Australasian Medical Journal
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Treatment of diabetes in Malaysia and Australia
Get PDFBackground Once a disease of developed countries, type 2 diabetes mellitus (T2DM) has become widespread worldwide. For people with T2DM, achievement of therapeutic outcomes demands the rational and quality use of medicine. Aims The primary aim of this study was to examine the prevalence of diabetes and prescribing patterns of anti-diabetic medications in Australia and Malaysia. Methods The most recent, publicly available, statistical reports (2004–2008) on the use of medicines published in Australia and in Malaysia were evaluated. Defined daily doses (DDDs/1,000 population/day) were derived from the reports and used to rank and compare individual drug use. Results There was an increasing trend in the prevalence of diabetes in Australia, although there is a greater predicted increase in prevalence for Malaysia. While drugs used for the treatment of diabetes were not the most highly used drugs in Australia, their use increased during the study period, from 42.64 to 48.61 DDD/1,000/day. Anti-diabetic drugs were the most frequently dispensed class of drugs in Malaysia. Although the total consumption of anti-diabetic drugs in Malaysia decreased between 2006 and 2007 (from 40.30 to 39.72), this was followed by a marked increase to 46.69 in 2008. There was a marked reduction in the dispensing of insulin in Malaysia from 2004 to 2007 (7.77 to 3.23). Conclusion The use of drugs to treat diabetes does not reflect the usage patterns of found in Australia. Effective drug use reviews are required to ensure impartial access in middle- and low-income countries
A unique case of bilateral sciatic nerve variation
Get PDFAn abnormal course of a nerve either through or around a muscle may yield multiple or anomalous muscle innervation. Further, if nerves are inappropriately trapped within the confines of a muscle or irregular boundaries, variant emergence of a nerve could give rise to symptoms of an entrapment neuropathy. Upon routine dissection in the Department of Anatomy at the American University of Antigua College of Medicine, bilateral variants in the emergence of the sciatic nerve from the pelvis to the gluteal compartment were discovered in an elderly adult female cadaver. In the left gluteal compartment, the sciatic nerve had a high division where the peroneal division exited the pelvis superior to the piriformis muscle while the tibial division exited inferior to the piriformis. In the right gluteal compartment, the peroneal division was observed to have exited the pelvis between a split piriformis muscle before it joined the tibial division of the sciatic nerve. Knowledge of such variations in the course of the sciatic nerve may improve diagnosis and treatment of pathologies in this region
ansa cervicalis: anatomical variation
No full textThe ansa cervicalis is a loop of nerves that is usually formed by the union of ventral rami of spinal nerves C1, C2, and C3. It is located in the carotid triangle of the neck, lying superficial to the carotid sheath. During routine dissection, unilateral variation of the ansa cervicalis was observed. The superior root, arising from hypoglossal nerve, was initially bifurcated and later united to form a single superior root. IN addition, the inferior root consisted of fibres arising from the spinal accessory nerve, C1, C2 and C3 spinal nerves that joined separately. Fibres from the spinal accessory and C1 joined to form a single root. Thus, a ‘triple form’ of ansa cervicalis was observed. An interconnection was observed between the C2 and C3 fibres. Knowledge of such anatomical variations is important for surgery, clinical intervention or trauma involving the carotid triangle or the structures within or deep to this region
A pharmacist's role in GP Super Clinics
No full textBackground The Australian government’s General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting. Aims To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting. Methods Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semi- rural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff. Results Three themes emerged conveying perspectives on: working relationships between staff; a pharmacist’s current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their “team approach”. Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists’ prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations. Conclusion Results suggest a pharmacist’s services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention to funding and government legislation
Infant mortality rates and decentralisation in Uganda
Get PDFBackground Many countries in the developing world have embarked on the path of decentralisation over the last three decades to improve the provision of public goods such as healthcare services. It is hypothesised that devolving power to local governments would improve efficiency as well as equity and thereby health outcomes by bringing decision makers closer to the people, and by enhancing the participation of the community in the decision-making and implementation processes. Aims This paper aims to assess the impact of decentralisation on infant mortality rates in Uganda. Methods The intervention model was used to analyse national representative data from Uganda Demographic Health Surveys (1988/89, 1995, 2001, 2006). Results Results indicate that infant mortality rates deteriorated during the decentralisation period in three out of four regions in Uganda, but not overall when analysed for the whole country. Conclusion Decentralisation was supposed to lead to a decrease in infant mortality rates, however, the opposite effect was seen with rates increasing in individual regions. There is need for further detailed studies to understand why infant mortality rates increased during the period of decentralisation in Uganda
Escherichia coli in hospitalised patients
Get PDFBackground Extended spectrum betalactamase (ESBL)-producing organisms are a major cause of hospital-acquired infections. ESBL-producing Escherichia coli (E. coli) have been recovered from the hospital environment. These drug-resistant organisms have also been found to be present in humans as commensals. The present investigation intended to isolate ESBL-producing E. coli from the gut of already infected patients; to date, only a few studies have shown evidence of the gut microflora as a major source of infection. Aims This study aimed to detect the presence of ESBL genes in E.coli that are isolated from the gut of patients who have already been infected with the same organism. Methods A total of 70 nonrepetitive faecal samples were collected from in-patients of our hospital. These in-patients were clinically diagnosed and were culture-positive for ESBL-producing E. coli either from blood, urine, or pus. Standard microbiological methods were used to detect ESBL from clinical and gut isolates. Genes coding for major betalactamase enzymes such as blaCTX-M, blaTEM, and blaSHV were investigated by polymerase chain reaction (PCR). Results ESBL-producing E. coli was isolated from 15 (21 per cent) faecal samples of the 70 samples that were cultured. PCR revealed that out of these 15 isolates, the blaCTX-M gene was found in 13 (86.6 per cent) isolates, the blaTEM was present in 11 (73.3 per cent) isolates, and blaSHV only in eight (53.3 per cent) isolates. All 15 clinical and gut isolates had similar phenotypic characters and eight of the 15 patients had similar pattern of genes (blaTEM, blaCTX-M, and blaSHV) in their clinical and gut isolates. Conclusion Strains with multiple betalactamase genes that colonise the gut of hospitalised patients are a potential threat and it may be a potential source of infection