Australasian Medical Journal
Not a member yet
1482 research outputs found
Sort by
Improving Medical Students' Communications Skills
No full textBackground Although communication skills are important for a good physician-patient relationship, Indian medical curricula give very little emphasis on training medical students in this aspect. Aim To determine the change in communication skills of final- year medical students following focused training. Methods This was an educational interventional study done at Pondicherry Institute of Medical Sciences, a tertiary care teaching hospital in South India, to assess communication skills among final-year MBBS students. Fifty-two students (24 males and 28 females) participated in the study. A pre- test was conducted in the form of an objectively structured clinical examination (OSCE), followed by focused training for four hours. The same OSCE was administered as post-test. A comparison between the pre-test and post-test scores was done using Wilcoxon Signed Ranks Test. Results Ninety-six per cent of participants (50 out of 52) showed improvement in their performance after the focused training. The mean marks of the pre-test and post-test were 10.77+ 3 and 18.04+2, respectively, out of a maximum mark of 20 (
Polyarthritis and massive small bowel bleed: An unusual combination in Scrub typhus
Get PDFScrub typhus is an acute febrile illness caused by the intracellular parasite Orientia tsutsugamushi. Although most cases present with mild symptoms and signs and recover spontaneously, some cases can be severe with multi-organ dysfunction and a protracted course, which may be fatal if left untreated. Apart from fever and constitutional symptoms, atypical presentations allow this disease to mimic several common conditions. We report a case of scrub typhus in an 18-year-old male who presented with severe polyarthritis involving all large joints and a massive lower gastrointestinal bleed from ulcers in the terminal ileum, secondary to vasculitis in the small bowel. This combination of pathologies has not previously been reported in cases of scrub typhus. The patient improved following surgical intervention and specific anti-rickettsial therapy with azithromycin
Statins and Memory Loss: The Australian Perspective
No full textBackground Statins are a first-line drug treatment for hypercholesterolaemia. Recently there has been general public and media interest surrounding uses and side effects of statins, including memory loss. Aims We analysed an Australian experience in statin usage in an attempt to improve understanding of the relationship between statins and memory-related adverse events. Methods Total adverse events (TAE) and adverse events with single suspected medicines (SSM) for memory loss and other memory-related adverse events were searched for statin compounds from January 1992 to May 2013, using the Medicare Australia and Pharmaceutical Benefits Scheme (PBS) websites and Therapeutic Goods Administration (TGA) adverse events data. TAE and SSM were compared to the number of prescriptions by item number searched using the PBS. The process was repeated for non-statin cholesterol-lowering drugs. Results The most common adverse event was amnesia (167 events for statins and six for non-statins). There were 239 TAE (incidence rate=0.88) listed for statins and 10 for non-statins (incidence rate=0.53). There were 217 SSM events listed for the statins (incidence rate = 0.08) and eight for the alternatives (incident rate=0.04). The differences between TAE and SSM incidence rates between statins and non-statins drugs were not significant (both p values >0.05). Conclusion We found that there were no differences in memory-related adverse events between statins and other cholesterol-lowering medications using Australian PBS and TGA adverse events data
Serum vitamin D and parathyroid hormone profiles in patients with various stages of renal disease
Get PDFBackground The prevalence of vitamin D deficiency among Saudi population has increased recently. The social and pathological factors, including kidney disease that may have influenced the vitamin status have not been investigated in the Hail population. Aims The present study aims to: (1) investigate changes in the serum vitamin D, parathyroid hormone, serum calcium, and phosphate levels in Saudi patients with kidney disease; and (2) elucidate the other possible physiological factors that may have influence on the vitamin status. Methods A cross-sectional study was carried out in King Khalid Hospital in Hail, Saudi Arabia. The database of kidney disease patients that attended the Kidney Unit between September 2012 and June 2013 was searched and data classified according to the estimated glomerular filtration rate into stages 1–4. Beside the kidney function parameters, serum calcium, phosphorus, vitamin D, and parathyroid hormone were measured. Results Out of the 167 patients who visited the kidney unit, the data of 96 patients was included in the study. The results exhibited significant reductions in serum vitamin D level in stage 4 patients by 52.05 per cent with significant increase in the serum PTH level amounting to 3.5-fold. Kidney impairment at stage 4 caused significant increase in the serum phosphate level by 15.74 per cent and the serum calcium by 8.17 per cent. Significant correlations were observed between serum creatinine and Log PTH (r=0.704,
General practice and residential aged care
Get PDFBackground More than 169,000 people live in residential aged care facilities (RACFs). As people age they use health services, particularly general practitioner (GP) services, more frequently but many GPs do not attend patients in RACFs. Aims To examine GPs’ perceptions of barriers to providing care to patients in RACFs. Methods This study was conducted in June 2014 in the Bayside Medicare Local (BML) region in Victoria, Australia; all participants were drawn from this region. Two focus groups (FGs) were conducted. One was for GPs (n=5) that have a specific interest in practicing in RACFs, the other with RACF staff (n=8) representing public, private, and not-for-profit aged care providers. Results were presented to the Royal Australian College of General Practitioners (RACGP) National Standing Committee for General Practice Advocacy and Support for feedback and validation of the findings against national perspectives of the effect of remuneration on the provision of GP services in RACFs. Results Remuneration problems are a barrier to the provision of GP services to patients in RACFs. These problems can be grouped into: direct remuneration, opportunity cost, additional administrative burden, and unremunerated work. GPs’ perceptions of the effects of these problems on willingness to practice in RACFs are described. Conclusion Innovative models of remuneration for GPs attending RACFs are needed to ameliorate the problems identified. Such models need to capture and pay for activities that are time consuming but often unremunerated
Cortical Venous Thrombosis
Get PDFBackground Our study retrospectively reviewed the presentation, neuro-radiological findings, and outcomes of eight adult patients presenting at our institution with subarachnoid haemorrhage (SAH), which was subsequently proven to be due to cortical venous thrombosis (CVT). Methods We reviewed the case records and neuroimaging findings of eight patients diagnosed with SAH and CVT over a span of two years at our institution, a tertiary care centre in Western India. All details pertaining to their presentation, clinical findings, neuroimaging, management, and outcome following therapy with anticoagulants were collected until patient discharge. Results There were a total of eight patients, with the average age being 34 years (range 25–42). Only one patient was female. Six patients had a history of recent binge drinking. None of the patients had a past or family history of common risk factors for thrombosis. All patients presented acutely, with headache (n=6) and seizures (n=6) being the most common presenting features, occurring in three-quarters of the patients examined. Non-contrast computed tomography (NCCT) was the initial imaging study for all but one of the patients and showed cortical SAH (cSAH) without basilar haemorrhage. Magnetic resonance imaging/magnetic resonance venography (MRI/MRV) confirmed the underlying CVT. Unfractionated heparin was used in all cases. Seven patients improved and were discharged on oral anticoagulation. The eighth patient died. Conclusion Localised cSAH with sparing of basal cisterns can be a presentation for CVT. In patients with cSAH, MRI/MRV can be useful to make a diagnosis of CVT. Anticoagulation for CVT, even in the presence of SAH was related to seven out of eight patients being discharged
Selective myelosuppression following yellow phosphorus ingestion
Get PDFToxicity from accidental and intentional ingestion of yellow phosphorus, ubiquitously present in fireworks and rodenticides, has recently become more frequent. Gastrointestinal, renal, neurologic, and cardiovascular manifestations are common, with mortality of 23 per cent to 73 per cent. Reports of haematological abnormalities are rare. We report only the second case of severe neutropenia secondary to selective myelosuppression in a 14-year-old girl following intentional ingestion of yellow phosphorus. Leucocyte counts recovered spontaneously without further complications. Our case indicates that, besides hepatic and renal function monitoring, physicians should meticulously monitor blood counts in such cases for early detection of marrow suppression. Further studies are required to elucidate the complex mechanisms and significance of this unusual toxicity of yellow phosphorus