Australasian Medical Journal
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Effect of Medical Thrombrophylaxis on Mortality
Get PDFBackground Several studies have failed to discover a beneficial effect of medical thromboprophylaxis on mortality. Aims To examine the relative influence of acute fatal pulmonary embolism (PE) and fatal major haemorrhage on overall mortality in medical patients treated with low molecular weight heparin (LMWP) for prophylaxis. Methods The author compared deaths from the above factors using data from a recent Cochrane Collaboration meta-analysis. Data from trials satisfying the criteria of the Cochrane analysis plus additional exclusions to avoid bias were pooled to produce point estimates of mortality from PE and major bleeds to estimate net mortality benefit. Estimates were then subject to limited sensitivity analysis based on reported epidemiological data. Results Reported PE and major bleeds were 0.44 per cent and 0.27 per cent, respectively. The corresponding case-specific mortality rates were 30.8 per cent and 12.8 per cent and the relative risk reduction (RRR) for PE was 23.2 per cent. Estimated deaths from major bleeds exceeded PE deaths avoided by a small margin (3/100,000 patients given prophylaxis). This excess increased to 30/100,000 when more plausible literature values for PE case fatality rates were applied. Conclusion Medical thromboprophylaxis has a finely balanced effect on mortality but may increase it. Such an effect would explain the failure to discover a mortality benefit from medical thromboprophylaxis. Further work, including a formal meta- analysis and additional clinical studies, is required to confirm this picture
The Traditional Health Practitioners Act No 22 (2007) of South Africa
No full textBackgroundYears of South African legislation on traditional healing practices preceded the Traditional Health Practitioners Act (Act No 22, 2007). The first laws date as far back as 1895. It seems as if the intention of the pre-1994 legislation was not to promote traditional healing practices, but to limit the power of the traditional healer.AimsThe study aims to describe the history that came before Act No 22 of 2007.Methods This is an exploratory and descriptive study in line with the modern-day historical approach of investigation and reviewing research. The emphasis is on the use of present-day documentation, like articles, books and newspapers, as primary sources to reflect on the development and promulgation of Act No 22. The findings are offered in narrative format.Results Various political and legal processes can be identified as contributing to the promulgation of the Act in 2007, especially after the 1994.ConclusionIt had taken more than 45 years of unofficial and seven years of official struggle to get Act No 22 promulgated in 2007. Today, nearly a decade after promulgation, it has still not been fully enacted
Carney complex with PRKAR1A mutation: A case report
Get PDFCarney complex is a multiple endocrine neoplasia syndrome with various features which include myxomas, endocrine tumours and lentigines lesions. We report a case of Carney complex with components of lentigines, ACTH independent adrenal Cushing’s syndrome (with a paradoxical increase in 24 hour urinary cortisol following the high dose (8mg) dexamethasone suppression test – and is likely to be due to primary pigmented nodular adrenal hyperplasia) positive for a protein kinase A type 1A regulatory subunit (PRKAR1A) gene mutation
A pet-type robot AIBO-assisted therapy as a day care program for chronic schizophrenia patients
Get PDFBackgroundAAT (Animal-assisted therapy) was developed to promote human social and emotional functioning as a day care program for psychiatric patients.AimsIn this study, we performed AAT using a pet-type robot, AIBO for schizophrenic patients.Methods After obtaining informed consent, we performed the AIBO-assisted therapy for three schizophrenic (ICD-10, F20.x2) patients (male: 1, female: 2) whose medication did not change over the 8 weeks study period in a ward.Results It was found that the AAT using AIBO may be useful for the patients with negative and general psychopathological symptoms such as “Anxiety” and “Uncooperativeness”.ConclusionWe make use of this result, and we want to develop the AAT program using a pet-type robot, AIBO which may be suitable for Japanese psychiatric patients
Coronary CT angiography in coronary artery disease
Get PDFCoronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualization of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterization of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease
Small bowel obstruction and volvulus secondary to strongyloidiasis
Get PDFWe report the case of a 27-year-old Sudanese man with episodes of small bowel obstruction and volvulus, and significant malnutrition with severe hypoalbuminaemia due to strongyloidiasis. Interestingly, he did not have the common associated eosinophilia or any of the known risk factors of strongyloidiasis. His symptoms improved after treatment with ivermectin and albendazole. Health care providers should be aware of the possible absence of the well-described risk factors and the potential atypical presentation of this disease due to the growing population of migrants from the endemic areas in Australia
Administrative burdens in medical research
No full textBackground Conducting ethically grounded research is a fundamental facet of all investigations. Nevertheless, the administrative burdens of current ethics review are substantial, and calls have been made for a reduction in research waste. Aims To describe the heterogeneity in administration and documentation required by Human Research Ethics Committees (HRECs) and Research Governance Offices (RGOs) across Australia. Methods In establishing a nationwide study to investigate the molecular aetiology of Giant Cell Arteritis (GCA), for which archived pathological specimens from around Australia are being recruited, we identified variation across separate HREC and RGO requirements. Submission paperwork and correspondence from each collaborating site and its representative office for research were reviewed. This data was interrogated to evaluate differences in current guidelines. Results Twenty-five pathology departments across seven Australian States collaborated in this study. All states, except Victoria, employed a single ethics review model. There was discrepancy amongst HRECs as to which application process applied to our study: seven requested completion of a “National Ethics Application Form” and three a “Low Negligible Risk” form. Noticeable differences in guidelines included whether electronic submission was sufficient. There was variability in the total number of documents submitted (range five to 22) and panel review turnaround time (range nine to 136 days). Conclusion We demonstrate the challenges and illustrate the heavy workload involved in receiving widespread ethics and governance approval across Australia. We highlight the need to simplify, homogenise, and nationalise human ethics for non-clinical trial studies. Reducing unnecessary administration will enable investigators to achieve research aims more efficiently
Clinical profile of high-risk febrile neutropenia in a tertiary care hospital
Get PDFBackgroundInfection in the immunocompromised host has been a reason of concern in the clinical setting and a topic of debate for decades. In this study, the aim was to analyse the clinical profile of high-risk febrile neutropenic patients.AimsTo study the clinical profile of high risk febrile neutropenia patients with the objective of identifying the most common associated malignancy, most common associated pathogen, the source of infection, to correlate the treatment and management with that of the Infectious Diseases Society of America (IDSA) 2010 guidelines and to assess the clinical outcome.MethodsA cross-sectional time bound study was carried out and a total of 80 episodes of high-risk febrile neutropenia were recorded among patients with malignancies from September 2011 to July 2013 with each episode being taken as a new case.ResultsNon-Hodgkin’s lymphoma (30 per cent) was the most common malignancy associated, commonest source of infection was due to central venous catheters, the commonest pathogens were gram negative (52 per cent) the treatment and management of each episode of high risk febrile neutropenia correlated with that of IDSA 2010 guidelines and the mortality rate was 13.75 per cent.ConclusionFebrile neutropenia is one of the major complications and cause of mortality in patients with malignancy and hence understanding its entire spectrum can help us reduce morbidity and mortality
Knowledge and personal beliefs about human papilloma virus infections among nursing professionals
No full textBackgroundPersistent infection with high risk type of human papilloma virus (HPV) has been identified as most important risk factor for cancer cervix. Because of high incidence of HPV infections; HPV testing for cervical screening has been recently advocated in many countries.AimsThe aim of this survey was assess knowledge and personal beliefs about (HPV) infection among female nursing professionals.Methods Between April 2012 and February 2013, a pre-designed, pretested, self-administered multiple responses questionnaire survey was conducted among female staff nurses’ working in the hospitals of Sikkim. Results Overall, 72.6 per cent nursing staff responded that they had ever heard of HPV. An association between HPV infection and cancer cervix was aware by only 62.3 per cent nursing staff. Actual knowledge about HPV was poor. Only 23 per cent nursing staff knew that high risk HPV type 16, 18 causes most (70 per cent) of the cervical cancers. Only 16.7 per cent (n=43) nursing staff had adequate knowledge about HPV. Age was the only significant predictor (p < 0.0001) which determined awareness of HPV infection with nursing staff in their 20–30s were more likely to be aware of HPV infection. Stigmatizing beliefs about HPV infection was common with 63 per cent participants believed that infected individuals are to blame themselves for causing their own infection while 17.5 per cent maintained their belief that one should keep a social distance from those who are infected.ConclusionThere is an urgent need for well-designed HPV education program integrated into a national cervical cancer control program and incorporation of updated detailed information in nurses existing curriculum