Australasian Medical Journal
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The importance of American College of Radiologists’ (ACR) compliance with respect to imaging and intervention protocol for reducing in-hospital mortality rate due to the aortic aneurysm
No full textBackgroundThere is no direct evidence from the available literature on whether aneurysm mortality rates in hospitals decreases if they comply with American College of Radiologists’ (ACR) guidelines on diagnostic imaging and treatment interventions. This study investigated on the possibility of increasing ACR compliance levels progressively reducing in-hospital mortality rates of aneurysm patients.AimsThe study was aimed at examining whether the mortality rates of aortic aneurysm patients in hospital decrease if the hospitals comply with ACR guidelines on diagnostic imaging and treatment interventions. The second aim was to test the assumption that increasing compliance levels will progressively decrease the in-hospital mortality rate.Methods Data on 36,104 net samples of patients collected from NIS data covering 47 US hospitals based on ICD-9 classification were collected for the period of 2008–2012. The collected data were analysed for effect of ACR compliance of imaging methods and a modified ACR appropriateness rating on mortality rates of six major types of aortic aneurysm patients. Pearson’s Chi-Square test, Gamma Correlation test and Logistic Regression test were done using the latest version of SPSS software. A predictive probabilistic equation for odds relationship of ACR compliance with mortality rate was also developed.Results A large majority of US hospitals did not fully or partially comply with ACR guidelines. Clear evidence of increasing compliance level with ACR guidelines on both imaging methods and appropriateness rating on reduction of in-hospital mortality rates were obtained. There was negative relationship between compliance level and mortality rate. The relationship was linear and not affected by other predictors. This negative relationship reflected in the predictive equation. Therefore there is a strong case for hospitals implementing full compliance with ACR guidelines.ConclusionThe overall conclusion is that there is negative relationship between ACR compliance level and in-hospital mortality rate of aortic aneurysm patients. Increasing levels of ACR compliance progressively decreased in-hospital mortality rates, although this relationship may not be cause-effect relationship. Policies for implementing full ACR compliance by hospitals may reduce in-hospital mortality rate of aneurysm patients significantly
Dental patients’ knowledge, awareness, and attitude regarding infection control procedures
Get PDFBackgroundAssessing patients’ opinion about policies against cross infection in the dental office is of significance. Since it has been shown to enhance compliance and motivation among patients and healthcare workers.AimsThis study was designed to investigate patients’ awareness, attitude and knowledge of infection control practice and the effect of demographic data on these measures.Methods A cross-sectional survey of 302 patients attending outpatient dental clinics to determine knowledge, attitudes, and awareness regarding infection control procedures. Questionnaire was designed and distributed in local Language.Results Our study revealed reasonable knowledge and awareness of PPE use and its rationale. Visual assurance was central aspect of patient perception of infection control. Knowledge was affected by several sociodemographic characteristics.ConclusionEven though the sample reflected a reasonable level of awareness and knowledge about infection control in dental clinics, and the possible paths of disease transmission, more knowledge is to be disseminated especially concerning Transmissible diseases
Comparison of the effectiveness of femoral fixation techniques (Aperfix and Endobutton) in anterior cruciate ligament surgery
Get PDFBackgroundAnterior cruciate ligament (ACL) is a Strengthener ligament of the knee. About 50 persons per 100,000 annually counter ACL rupture. Based on studies, the majority of people who have high mobility jobs, and had reconstruction surgery after ACL rupture, have returned to pre-injury level of activity.AimsWe compared two methods of surgery (aperfix and endobutton) in this article. We want to answer these two main questions in this study:1 is the effectiveness of surgical methods (aperfix and endobutton) in patients with anterior cruciate ligament rupture, the same?.2 Are the aspects of the knee function, in two surgical methods (aperfix and endobutton) after ACL reconstruction surgery, the same?Methods This study is a prospective clinical trial on patients who had complete ACL rupture in an isolated trauma, who were nominated for ACL reconstruction surgery. We excluded the cases that had underlying disease or other damages from the study. 100 patients were randomly divided into two groups of 50 individuals. Then each group underwent surgery. The femoral fixations were by the two common methods of ";;;;;;;;;;;Aperfix";;;;;;;;;;; or ";;;;;;;;;;;Endobutton";;;;;;;;;;;. We followed up, the cases one year after surgery and evaluated them by lysholm score as well as with IKDC score.Results The mean lysholm score and IKDC score do not have statistically significant difference in the two groups. (Mean lysholm score in Aperfix group=95.66 vs. 94.56 in Endobutton group (p=0.057) and IKDC score=92.32 in Aperfix group vs 92.20 in Endobutton group (p=0.28)). However, in some aspects of knee function, such as locking, Swelling, and climbing stairs, patients who had undergone Aperfix approach, had better results.ConclusionSurgical methods have little difference however due to better results in some aspects of knee functions in this study and due to other studies, it can be said Aperfix method slightly has more benefits. Further investigations with larger number of cases and longer duration of follow-up are recommended
Therapy choice - Therapy possibility in PCOS infertility patients
No full textBackgroundPolycystic ovarian syndrome (PCOS) constitutes the most common endocrinopathy of women of reproductive age. Infertility due to the PCOS is a complex and specific condition but the majority of the problem is the ovulatory dysfunction.AimsEvaluation of the therapy choice and reproductive therapy possibilities in PCOS infertility patients. Make it easier for clinicians.Methods Clinical experience based on review of the literature.Results The syndromes heterogeneity is reflected in the different response to the various ovulation inducting drugs. Management of anovulatory infertility associated with PCOS is based on the overall clinical picture. Lifestyle change programs, weight reduction diet and exercise, have been shown to be very effective in improving reproductive as well as metabolic characteristics of overweight and obese patients with PCOS. In women with anovulatory infertility, the first line of treatment for induction of ovulation is clomiphene citrate. Aromatase inhibitors have been suggested as an alternative treatment to clomiphene therapy. Gonadotropin treatment is effective, but there is a risk of ovarian hyperstimulation syndrome. Surgery, such as laparoscopic ovarian drilling should be considered in some patients. Reconsider a use of metformin and supplements.ConclusionUnderstanding specific features and metabolic implications of different PCOS patients, may guide us to treat individuals optimally, as well as to develop effective prevention strategies to reduce the risk of long term complications- consequences and improve reproductive outcomes. Individual treatment modalities in PCOS patients are imperative for successful therapy
Fluconazole-Warfarin interaction: A case report with deadly consequences
Get PDFAdverse drug-drug interactions are more common in the elderly because of the commonality of polypharmacy. When one of the interacting drugs has a low therapeutic index, the consequences can be life-threatening or fatal. This case describes a fatal cerebral haemorrhage in an 80-year old male on stable doses of warfarin prescribed by his cardiologist, who was prescribed fluconazole 200mg, once daily, for 14 days by an oral and maxillofacial surgeon to treat an intraoral fungal infection. The oral surgeon was aware that the patient was on warfarin and his INR two days prior to the appointment was 2.4. While a drug interaction alert was sent to the patient’s primary care family physician regarding fluconazole and the simvastatin she had been prescribing, the interaction was not reviewed by her for another 9- days. She then informed the patient that “it was fine” to finish the fluconazole. However, this phone conversation prompted the patient to discontinue the fluconazole after 8 doses. Two days later, the patient was confused and driving his car erratically. His son rushed him to the hospital where a CAT scan revealed a large frontal intraparenchymal haemorrhage. His INR was a 9.6. This event illustrates that this well-documented adverse drug interaction needs to be better highlighted in dental and medical training. Warfarin’s primary metabolic pathway involves the cytochrome P-450 2C9 isoform and fluconazole is a strong inhibitor of this enzyme, with the potential outcome being excessive warfarin blood levels. Frequent INR monitoring with potential warfarin dosage adjustments downward if fluconazole is prescribed, or the complete avoidance of fluconazole is recommended in patients taking warfarin. The importance of communication and coordinated care between different health care providers cannot be overstated
A 10-year analysis of jaw fractures in Australia
No full textBackground Previous analysis of jaw fracture hospitalisations in Western Australia (WA) indicated disproportionately high rates of hospitalisations for Aboriginal people. This study was to follow-up on the earlier analysis to determine if inequalities in terms of jaw fracture hospitalisation rates between Aboriginal and non-Aboriginal people have changed. Aims This study, done over a 10-year period from 1999/2000 to 2008/2009, aimed to determine rates of hospitalisations for jaw fractures in WA, trends over the 10–year period, and direct costs associated with these hospital admissions. Methods Hospitalisation data were obtained from the Western Australian Hospital Morbidity Data System (HMDS). Episodes were selected on the basis of an ICD10-AM code being S02.4 (Fracture of the malar and maxillary bones) and S02.6 (Fracture of the mandible). Self-reported Aboriginality were used to compare Aboriginal to non-Aboriginal populations. Estimated cost of care was determined for each episode using the national standard diagnostic-related group (DRG) average price. Results Our findings indicate that inequalities between Aboriginal and non-Aboriginal people in terms of hospital admissions for jaw fractures exist in WA, and continued over a decade- long period. Higher fracture rates occurred amongst males, Aboriginal people, younger adult age-groups, those from low socioeconomic areas, and those from remote and very remote areas. The DRG cost per person for jaw fractures ranged between AUD 109,002, with a median cost of $4,965. Conclusion Hospital admission rates for the treatment of maxillary and mandibular fractures is very strongly divided along racial and socioeconomic lines in WA
The issue of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenitis
No full textBackgroundDue to different reports about the value of fine needle aspiration cytology (FNAC) as a simple and minimal invasive diagnostic tool for extra-pulmonary tuberculosis, we attempted to demonstrate the sensitivity of FNAC in patients with cervical tuberculous lymphadenitis in Iran. We wanted to know if fine needle aspiration (FNA) is an accurate method as a first step in diagnosis or not.Methods This study covered a 14 year period identifying 137 patients with a pathological report of granulomatosis in excisional biopsy of lymphadenopathy in two tertiary referral hospitals of Tehran, Iran. The results of fine needle aspiration cytology (FNAC) in 67 patients with tuberculosis cervical lymphadenitis were evaluated. Results The FNA cytology showed granuloma with background necrosis in five patients (7.46 per cent) and granuloma with or without necrosis in 13 patients (19.40 per cent). Patients with positive results of FNAC had a longer duration of lymphadenopathy compared to other patients.ConclusionIn this study, sensitivity of FNAC was reported to be low. The sensitivity of this method was 7.46 per cent (including pathology granuloma with background necrosis) and 19.40 per cent (total cases of granuloma with or without necrosis). It seems that the sensitivity of FNAC is significantly lower in patients with early cervical tuberculosis (TB) lymphadenitis. Combining acid-fast bacillus (AFB) staining and non-culture methods like polymerase chain reaction (PCR) could increase FNA sensitivity in these patients
Reliability and factor analysis of general health questionnaire 12 in malay version among women with abnormal pap smear results
Get PDFBackgroundThe General Health Questionnaire-12 (GHQ-12) is widely used to detect minor psychiatric and potential non-psychiatric disorders, and has been translated into many languages and validated for a variety of populations. GHQ-12 has been used for medical students, in health sciences, and other disciplines in order to study the impact on general health of current disease.AimsThe purpose of this study is to determine the reliability and validity of GHQ-12 in Malay version among women with an abnormal Pap smear result.MethodsThis is a cross-sectional study of 70 Malaysian women with an abnormal Pap smear. The data was collected in 2015. The self-administered questionnaire on sociodemographic and GHQ-12 was completed by respondents within 15 minutes. Data was analysed using SPPS version 22.ResultsExploratory factor analysis in the Malay version of GHQ-12 depicts five models with a three factor structure for each model. Faster loading of all items was above 0.6 except three items in item number 7, 8 and 10. Cronbach’s alpha for all models of GHQ-12 range from 0.75 to 0.81. All of the items in GHQ-12 were more than 0.6, which demonstrated a reasonably excellent internal consistency.ConclusionThis study found that the Malay version of GHQ-12 was reliable and valid to assess the general health among women with abnormal Pap smear results, whereby 12 items possess excellent internal consistency. It also helps to detect stress and depression among women with abnormal Pap smear results which will impact their general health