Australasian Medical Journal
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Rapid Psychological assessment of depression and its relationship with physical health
Get PDFBackgroundOld age is associated with increased occurrence of a wide array of Psychological impairments or losses, which might contribute to physical disabilities. As Depression has been identified as the most common aberration its rapid assessment would be able to identify the quality of individual and family life of the elderly.AimsTo assess psychological health status with respect to depression among geriatric urban community, and the relationship of depression with health perception and physical health status has been explored.Methods A cross-sectional total geriatric population survey consisting of 254 elderly has been carried out at urban field practice area. A standard geriatric depression scale (Short form) has been utilized to assess psychological status. Detailed physical examination and investigations with special reference to Diabetes, Hypertension and Visual defects was carried out. Data was analyzed to find out the relationship of various socio-demographic factors, physical morbidities with depression.Results Out of 254 elderly examined, 32 per cent females and 23 per cent males were found to be suffering from depressive disorders. When assessed for individual health status perception, 25 per cent felt to have good health. Out of 190 geriatric subjects perceiving fair to bad health, 110 were found to be suffering from depression (p < 0.001). Depression was also found to be associated with history of hospital admission in the previous year (p < 0.05), low vision (p < 0.05), diabetes (p < 0.01) and hypertension (p < 0.01).ConclusionDepression among geriatric age group is associated with physical illness and perception of health
Knowledge and beliefs regarding breastfeeding in college students of Karachi
No full textBackgroundBreast feeding has been shown to decrease infant mortality rates. However, the increasing number of neonatal deaths and decline in breastfeeding reflect a lack in knowledge about its importance and benefits.AimsTo assess the knowledge and beliefs of college students regarding breastfeeding and to determine the factors affecting the knowledge scores regarding breastfeeding in studentsMethodsA cross-sectional study was carried out with a convenience sample of 1500 undergraduate college students via self-administered questionnaires. Structured questionnaires were distributed in six well known universities of Karachi. Data analysis of socio-demographics, beliefs and knowledge of students regarding breastfeeding was done using SPSS (V20) software.ResultsThe response rate of the survey was 93.3 per cent. The difference in overall knowledge between medical and non-medical students was significant (p < 0.001) with 61.1 per cent of medical and only 14.4 per cent of non-medical students having adequate knowledge. Results regarding the basic knowledge about breastfeeding reflected that 49 per cent of non-medical participants had a poor knowledge compared to the 19.6 per cent of medical students. 39.4 per cent of medical and 64.5 per cent of non-medical participants considered their knowledge of breastfeeding to be inadequate. On multivariate analysis, non-medical participants were 6.85 times more likely to score in the inadequate range for knowledge compared to medical participants.ConclusionThe results indicated that medical students had a better knowledge regarding the advantages of breastfeeding as compared to non-medical students. However, the overall knowledge among undergraduates from both groups was low. Therefore, in order to improve this inadequacy, it is important that public campaigns targeting the advantages and significance of breastfeeding be conducted in Pakistan
The present-day diagnosis and treatment model of the South African traditional healer
No full textBackgroundAt present, no formal guides or curricula exist to direct and instruct diagnosis and treatment in the practice of the traditional healer. To gain knowledge of how the traditional healer makes diagnoses and offers treatment, the researcher has to rely on the reflections in the literature as well as writings and communications offered by a few authors and the traditional healer organizations. These materials are sometimes insufficient and even misleading and cannot serve as trustworthy information in isolation.AimsThe present study is aimed at determining and describing the present diagnosis and treatment model of the traditional healer.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 study of present-day documentation, like articles, books and newspapers as primary resources to reflect on the development and promulgation of the Traditional Health Practitioners Act No 22 (2007). By implementing this approach, new information can be uncovered on the present-day diagnosis and treatment model of the traditional healer. The findings are offered in narrative format.Results The regulations and definitions of the Traditional Health Practitioners Act (Act No 22, 2007) is not effective in evaluating the procedure of diagnosis and treatment of the present day traditional healer, as this act, being promulgated in 2007, is applicable to diagnosis practices and training processes still to be developed.ConclusionA traditional healthcare model based on scientific research to guide and teach the student of traditional healing and about diagnosis and treatment is non-existent in South Africa. Traditional leaders acquire their current knowledge and understanding of the diagnosis and treatment through various doubtful ways of learning, mostly verbally and in practice from unqualified traditional healing masters or tutors. This means that the pre-modern traditional health know-hows, styles and approaches which are being offered, differ immensely in standards from tutor to tutor
Hospitals in the home for patients with delirium: No place like home?
No full textBackgroundManagement of patients with delirium presents a challenge.AimsSupported discharge with Hospital in the Home (HITH) for patients with delirium was developed and evaluated.Methods Patients admitted acutely to internal medicine and geriatrics, with a diagnosis of delirium were considered for HITH. Patients with a full time career and who lived in their own residence were eligible for the program. Delirium was diagnosed using CAM. Outcomes were compared against historical control. All data was collected prospectively.Results A total of 89 patients (9.2 per cent) were diagnosed with delirium. Of 31 patients eligible for HITH, 17 had suitable carers. Sixteen patient-caregiver teams were successfully discharged on HITH. Age, frailty score, length of stay and readmissions did not vary significantly between the intervention and control group (N=7). Thirteen patient-carers provided feedback and which was supportive of the intervention.ConclusionThis innovative model of care was feasible and well received. Further studies are recommended
A rare presentation of HBV infection
No full textHepatitis B virus (HBV) infection presenting as crescentic glomerulonephritis in the absence of cryoglobulinemia is an extremely rare phenomenon. We report a case of a 44-year- old male with HBV infection, who underwent kidney biopsy for rapidly progressive renal failure and nephrotic range proteinuria. Histopathological evaluation of the kidney biopsy was consistent with immune complex mediated crescentic membranoproliferative glomerulonephritis (MPGN). The patient achieved complete renal and virological remission with steroids, plasmapheresis and antiviral therapy. This case report summarises the importance of early initiation of immunosuppression and plasmapheresis under antiviral coverage for improved clinical outcomes
Mesothelioma - A rare cause of dysphagia
Get PDFA 81-year-old elderly Caucasian male presented with progressive dysphagia and unintentional weight loss over four months. His history was significant for asbestos exposure; however there was no history of asbestos related lung disease. Barium swallow showed achalasia and a subsequent CT chest showed a posterior mediastinal mass 11.8×9.1×5.8cm, compressing the distal oesophagus. Laparoscopic biopsy of the mass showed an epitheloid mesothelioma. Mass was deemed unresectable and patient was started on chemotherapy with Cisplatin/Pemetrexed. Localised mesothelioma is extremely rare, and dysphagia can be uncommon presenting feature. 7.4 per cent of cases of Pseudoachalasia are attributed to mesothelioma
Predicting Hospital Re-admissions in Diabetic Patients
No full textBackground Diabetic patients are commonly hyperglycaemic on presentation. Admission hyperglycaemia is associated with adverse outcomes, particularly prolonged hospitalisation. Improving inpatient glycaemia may reduce length of hospital stay (LOS) in diabetic patients. Aims To determine whether in-hospital recognition and treatment of admission hyperglycaemia in diabetic patients is associated with reduced LOS. Methods Medical records were reviewed from 1 November 2011 to 31 May 2012 for 162 diabetic patients admitted with a blood glucose level (BGL) ≥11.1mmol/L. In-hospital outcomes were compared. Stepwise multiple regression was used to evaluate factors contributing to LOS. Results Compared to the untreated individuals (n=67), hyperglycaemia treatment (n=95) was associated with a longer LOS (median eight vs. four days,
Dancing eyes and dancing feet in scrub typhus
Get PDFA 26-year-old male, presented to us with complaints of fever for five days and breathlessness for one day. During the hospital stay, he developed myoclonic jerks in all four limbs, head titubation, and saccadomania. Magnetic resonance imaging (MRI) of the brain ruled out structural lesions and cerebro spinal fluid (CSF) analysis ruled out meningo-encephalitis. Weil Felix was strongly positive, OX K titres were one in 640, and IgM for scrub typhus was positive. He was treated with doxycycline for one week. On follow-up he was found to be doing well with resolution of opsoclonus myoclonus
Diabetic foot complications in a secondary hospital: A clinical audit
No full textBackground Previous studies conducted in Australian hospital settings suggest high variability in assessments, investigations, and management of diabetic foot infections and poor adherence to widely accessible evidence-based protocols and guidelines. Diabetic foot complications require a multidisciplinary approach and often involve both medical and surgical teams during inpatient care. Aims The aim of this clinical audit was to better understand the scope of diabetes-related foot complications, evaluate whether current assessment and management strategies are in line with best practice guidelines, and to formulate future models of care. Methods A retrospective review of patients was carried out between 12 July 2012 and 11 July 2013. Recorded assessments of inpatient care, including risk factors, surgery, and length of stay, interdepartmental referrals, and antibiotic administration were reviewed. Results There were 24 admissions in 12 months (total patients n=19). Fifty-eight per cent of patients were admitted to the medical ward. More than a quarter had evidence of osteomyelitis. While one patient required intensive care unit (ICU) management, there was no inpatient mortality. Two patients experienced significant delay to undergo initial surgical intervention presumably because of failed medical treatment. Clinical data was recorded poorly, especially regarding neuropathy, HbA1c, and clinical examination findings. Twelve per cent of patients did not undergo any follow-up. The average length of stay was 12 days. One-half of the cohort was not evaluated by the endocrinology department. Conclusion This audit highlights the need for improved care for patients with diabetic foot complications and better coordination among the multidisciplinary teams involved