Australasian Medical Journal
Not a member yet
1482 research outputs found
Sort by
Clinical profile of urinary tract infections in diabetics and non-diabetics
Get PDFBackground The risk of urinary tract infection (UTI) is higher in diabetics compared to non-diabetics. The etiology and the antibiotic resistance of uropathogens have been changing over the past years. Hence the study was undertaken to determine if there are differences in clinical and microbiological features of UTI between diabetic and non-diabetic subjects, to study the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern in patients with UTI. Method A total of 181 diabetics (83 males and 98 females) and 124 non-diabetic subjects (52 males and 72 females) with culture positive UTI were studied. Patients with negative urine culture (n=64), those diagnosed and treated outside (n=83) and not willing to participate in the study (n=24) were excluded. Results Almost 30% of the patients (both diabetics and non-diabetics) presented with asymptomatic bacteriuria and the prevalence of pyelonephritis was significantly higher (p-0.04) in diabetics compared to non-diabetic patients. Majority of the diabetics with UTI (87.14 %) had HbA1c > 6.5 % with p < 0.001. The isolation rate of Escherichia coli from urine culture was higher (64.60%) among diabetic patients followed by Klebsiella (12.10%) and Enterococcus (9.90%). The prevalence of extended-spectrum beta-lactamase (ESBL) producing E.coli was significantly higher in diabetics (p- value 0.001) compared to non-diabetics. E.coli showed maximum sensitivity to carbapenems in both diabetic and non-diabetic subjects and least susceptibility to ampicillin. Conclusion The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate. Elevated glycosylated hemoglobin predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications
Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia
Get PDFBackground Patients’ satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patients’ satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations. Aims The study aimed to assess patients’ level of satisfaction with public healthcare services and to determine the factors that may influence their satisfaction level. Method A cross-sectional study was conducted using self-administered questionnaires distributed to a convenience sample of the general public in Kedah, Malaysia. Results A total of 435 out of 500 people invited to participate in the study agreed to take part, giving a response rate of 87%. In this study, only approximately half of the participants (n=198, 45.5%) were fully satisfied with the current healthcare services. The majority of the participants agreed that doctors had given enough information about their state of health (n=222, 51%) and were competent and sympathetic (n=231, 53.1%). Almost half of the participants (n=215, 49.5%) agreed that the doctors took their problems seriously. Only 174 (40%) participants agreed that doctors had spent enough time on their consultation session. Some 266 (61.2%) respondents agreed that healthcare professionals in the public health sector were highly skilled. The majority of the respondents described amenities, accessibility and facilities available in the public healthcare sector as good or better. In this study, waiting time was significantly associated with patients’ satisfaction as the results showed that those who waited longer than two hours were less satisfied with the services than those who waited under two hours. Conclusion The study findings showed that approximately half of the respondents were fully satisfied with current healthcare services. In this study, waiting time was the main factor that affected the patients’ satisfaction level. Other factors that influenced the satisfaction level included the length of consultation sessions and the process of patient registration. Hence, improvement in the health services that leads to a shorter waiting time may increase the satisfaction level of patients
The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students
Get PDFBackground Self-directed learning (SDL) has become popular in medical curricula and has been advocated as an effective learning strategy for medical students to develop competence in knowledge acquisition. Aims The primary aim was to find out if there was any benefit of supplementing self-directed learning activity with a traditional lecture on two different topics in physiology for first-year medical students. Method Two batches of first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) (Batch A and Batch B) comprising 125 students each, received an SDL session on Morphological classification of anaemia. The students belonging to Batch A received a one-hour lecture on the same topic three days prior to the SDL session. The students were given 10 multiple choice questions (MCQ) test for a maximum of 10 marks immediately following the SDL session. The next topic, Conducting system of the heart, disorders and conduction blocks was taught to both batches in traditional lecture format. This was followed by an SDL session on the same topic for Batch A only. The students were evaluated with a MCQ test for a maximum of 10 marks. Results The mean test scores on the first topic were 4.38±2.06 (n=119) and 4.17±1.71 (n=118) for Batch A and Batch B, respectively. The mean test scores on the second topic were 5.4± 1.54 (n=112) and 5.15±1.37 (n=107) for Batch A and Batch B, respectively. There was no significant difference between the groups. Conclusion For first-year medical students, SDL is an effective teaching strategy for learning physiology. However, no additional benefit is gained by supplementing SDL with a lecture to facilitate learning physiology.
The current status of medical thromboprophylaxis in Australia
No full textBackgroundAustralia has two published national guidelines for general medical thromboprophylaxis (MT), but the two differ in detail and the basis for patient selection remains uncertain. Several aspects of current guidelines are controversial, as is the proposed design of a dedicated prescribing box in the National Inpatient Medication Chart. AimTo discuss and comment on the current standing of medical thromboprophylaxis in Australia. MethodWe have marshalled literature known to us from our previous published research, and have applied this knowledge to discuss shortcomings, which, in our opinion, exist in current medical thromboprophylaxis practice, and to suggest solutions. ConclusionAustralian guidelines are flawed because they are based on unsuitable evidence (incidence of subclinical thrombotic disease) and define eligibility broadly, such that about 80 per cent of patients are considered eligible. They urge that prescribers should “consider” prophylaxis without supplying an adequate basis for doing so. They do not provide grounds for assessing the balance between hazard (in the form of major bleeds) and benefit (thrombotic events avoided). Other clinical factors promoting unnecessary use of medical thromboprophylaxis include the use of age as a risk factor and proposed inclusion of a new DVT prophylaxis section in the National Inpatient Medication Chart (NIMC), which implicitly discourages non-prescription of prophylaxis
Vitamin B12 deficiency presenting as pancytopenia in a young boy--Helicobacter Pylori, a novel causative agent
No full textDeficiency of vitamin B12 (cobalamin) is a well-known cause of megaloblastic anemia. It is a reversible cause of bone marrow failure and demyelinating nervous system disorder, hence early detection and prompt treatment of vitamin B12 deficiency is essential. After diagnosing vitamin B12 deficiency, tracking down its root cause is important in individualizing the treatment approach. Helicobacter pylori-related (H. pylori) B12 deficiency presenting as pancytopenia in pediatric age groups has been reported. However, vitamin B12 deficiency presenting as retinopathy in pediatric age groups has been rarely reported in the medical literature. We herein present the case of an adolescent male with pancytopenia and retinopathy, secondary to vitamin B12 deficiency-associated H. pylori infection
Acute Multiple Cranial Neuropathy-a cranial variant of Guillain Barre Syndrome
No full textWe report the case of a 20-year-old male who presented to us with acute bilateral multiple cranial neuropathy in the form of bilateral total ophthalmoplegia and bulbar dysfunction. The patient had normal haematological and biochemical investigations, however, cerebrospinal fluid (CSF) analysis showed raised protein (96mg/dl) in the second week of illness. Peripheral nerve conduction studies and an MRI of the brain were normal. The patient showed gradual improvement after three weeks of supportive treatment. Considering the course of illness and the clinical and investigational profile, a diagnosis of an oculopharyngeal variant of Guillain-Barré syndrome (GBS) was made
