Australasian Medical Journal
Not a member yet
1482 research outputs found
Sort by
Proton Pump Inhibitors: Are We Still Prescribing Them Without Valid Indications?
Get PDFBackgroundEvidence from several Western studies has shown an alarmingly high and inappropriate rate of prescription of proton pump inhibitors (PPIs), which may be associated with increased healthcare costs and adverse outcomes. PPI prescribing patterns remain largely unknown in well- developed healthcare systems in Southeast Asia.AimsWe aimed to determine the prevalence of inappropriate prescription of PPI among elderly patients without documentation of valid indications, in a tertiary teaching hospital in Singapore.MethodsWe carried out a retrospective clinical records review of 150 elderly patients aged ≥65 years that had been admitted to two internal medicine wards between 25 May 2011 and 28 June 2011 to determine the appropriateness of indications for PPIs prescribed at hospital discharge. PPI indications were categorised as “valid”, “likely invalid”, and “probable” based on current clinical literature. Pre-admission and discharge prescriptions were reviewed to determine continuation of pre-admission and new PPI prescriptions at discharge. Data on clinical characteristics and concurrent use of ulcerogenic medications were collected.ResultsFrom a total of 150 patients, 80 (53 per cent) received prescriptions for PPIs. Of these, 65 (81.2 per cent) had no valid documented indications (i.e., the indication was classed as “likely invalid”); 10 (12.5 per cent) had valid indications; and in five cases (6.2 per cent) the indication was “probable”. The most common “likely invalid” indication was primary gastrointestinal bleeding prophylaxis (GIP) among low-dose aspirin users in 28 patients (43 per cent) of invalid PPI prescriptions.ConclusionInappropriate prescribing of PPIs without documented valid indications was prevalent among elderly patients at our tertiary teaching hospital in Singapore, providing evidence that shows a similar trend to PPI prescribing to data from Western countries
Impact of community pharmacy-based educational intervention on patients with hypertension in Western Nepal
Get PDFBackground There is a paucity of data regarding the feasibility and impact of community pharmacy-based educational interventions on the management of chronic diseases in developing countries. AimsThe aim of this study was to establish the feasibility, and to investigate the impact, of community pharmacy-based educational intervention on knowledge, practice, and disease management of patients with hypertension in Western Nepal.MethodA single-cohort pre-/post-intervention study was conducted from August 2012 to April 2013. The participants included in the study were patients diagnosed with hypertension attending a pharmacist-led hypertension clinic. The educational intervention was conducted by pharmacists, was individualized, and consisted of three counseling sessions over a period of six months. The patients’ knowledge of hypertension, their practice of lifestyle modification and non-pharmacological approaches concerning hypertension management, and blood pressure were assessed at baseline and again after 9 months by using a pre-validated questionnaire. ResultsFifty patients met the inclusion criteria and were enrolled in the study. The median (IQR) knowledge score changed from 6 (4) to 13 (0) after the intervention (
Young Australian adults’ reactions to viewing personalized UV photoaged photographs
No full textBackgroundDespite two nationwide sun-protection awareness campaigns, young Australian adults continue to sunbathe. Since their primary motivation for tanning is appearance enhancement, it may well be that campaigns that highlight the negative effects of tanning on appearance are more effective than campaigns that emphasise the health risks associated with sun exposure.AimsThis study aims to explore young adults’ reactions to viewing a photoaged photograph of the sun damage already visible in their facial image.MethodsSemi-structured interviews were conducted with seven females and three males aged 20–30 years. The interview transcripts were transcribed verbatim and were then subjected to Interpretive Phenomenological Analysis (IPA).ResultsThree themes and eight sub-themes emerged from the analysis. Collectively they revealed that participants’ fear-based reaction to their photoaged photographs triggered in them feelings of unattractiveness, which in turn motivated them to change to their existing sun-tanning behaviours.ConclusionAlthough media-popularised representations of suntanned skin being the desired norm were identified as a barrier to skin-protective behavioural change, personalised ultraviolet (UV) photoaged photographs, when accompanied by an explanation of the skin damage that unprotected ultraviolet radiation (UVR) exposure causes, were effective in changing young adults’ sun-tanning intentions. Hence, a need exists for positive non-tanning appearance-related messages to be incorporated into sun exposure education campaigns
Paracetamol induced acute liver failure: Would a standard set of guidelines improve outcomes?
No full text
Acute coronary syndrome in Australia
Get PDFBackgroundAcute coronary syndrome (ACS) is a significant contributor to both morbidity and mortality in Australia. Generally speaking, sufferers of ACS who live in rural areas and are treated at rural hospitals have poorer outcomes than those living in metropolitan areas.AimsTo characterise the differences in the management and outcomes of rural and metropolitan populations in the context of ACS, as well as identify factors responsible for these differences and suggest how they may be addressed.MethodA review of the current literature surrounding ACS in Australia was undertaken. Through the MEDLINE/PubMed database a thorough search using the terms “acute coronary syndrome” and “Australia” identified 460 papers for review, excluding abstracts and adding “rural”, “metropolitan”, “reperfusion”, and “outcomes” to this search narrowed the results to 149 papers for review. Data was also extracted from the Australian Institute of Health and Welfare and other Australian government publications. The review draws on insights from both local and international resources and seeks to provide an understanding of the contemporary landscape of ACS in both rural and metropolitan Australia. The review is broken down into three key sections:1. An outline of the 2011 National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guidelines and adjuvant tools used in the assessment and treatment of ACS, and to what extent these guidelines have been implemented clinically.2. An exploration of the current landscape of ACS in Australia and identification of the disparities facing rural populations compared to those in metropolitan areas.3. Discussion of the factors that are resulting in poorer outcomes for ACS sufferers and suggestions of novel approaches towards addressing these factors.ConclusionDisparities exist between the management and outcomes of rural and metropolitan populations experiencing ACS. While the causes of these discrepancies are multifactorial, the onus is on the healthcare system to effectively reduce associated morbidity and mortality. Improvements in the management of ACS may be achieved through a continued reduction in call-to-needles time via the use of remote and mobile thrombolysis services as well as improvements in in-hospital risk assessment in order to flag and investigate those at risk of ACS
Initial experience with GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program
Get PDFBackgroundMycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. Rapid and accurate diagnosis of pulmonary and extra-pulmonary tuberculosis (TB) is still a great challenge. The GeneXpert MTB/RIF assay is a novel integrated diagnostic device for the diagnosis of tuberculosis and rapid detection of Rifampin (RIF) resistance in clinical specimens. In 2012, the Arkansas Tuberculosis Control Program introduced GeneXpert MTB/RIF assay to replace the labour-intensive Mycobacterium Tuberculosis Direct (MTD) assay.AimsTo rapidly diagnose tuberculosis within 2 hours and to detect RIF resistance.Objectives1. Describe the procedure used to introduce GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program. 2. Characterize the current gap in rapid M. tuberculosis diagnosis in Arkansas. 3. Assess factors that predict AFB smear-negative but culture-positive cases in Arkansas. 4. Illustrate, with two case reports, the role of GeneXpert MTB/RIF assay in reduction of time to confirmation of M. tuberculosis diagnosis in the first year.MethodBetween June 2012 and June 2013, all sputum smear-positive cases and any others, on request by the physician, had GeneXpert MTB/RIF assay performed as well as traditional M. tuberculosis culture and susceptibilities using Mycobacteria Growth Indicator Tube (MGIT) 960 and Löwenstein-Jensen (LJ) slants. Surveillance data for January 2009–June 2013 were analysed to characterize sputum smear-negative but culture-positive cases. Results Seventy-one TB cases were reported from June 2012–June 2013. GeneXpert MTB/RIF assay identified all culture-positive cases as well as three cases that were negative on culture. Also, this rapid assay identified all 6 smear-negative but culture-positive cases; 2 of these cases are described as case reports.ConclusionGeneXpert MTB/RIF assay has made rapid TB diagnosis possible, with tremendous potential in determining isolation of TB suspects on one hand, and quickly ruling out TB whenever suspected
Rosai-Dorfman disease: A rare clinico-pathological presentation
Get PDFRosai-Dorfman disease (RDD) is also known as Sinus Histiocytosis with Massive Lymphadenopathy (SHML). It is a rare, benign, self-limiting disease of phagocytic histiocytes affecting a young age group presenting with massive painless cervical lymphadenopathy. RDD has nodal and also extra-nodal involvement with episodes of exacerbation and remissions, whose aetiology remains poorly elucidated. It is highly variable in its clinical presentation and response to treatment. Its treatment is poorly defined but the prognosis is usually favourable. Here we are reporting a rare, unusual clinical presentation of cervical lymphadenopathy and nasal mass diagnosed as RDD with cyto-histopathological correlation. Only a few such cases have been reported in the literature. We also emphasize that clinicians and pathologists should always be aware of RDD in making a differential diagnosis of cervical lymphadenopathy
Unilateral supernumerary kidney with contra lateral hydronephrosis-a rare case report
Get PDFSupernumerary kidney is the rarest of all renal anomalies; fewer than 80 cases have been reported in the literature over the years. Supernumerary kidneys are most commonly located on the left side of the abdomen. Different pathologic conditions are reported to affect supernumerary kidneys and they may be associated with malformations of the upper urinary tract and genital tract. Because of their infrequent occurrence and reporting, they frequently cause diagnostic challenges. Here we report a case in a 14-year-old male patient of unilateral supernumerary kidney on the right side of the abdomen with multiple calculi, mal-rotation and a gross hydronephrotic left kidney