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1.  Catheter-directed thrombolysis for acute limb ischaemia: An audit 
The Australasian Medical Journal  2014;7(12):471-475.
Background
Acute limb ischaemia (ALI) is commonly managed with surgical intervention but catheter-directed thrombolysis (CDT) is a proven treatment alternative. CDT as a treatment for ALI is not common and is dependent on local practice. All patients receiving urokinase infusions at our institution currently require a bed in the high-dependency unit (HDU). Administering the infusion requires significant nursing time and this can be accommodated in HDU where the nurse-to-patient ratio is higher than it is on general wards.
Aims
To report the outcomes of the initial admission of patients who received CDT to manage ALI, and to give a cost estimate of their care.
Method
A retrospective audit was undertaken of all patients who received CDT with urokinase for the management of ALI over a four-year period. Success of thrombolysis was defined as a patient’s survival with no need for any surgical intervention prior to discharge. Outcome measures included the requirement for further vascular procedures in the same admission, the complication rate, and the median urokinase dose and duration. Cost estimates were based on hospital pharmacy and administration data.
Results
Seventy-three patients (median age 66 years, range 27–93 years) were included in the audit. The median urokinase dose was 2.3 million units (range 0.9–5.0 million units) with a median duration of treatment of 26 hours (range 3–96 hours). Fifty-seven patients did not require any further intervention prior to discharge, 14 had further intervention, and two died (one from a brainstem haemorrhage and one who deteriorated despite thrombolysis).
The total cost per CDT case at our institution is currently approximately AUD $4,500 and AUD $6,700 for a patient being treated in HDU for one and two days, respectively. If patients were treated on a general ward, the cost would be approximately AUD $2,600 and AUD $3,000, respectively.
Conclusion
Rates of clinically acceptable clot lysis were high for patients treated with urokinase for ALI. Complication rates were comparable with published studies. Infusions can be required for prolonged periods of time and given the low complication rate, managing patients on a general ward rather than in the HDU is a feasible alternative and would reduce costs substantially.
doi:10.4066/AMJ.2014.2065
PMCID: PMC4286578  PMID: 25646123
Acute limb ischaemia; Catheter-directed thrombolysis; Urokinase
2.  An educational intervention’s effect on healthcare professionals’ attitudes towards pharmacovigilance 
The Australasian Medical Journal  2014;7(12):478-489.
Background
Pharmacovigilance concerns the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. Consumer pharmacovigilance is the involvement of consumers in adverse drug reaction (ADR) reporting. Assessing healthcare professionals’ (HCPs) knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance is integral to strengthening adverse drug reaction reporting systems.
Aims
To study knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance among HCPs from KIST Medical College, Lalitpur, Nepal, and to plan an appropriate educational intervention to address deficiencies noted.
Method
The study was conducted from February 2013 to December 2013 at KIST Medical College using a self-administered, pretested, structured questionnaire. The maximum possible scores for knowledge, attitude, and total were 100, 95, and 195, respectively. Baseline knowledge and attitude were studied. Two months after the questionnaire, an intervention that used a combination of methods about pharmacovigilance and consumer pharmacovigilance was undertaken. Knowledge and attitudes were studied immediately after the intervention. Scores before and after the intervention were compared using Wilcoxon signed-rank test.
Results
A total of 105 HCPs participated. The median (interquartile range) knowledge, attitude, and total scores before the intervention were 56 (7), 72 (9), and 127 (16), respectively. After the intervention the scores increased significantly to 72 (8), 75 (11.5), and 146 (16.5) (p<0.001), respectively.
Conclusion
The intervention was effective in improving HCPs’ knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance. More studies on this topic among HCPs at other institutions and in the community are required.
doi:10.4066/AMJ.2014.2235
PMCID: PMC4286579  PMID: 25646124
Attitude; pharmacovigilance; consumer pharmacovigilance; healthcare professionals; Nepal
3.  Team-based learning as a teaching strategy for first-year medical students 
The Australasian Medical Journal  2014;7(12):490-499.
Background
Teaching programmes in medical education are now routinely employing active learning strategies to enhance the learning process and engage students in higher levels of learning. Team-based learning (TBL) is one active learning strategy that builds on individuals’ strengths by allowing them to collaborate and work as a team to achieve a common learning objective.
Aims
The present study aims to evaluate the impact of TBL on student performance. It also aims to assess students' attitudes towards TBL and the feasibility of its incorporation into the course curriculum.
Methods
From a class of 241 students, 128 who agreed to participate in the study underwent two sessions of TBL each consisting of Individual and Group Readiness Assurance Tests (IRATs and GRATs). The readiness assurance tests each had 13 multiple choice questions (MCQ). To analyse the impact of TBL supplementation, the median sessional MCQ scores of students who underwent TBL supplementation (group 1) were compared with those who did not undergo the session (group 2). Students' experiences with TBL and their attitudes towards incorporation of TBL into the course curriculum were analysed using a feedback questionnaire that was given to students who underwent TBL.
Results
Students belonging to the TBL group performed significantly better than the students who did not undergo TBL (p<0.001). The median sessional MCQ score of the TBL group was seven and non-TBL group was six. The overall mean attitude score obtained from feedback questionnaires was 3.57, which indicates a positive attitude towards TBL.
Conclusion
The team-based learning session improved student engagement with course content. The majority of the students felt that TBL supplementation enhanced their understanding of course content and believe that it will help them perform better in their exams.
doi:10.4066/AMJ.2014.2244
PMCID: PMC4286580  PMID: 25646125
Team-based learning; medical students; individual readiness assurance test; group readiness assurance test; active learning
4.  Satisfaction amid professional challenges: International medical graduates in rural Tasmania 
The Australasian Medical Journal  2014;7(12):500-517.
Background
At the time of recruitment, migration, and placement, international medical graduates (IMGs) encounter professional challenges. These challenges may include a loss of status and professional identity, professional isolation in rural practice, restrictions on medical practice, and social isolation. Understanding the nature of these challenges may facilitate the recruitment, placement, and success of international medical graduates within rural Tasmania.
Aims
The aim of this study was to investigate the experiences, challenges, and barriers that IMGs encounter as they work and live in rural Tasmania.
Methods
The study used a mixed-methods design where data were collected using a questionnaire and semi-structured interviews across the south, north, and northwest of Tasmania. IMGs were recruited through purposive snowball and convenience sampling.
Results
A total of 105 questionnaires were returned (response rate 30.0 per cent) and 23 semi-structured interviews were conducted with IMGs across Tasmania. Questionnaire participants indicated that the majority of IMGs are satisfied in their current employment; however, interview participants indicated there were a number of barriers to practising medicine in Tasmania as well as factors that would influence ongoing employment in the state. Despite these challenges, professional support was recognised as a key contributor to professional satisfaction, particularly among IMGs who had just arrived.
Conclusion
The study contributes to the current knowledge and understanding of IMGs who live and work in rural areas. The study shows that there are high levels of satisfaction among IMGs with their current position; however, the research also provides insight into the complexities and factors that impact IMGs as they work and live within rural areas such as Tasmania. This study offers an understanding for policy to improve greater retention of IMGs across rural areas.
doi:10.4066/AMJ.2014.2267
PMCID: PMC4286581  PMID: 25646126
international medical graduates; professional challenges; employment; satisfaction; rural practice
6.  Student feedback on problem-based learning processes 
The Australasian Medical Journal  2014;7(12):522-529.
Background
Problem-based learning (PBL) sessions consist of a brainstorming phase, search phase, individual study, and reporting phase. At the Xavier University School of Medicine, Aruba, PBL is a new learning modality first introduced in May 2013.
Aims
PBL processes have not been studied previously at the Xavier University School of Medicine, hence the present study was carried out to obtain information about the PBL processes and note differences, if any, among different groups of students.
Method
The study was conducted among first- to fourth-semester undergraduate medical students during July 2014 using a previously validated PBL processes instrument developed by van den Hurk et al. Information about gender, semester, weekly hours of study, and learning resources used was obtained. Respondents’ agreement with a set of 23 statements was noted using a Likert-type scale, which was scored as 1=totally disagree with the statement, 2=disagree, 3=neutral, 4=agree, and 5=totally agree with the statement. Mean scores were compared among different groups of respondents.
Results
Fifty-one of the 58 students (87.9 per cent) participated. The weekly average study time was 29.9 hours. Lecture handouts and textbooks were commonly used information sources. The mean scores (scale 1 to 5) for learning-issue-driven searching, and extensiveness of searching were 3.49 and 3.45, respectively. The score for explanation-oriented preparation was 3.94, while those for breadth and depth of discussion were 3.75 and 3.62, respectively. Most scores were higher among second-semester students, but the difference was not significant.
Conclusion
The self-reported scores were comparable to those reported in previous studies done using the same PBL processes instrument in other medical schools. At Xavier University School of Medicine interactive lectures are the major teaching method and topics covered during PBL are also likely to be covered during lectures, which could influence the scores. The findings of our study providing information about how students function during PBL brainstorming and presentation sessions and how they use different learning resources would be of interest to other medical schools worldwide following a hybrid curriculum. Further studies are required.
doi:10.4066/AMJ.2014.2208
PMCID: PMC4286583  PMID: 25646128
Medical school; presentation; problem-based learning; reporting; search; self-directed learning
7.  Congenital middle mesocolic hernia: A case report 
The Australasian Medical Journal  2014;7(11):432-435.
Internal hernia is herniation of a viscus, usually in the small bowel, through a normal or abnormal aperture within the peritoneal cavity. Its incidence has been reported to be one to two per cent. Internal hernias are classified based on location, and the hernial orifice can be either congenital or acquired. Paraduodenal hernias are the most common type (53 per cent). Paraduodenal hernia is often a misnomer and is referred to as a mesocolic hernia. Left and right mesocolic hernias are common, while middle and transverse types are rare. We are reporting a rare congenital middle mesocolic hernia presenting as a complete transection of the small intestine due to blunt injury to the abdomen.
doi:10.4066/AMJ.2014.2179
PMCID: PMC4259206  PMID: 25550713
Paraduodenal; internal hernia; blunt injury abdomen
8.  Cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome (CIKPLA) in Western Australia? 
The Australasian Medical Journal  2014;7(11):436-440.
Virulent serotypes of Klebsiella pneumoniae are recognised to cause metastatic infections at various sites. Prevalence of this invasive syndrome has been observed worldwide with predominance in Asian series. However, reports in an Australian setting have been limited. We report two cases of fulminating community-acquired invasive Klebsiella pneumoniae liver abscess syndrome occurring in two Caucasian patients, from two different, distant suburbs in Western Australia with no known clinical comorbidities prior to the hospital presentation and no history of recent travel overseas. The interval between both admissions was 18 days, where only one patient survived.
doi:10.4066/AMJ.2014.2188
PMCID: PMC4259207  PMID: 25550714
Interventional radiology; invasive liver abscess syndrome; Klebsiella pneumoniae
9.  Dengue co-infection in a blood stream infection caused by Stenotrophomonas maltophilia: A case report 
The Australasian Medical Journal  2014;7(11):441-444.
Stenotrophomonas maltophilia (S. maltophilia) is an emerging opportunistic bacterial pathogen with resistance to several commonly used antibiotics. Owing to its multidrug resistance (MDR), management of S. maltophilia blood stream infection (BSI) is challenging and requires the selection of appropriate antibiotic therapy. The presence of thrombocytopenia and shock are independent risk factors associated with increased mortality in patients with S. maltophilia BSI. We describe an unusual case of S. maltophilia BSI in a middle-age female complicated by dengue fever. We highlight the importance of early recognition of both dengue and S. maltophilia infection in management of such cases.
doi:10.4066/AMJ.2014.2205
PMCID: PMC4259208  PMID: 25550715
Stenotrophomonas maltophilia; Dengue fever; Blood stream infection
10.  The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students 
The Australasian Medical Journal  2014;7(11):448-453.
Background
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 a 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.
doi:10.4066/AMJ.2014.2211
PMCID: PMC4259209  PMID: 25550716
lecture; self-directed learning; physiology; medical education
11.  Young Australian adults’ reactions to viewing personalised UV photoaged photographs 
The Australasian Medical Journal  2014;7(11):454-461.
Background
Despite 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.
Aims
This study aims to explore young adults’ reactions to viewing a photoaged photograph of the sun damage already visible in their facial image.
Method
Semi-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).
Results
Three 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.
Conclusion
Although 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.
doi:10.4066/AMJ.2014.2253
PMCID: PMC4259210  PMID: 25550717
photoaged photography; young adults sun-tanning intentions; unprotected UVR sun exposure; skin-protective measures
13.  Proton pump inhibitors: Are we still prescribing them without valid indications? 
The Australasian Medical Journal  2014;7(11):465-470.
Background
Evidence 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.
Aims
We 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.
Method
We 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.
Results
From 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.
Conclusion
Inappropriate 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.
doi:10.4066/AMJ.2014.2093
PMCID: PMC4259212  PMID: 25550719
Proton pump inhibitors; prescribing; elderly; valid indications
14.  A study of acute otitis externa at Wellington Hospital, 2007–2011 
The Australasian Medical Journal  2014;7(10):392-399.
Background
Acute otitis externa (AOE) is a common inflammatory condition affecting the external ear that occasionally presents with persistent, severe pain, which may be unresponsive to first-line therapy and require assessment and treatment in the hospital setting.
Aims
To identify the microorganisms responsible for cases of otitis externa presenting to Wellington Hospital, New Zealand, over a five-year period between 2007 and 2011. We also aim to evaluate current management of this condition and to recommend future treatment options.
Method
A five-year retrospective study, with data obtained from case notes and electronic records for all patients presenting with otitis externa to Wellington Hospital between 2007 and 2011.
Results
Of 347 cases identified, 144 were included in the study. Pseudomonas aeruginosa (P. aeruginosa) was the most common organism (46.5 per cent), while Staphylococcus aureus (S. aureus) was the second most common (31.9 per cent). Most patients received appropriate topical treatment. However, a significant number were treated with systemic antibiotics alone without adverse outcomes.
Conclusion
Pseudomonas aeruginosa is the most common microbe causing acute otitis externa in patients that require hospital level management in Wellington, New Zealand. In most cases, patients received appropriate topical therapy; however, it appears a large number received systemic antibiotic therapy without topical treatment. We recommend broad-spectrum topical antimicrobial therapy in all patients with uncomplicated AOE and culture-sensitive topical treatment with consideration of systemic antimicrobials for severe AOE requiring hospital admission.
doi:10.4066/AMJ.2014.2094
PMCID: PMC4221774  PMID: 25379060
Acute otitis externa; microbiology; epidemiology
15.  Miliary tuberculosis with left brachial monoplegia: A case report 
The Australasian Medical Journal  2014;7(10):400-404.
Tuberculoma of the brain is a major neurological problem in developing countries accounting for 12 to 30 per cent of all intracranial masses. It often presents with focal neurological symptoms or seizures. Simultaneous occurrence of brain tuberculoma with miliary mottling in the lungs is uncommon in the immunocompetent patient. We report only the second case of monoplegia and miliary tuberculosis, wherein the patient presented with acute onset left brachial monoplegia, upper motor neuron facial palsy, and fever with an MRI of the brain showing multiple granulomas and chest x-ray showing miliary mottling. The patient’s neurological deficit started to resolve with corticosteroids and anti-tubercular treatment.
doi:10.4066/AMJ.2014.2169
PMCID: PMC4221775  PMID: 25379061
CNS tuberculoma; Miliary tuberculosis; Monoplegia
16.  SGLT2 inhibitors: New medicines for addressing unmet needs in type 2 diabetes 
The Australasian Medical Journal  2014;7(10):405-415.
The prevalence of type 2 diabetes mellitus (T2DM) is rising in Australia. Sodium glucose co-transporter 2 (SGLT2) inhibitors are an emerging treatment for T2DM. SGLT2 inhibitors offer a novel approach to lowering hyperglycaemia by suppressing renal glucose reabsorption and increasing urinary glucose excretion. The increased urinary glucose excretion has also been associated with caloric loss and osmotic diuresis. Dapagliflozin and canagliflozin are the SGLT2 inhibitors that are approved for clinical use in the US, the European Union (EU), and Australia. Their use results in reductions in HbA1c and body weight across a broad range of patient populations ranging from drug-naive patients to those who require additional therapy due to inadequate glycaemic control on their existing treatment. In addition, reductions in blood pressure (BP), particularly systolic BP, have also been noted. SGLT2 inhibitors are generally well tolerated with low rates of adverse events. Episodes of hypoglycaemia were mostly classified as minor, with low and balanced rates of severe hypoglycaemia across studies. The proportions of patients with genital infections and urinary tract infections were higher with dapagliflozin and canagliflozin versus their comparators. However, these infections were generally mild-to-moderate in intensity, treated with standard antimicrobial therapies, and rarely led to discontinuation. No dosage adjustments for dapagliflozin and canagliflozin are recommended for normal-to-mild renal impairment. Dapagliflozin and canagliflozin are not recommended for use in patients with eGFR<60 and <45mL/min/1.73m2, respectively. Overall, SGLT2 inhibitors have shown the potential to become an important addition to the treatment armamentarium for effective management of patients with T2DM.
doi:10.4066/AMJ.2014.2181
PMCID: PMC4221776  PMID: 25379062
Type 2 diabetes; SGLT2 inhibitors; management; renal
17.  Jejuno-jejunal intussusception: An unusual presentation of malignant melanoma 
The Australasian Medical Journal  2014;7(10):416-418.
Jejuno-jejunal intussusception is a rare mode of metastatic melanoma presentation, with only six cases being reported in the English medical literature to date. We present a case of a 55-year-old female who presented to us with features of obstruction. On exploration, it was discovered that she had jejuno-jejunal intussusception, with enlarged blackened mesenteric lymph nodes. Resection and anastomosis were performed. On further histopathological examination, a lesion was found to be a metastatic malignant melanoma.
doi:10.4066/AMJ.2014.2190
PMCID: PMC4221777  PMID: 25379063
jejuno-jejunal; intussusceptions; malignant; melanoma; metastasis
18.  An unorthodox innervation of the gluteus maximus muscle and other associated variations: A case report 
The Australasian Medical Journal  2014;7(10):419-422.
Knowledge of peripheral nerve morphology, location, and variation is important for facilitating appropriate diagnosis and intervention. We present a unique case of absence of the inferior gluteal nerve and high division of the sciatic nerve. In this instance, the common peroneal nerve was found piercing the piriformis muscle and emerging distally in the form of two trunks: thin medial and thick lateral. The medial trunk presented an interesting course, supplying the gluteus maximus muscle before joining the lateral trunk to form the common peroneal nerve. Additionally, the arteria nervi ischiadisci was also observed accompanying and supplying the tibial nerve passing inferior to the piriformis. These variations are important for clinicians and surgeons for some radiological diagnoses and surgical procedures in the lower limb.
doi:10.4066/AMJ.2014.2225
PMCID: PMC4221778  PMID: 25379064
Gluteus maximus; sciatic nerve; common peroneal nerve; inferior gluteal nerve; piriformis; arteria nervi ischiadisci
19.  Social media and the future of medicine 
The Australasian Medical Journal  2014;7(10):423-426.
doi:10.4066/AMJ.2014.2230
PMCID: PMC4221779  PMID: 25379065
20.  Hymenolepis diminuta infection in a school-going child: A rare case report 
The Australasian Medical Journal  2014;7(9):379-381.
Hymenolepis diminuta (H. diminuta) is a common parasite of rats and mice. It is very rare among humans. The life cycle of this parasite is completed in two hosts. Human beings are accidentally infected due to ingestion of infected fleas. Most of the time human infections are asymptomatic. We report a case of Hymenolepis diminuta infection in a school-going 10-year-old girl from a coastal village in south Tamil Nadu. Demonstration of H. diminuta eggs in the stool is the important diagnostic tool. Absence of polar filaments confirms the Hymenolepis diminuta. Praziquantal is the drug of choice.
doi:10.4066/AMJ.2014.2136
PMCID: PMC4185331  PMID: 25324904
Hymenolepis diminuta; rat tapeworm
21.  Clinical handover: An audit from Australia 
The Australasian Medical Journal  2014;7(9):363-371.
Background
The Australian National Safety and Quality Health Service (NHQHS) Standards (the “Standards”) provide external criteria for hospitals to assess their practices. Since the introduction of the Standards, no Australian hospital has published a report on how its handover practices compare to these Standards.
Aims
To evaluate house medical officer (HMO) shift-to-shift handover practices against the Standards at a large regional hospital.
Method
All HMOs employed by Barwon Health were invited to participate in our qualitative and quantitative study by completing an online questionnaire and taking part in a focus group.
Results
Of the 100 HMOs, 61 completed the questionnaire and 11 HMOs participated in focus groups. Questionnaire results revealed that HMOs were concerned about the quality of shift-to-shift handovers. Fifty-three per cent reported that current shift-to-shift handover practices could be putting patients at risk of adverse events. Ninety-eight per cent indicated that the handover processes could be improved. One hundred per cent of the HMOs stated that the quality of handover varies according to the doctors involved. In the focus groups, issues were raised about current handover structure, documentation, attendance, content, and training.
Conclusion
HMOs in the current study identified multiple deficiencies in handover practice with regard to structure, documentation, attendance, content, and training. The primary methods to improve handover include making it more structured and standardised, and to provide HMOs with handover training.
doi:10.4066/AMJ.2014.2060
PMCID: PMC4185328  PMID: 25324901
Handover; House Medical Officer; Shift-to-shift; Communication; Accreditation
22.  Metastatic parathyroid carcinoma treated with radiofrequency ablation: A novel therapeutic modality 
The Australasian Medical Journal  2014;7(9):372-375.
Parathyroid carcinoma (PCA), accounting for less than one per cent of all endocrine malignancies, is a rare cause of primary hyperparathyroidism. A diagnosis of parathyroid carcinoma may be challenging in the presence of localised disease and involves a histological diagnosis based on capsular, vascular, or perineural invasion or the presence of metastasis. Distant metastasis remains a rare presentation, with the lung being the most common site. Surgery remains the treatment of choice as radiotherapy and chemotherapy have proved to be of limited benefit in metastatic disease. This case reports suggests that radiofrequency ablation has the potential to be a novel and effective treatment option in these patients.
doi:10.4066/AMJ.2014.2084
PMCID: PMC4185329  PMID: 25324902
Parathyroid; carcinoma; radiofrequency; metastasis
23.  Acute multiple cranial neuropathy: An oculopharyngeal variant of Guillain-Barré Syndrome 
The Australasian Medical Journal  2014;7(9):376-378.
We 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.
doi:10.4066/AMJ.2014.2123
PMCID: PMC4185330  PMID: 25324903
Multiple cranial nerve palsy; Guillain-Barré syndrome; Oculopharyngeal GBS
25.  NK/T cell lymphoma with inverted papilloma: A rare coexistence 
The Australasian Medical Journal  2014;7(8):318-322.
Natural killer/T-cell (NK/T) lymphomas are an infrequent tumour type of NK and NK-T cells commonly occurring in the upper aero-digestive tract. Most reported cases in the literature are random solitary cases of NK/T-cell lymphoma. A 35-year-old male farmer from Sikkim reported to our institution with NK/T-cell lymphoma (nasal type) with coexistent inverted papilloma of the nose. This case is being reported due to the unique and unusual simultaneous occurrence of these two tumour entities.
doi:10.4066/AMJ.2014.2025
PMCID: PMC4157151  PMID: 25279007
NK/T-cell lymphoma; inverted papilloma; nasal; tumour co-existence

Results 1-25 (366)