traditional medicines and the true income-generator seems to be the formal South African industry of complementary/-alternative medicines (CAM). This comprehensive, well-established and prominent medicines industry has been manufacturing and marketing South African traditional medicines for decades. They do this scientifically as a viable and sustainable enterprise. In comparison, there are the traditional healers’ unscientific practices and the medical products that they manufacture and sell outside of the formal healthcare sector. There is no sound foundation and substantiated evidence in the literature to confirm their primary role as manufacturers, developers and sellers of the modern-day South African traditional medical and health products. They fail the test as scientific, viable and sustainable role players in the field of South African traditional healing and TAM
The Traditional Health Practitioners Act No 22 (2007): A godsend or an act that spells doom for South Africa’s healthcare?
No full textBackgroundSouth Africa’s development and growth in healthcare since the 1900s is phenomenal, but certain present-day healthcare policies such as the Traditional Health Practitioners Act (Act No 22, 2007), could jeopardize it. AimsThe study aims to determine if the Traditional Health Practitioners Act No 22 is a godsend to the South African healthcare or if there is an indication of doom.Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the thinking and opinions around the contribution of the Traditional Health Practitioners Act No 22 of 2007 to the South African healthcare sector. The findings are offered in narrative form.Results It seems that the Traditional Health Practitioners Act No 22 (2007) was promulgated without comprehensive exploratory research and an in-depth consultation with all the role-players involved in South Africa’s healthcare, especially the already statutory registered health professionals.ConclusionPolitical influences played a strong part in the promulgation of the Traditional Health Practitioners Act in 2007. In 2017 it is still not fully operational and the indication is that it will take years for the traditional health practitioner to become a full member of the health sector, if ever. This health Act can cause serious long-term disturbances for the already established healthcare practitioners and the statutory healthcare sector
Ultrasound cervical length in predicting preterm birth
Get PDFBackgroundPreterm birth is a leading cause of perinatal morbidity and mortality and represents a major public health problem. It is associated with a 15–20 per cent mortality rate and remains responsible for 75 per cent of perinatal deaths in foetuses without anomalies.AimsThe aim of this study was to evaluate the importance of cervical length measured in the first trimester (11–14 Weeks of amenorrhea “WA”) and the second trimester (20–24 Weeks of amenorrhea” WA”) in an asymptomatic population of singleton pregnancies to assess the risk of spontaneous preterm birth compared to the digital assessment.Methods We conducted a prospective, longitudinal study involving 117 asymptomatic women with singleton pregnancies between January and December 2015.Results In our study, the clinical examination had a low positive predictive value and a low sensibility for screening women at risk of preterm delivery. Cervical length less than 35mm between 12–14WA and 30mm between 22–24WA predicts the occurrence of preterm birth with a high sensitivity (Se), and specificity (Sp).ConclusionWe conclude that ultrasound screening of preterm delivery is now highly recommended