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Year of Publication
1.  Vitamin B12 deficiency presenting as pancytopenia and retinopathy in a young boy—Helicobacter pylori, a novel causative agent 
The Australasian Medical Journal  2014;7(3):143-148.
Deficiency of vitamin B12 (cobalamin) is a well-known cause of megaloblastic anaemia. 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 individualising the treatment approach. Helicobacter pylorirelated (H. pylori) B12 deficiency presenting as pancytopenia in pediatric age groups has been reported. However, vitamin B12 deficiency presenting as retinopathy in paediatric 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.
doi:10.4066/AMJ.2014.1872
PMCID: PMC3973926  PMID: 24719649
Pancytopenia; retinopathy; Helicobacter pylori; vitamin B12 deficiency
2.  Acute coronary syndrome in Australia: Where are we now and where are we going? 
The Australasian Medical Journal  2014;7(3):149-156.
Background
Acute 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.
Aims
To 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.
Method
A 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:
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.
An exploration of the current landscape of ACS in Australia and identification of the disparities facing rural populations compared to those in metropolitan areas.
Discussion of the factors that are resulting in poorer outcomes for ACS sufferers and suggestions of novel approaches towards addressing these factors.
Conclusion
Disparities 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.
doi:10.4066/AMJ.2014.1921
PMCID: PMC3973927  PMID: 24719650
ACS; rural; metropolitan; Australia; outcomes
3.  Bilateral schizencephaly Type II 
The Australasian Medical Journal  2014;7(3):157-160.
Background
Schizencephaly is one of the most severe forms of neuronal migration defects and is an extremely rare cause of seizure disorder.
Case details
We report a case of bilateral schizencephaly (Type II) presenting as seizure disorder since birth.
Discussion
This case is rare because of the relatively benign features compared to other reported cases.
Conclusion
Compared to other cases, this patient has normal cognitive and motor functioning. Given the scant literature on schizencephaly in India’s paediatric population, this case highlights the possibility of a very rare entity associated with seizures. MRI can detect this condition.
doi:10.4066/AMJ.2014.1924
PMCID: PMC3973928  PMID: 24719651
Bilateral schizencephaly type II; seizure disorder
4.  Medicine shortages: Implications for the Australian healthcare system 
The Australasian Medical Journal  2014;7(3):161-163.
doi:10.4066/AMJ.2014.1943
PMCID: PMC3973929  PMID: 24719652
5.  Transient adrenal insufficiency and post-treatment bradycardia in scrub typhus – a case report 
The Australasian Medical Journal  2014;7(3):164-167.
Scrub typhus appears throughout the Asia-Pacific rim. This disease is known for its diverse clinical manifestations and complications. There is no literature on the association of scrub typhus with adrenal insufficiency. Relative bradycardia has been reported in scrub typhus during the febrile phase but not during convalescence. We report the case of a 45- year-old woman with scrub typhus whose blood pressure was persistently low due to acute adrenal insufficiency. Adrenal failure responded to supplementation with steroids. She also developed sinus bradycardia during the afebrile period following treatment.
doi:10.4066/AMJ.2014.1951
PMCID: PMC3973930  PMID: 24719653
Adrenal failure; scrub typhus; relative bradycardia; ACTH stimulation test
6.  Design of a new non-sterile glove-dispensing unit to reduce touch-based contamination 
The Australasian Medical Journal  2014;7(3):171-174.
Background
Despite best efforts by healthcare providers to sterilise their hands through hand washing prior to touching medical equipment and patients, bacteria are still present and can be spread through physical contact. We aimed to reduce the spread of touch-induced and airborne bacteria and virus spreading by using a touch-free glove-dispensing system that minimally exposes gloves in the box to air.
Method
The team met multiple times to undertake early prototyping and present ideas for the design. We experimented with folding gloves in varying patterns, similar to facial tissuedispensing boxes, and tried several methods of opening/closing the glove box to determine the most effective way to access gloves with the least amount of physical contact. We considered the user experience and obtained user feedback after each design iteration.
Results
Ultimately, we decided on a vertically oriented box with optional holes for dispensing a glove on the side of the box or on the bottom by means of the pull-down drawer mechanism. This system will dispense a single glove at a time to the user with the option of using a pull-down drawer trigger to decrease the likelihood of physical contact with unused gloves. Both methods dispense a single glove.
Conclusion
By reducing physical contact between the healthcare practitioner and the gloves, we are potentially reducing the spread of bacteria. This glove box design ensures that gloves are not exposed to the air in the clinic or hospital setting, thereby further reducing spread of airborne germs. This could assist in decreasing the risk of nosocomial infections in healthcare settings.
doi:10.4066/AMJ.2014.2043
PMCID: PMC3973931  PMID: 24719654
Disposable gloves; contamination; pathogens; clinic
7.  Western Australia coastal shark bites: A risk assessment 
The Australasian Medical Journal  2014;7(2):137-142.
Background
As Western Australia’s (WA) government enacts shark bite mitigation, the personal risk of shark bite in WA has not been studied.
Aims
Model the risk of large (>3m) white shark bite (Carcharodon carcharias, LWS) in southwest WA.
Method
An observational study inclusive of 1 January 1974 to 31 December 2013 was conducted. Analysis of prey abundance, location, water temperature, and water activity participation. Shark bite risk was benchmarked against serious or fatal recreational cycling crash risk in WA.
Results
Total and fatal shark bites have grown exponentially over 40 years (3 to 29 total, 0 to 7 fatal per 5 years), correlated with the 10 per cent annual growth in WA humpback whale (Megaptera novaeangliae) abundance (rtotal=0.96 95%CI 0.77–0.99, p<0.001; rfatal=0.96 95%CI 0.81-0.99, p<0.001) but not water activity participation rtotal= 0.25, 95%CI –0.45–0.76, p=0.48). LWS were implicated in 10 of 12 fatalities. Metropolitan Perth beach summer/autumn bathing less than 25m from shore in water less than 5m deep (risk lower than 1 in 20 years) is estimated to be at least 50x safer than cycling. Off-shore diving and surf sports off Perth, during winter/spring have a similar risk to cycling. Winter/spring off- shore diving south of Perth has between 3 and 11 times the cycling risk.
Conclusion
WA’s shark bite risk is likely to increase as whale abundance continues to increase off the WA coast. However, the risk to bathers less than 25m from shore in shallow water during the WA summer, is likely to remain very low, and well below the risk of other recreational activities undertaken in WA.
doi:10.4066/AMJ.2014.2008
PMCID: PMC3941575  PMID: 24611078
shark; injury; risk
8.  Shprintzen-Goldberg syndrome presenting as umbilical hernia in an Indian child 
Shprintzen-Goldberg syndrome (S-G) is a rare connective tissue disorder characterised by craniosynostosis, craniofacial dysmorphism, skeletal, cardiovascular, neurological, and other abnormalities. We herein present a case of a five-year-old Indian child who presented to our clinic with reducible umbilical hernia since birth, mental retardation, and delayed developmental milestones. After meticulous clinical examination with subsequent integration of clinical findings and investigations, we diagnosed her to possibly have Shprintzen-Goldberg syndrome. An attempt to compare the findings of our index case with the classical features as described by Greally et al. has been made. Given the rarity of this syndrome and the paucity of medical literature measuring the magnitude of this condition in the Indian population, this case serves to promote awareness of this rare entity.
doi:10.4066/AMJ.2014.1888
PMCID: PMC3941576  PMID: 24611072
Shprintzen-Goldberg syndrome; umbilical hernia; craniosynostosis; marfanoid habitus; Indian
9.  Current state of medical thromboprophylaxis in Australia 
Background
Australia 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.
Aim
To discuss and comment on the current standing of medical thromboprophylaxis in Australia.
Method
We 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.
Conclusion
Australian 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.
doi:10.4066/AMJ.2014.1915
PMCID: PMC3941577  PMID: 24611073
Thromboprophylaxis; low molecular weight heparin; risk factor analysis; medical patients; guidelines
10.  Carriage prevalence of carbapenem-resistant Enterobacteriaceae in stool samples: A surveillance study 
Background
With more people being exposed to antibiotics, intestinal microflora faces constant pressure of antibiotic selection, which has resulted in the emergence of multidrug resistant strains. This may pose a severe problem as intestinal Enterobacteriaceae members are commonly implicated in human infections.
Aims
This surveillance study was undertaken to investigate the carriage of carbapenem-resistant Enterobacteriaceae (CRE) in the gastrointestinal tract among patients attending the outpatient clinic in a tertiary care center of East Delhi, India.
Method
We performed a prospective surveillance study to screen 242 Enterobacteriaceae isolates for carbapenemase production from the stool samples of 123 outpatients attending a tertiary care hospital in East Delhi over a four-month period.
Results
Twenty-four (9.9 per cent) isolates demonstrated carbapenemase activity among 242 screened Enterobacteriaceae isolates. Four stool samples had two isolates of different species, both eliciting this feature and therefore indicating presence of multiple carbapenem-resistant Enterobacteriaceae (CRE) isolates in a single sample.
Conclusion
Screening for carriage of CRE in stools of patients undergoing elective or emergency gastrointestinal surgical procedures, with haematological malignancies taking chemotherapy, or those planned for bone marrow transplantation can guide clinicians about gut colonisation of multidrug-resistant Enterobacteriaceae as these groups of patients are at risk of possible endogenous infection.
doi:10.4066/AMJ.2014.1926
PMCID: PMC3941578  PMID: 24611074
Carbapenem resistant Enterobacteriaceae; gut colonisation; prophylactic antibiotic
11.  Rosai-Dorfman disease: A rare clinico-pathological presentation 
Rosai-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 emphasise that clinicians and pathologists should always be aware of RDD in making a differential diagnosis of cervical lymphadenopathy.
doi:10.4066/AMJ.2014.1931
PMCID: PMC3941579  PMID: 24611075
Rosai-Dorfman Disease; cervical lymphadenopathy; histiocytes; emperipolesis
12.  Antibiotic screening of urine culture as a tool for interal quality audit 
Background
Microbiologic culture of urine is an important component in the diagnosis of urinary tract infections (UTI). However, confounding factors like the patient’s current history of antibiotic usage can affect the interpretation of urine culture results.
Aims
This study was undertaken to find out the occurrence of unreported antibiotic consumption prior to urine culture and its clinical consequences.
Method
In this descriptive study conducted from February to August 2013, we tested consecutive urine specimens for the presence of antibiotics with a modified urine antibacterial substance assay (UABA) and compared the results obtained with the accuracy of antibiotic data entry on the accompanying request forms. In addition, the consequences of culturing urine specimens with incomplete antibiotic history received in the laboratory were investigated.
Results
Out of 2,040 urine specimens, 721 (35.34 per cent) were UABA positive. Comparison of antibiotic screening of urine with antibiotic data entry from request forms showed 1,299 (63.68 per cent) true-negative, 38 (1.86 per cent) true- positive, 20 (0.98 per cent) false-negative, and 683 (33.48 per cent) false-positive results. The sensitivity and specificity of this test were 65.52 per cent and 65.54 per cent, respectively. The positive and negative predictive values were 5.27 per cent and 98.48 per cent, respectively. The UABA had a positive diagnostic likelihood ratio of 1.901.
Conclusion
This internal audit demonstrates how the accurate history of current antibiotic usage in the request forms impacts the interpretation of urine culture results.
doi:10.4066/AMJ.2014.1956
PMCID: PMC3941580  PMID: 24611076
Antibiotic screening; internal audit; Antibiotic History; Urine culture
13.  The future of primary healthcare in Australia: Where to from here? 
doi:10.4066/AMJ.2014.1959
PMCID: PMC3941581  PMID: 24611077
14.  The current state of diabetes mellitus in India 
doi:10.4066/AMJ.2013.1979
PMCID: PMC3920109  PMID: 24567766
15.  Clinical profile of urinary tract infections in diabetics and non-diabetics 
Background
The risk of urinary tract infection (UTI) is higher in diabetics compared to non-diabetics. The aetiology 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 per cent of the patients (both diabetics and nondiabetics) presented with asymptomatic bacteriuria and the prevalence of pyelonephritis was significantly higher (p= 0.04) in diabetics compared to non-diabetic patients. The majority of the diabetics with UTI (87.14 per cent) had glycosylated haemoglobin (HbA1c) > 6.5 per cent with p < 0.001. The isolation rate of Escherichia coli (E. coli) from urine culture was higher (64.6 per cent) among diabetic patients followed by Klebsiella (12.1 per cent) and Enterococcus (9.9 per cent). The prevalence of extendedspectrum beta-lactamase (ESBL) producing E.coli was significantly higher in diabetics (p= 0.001) compared to nondiabetics. 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 (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.
doi:10.4066/AMJ.2014.1906
PMCID: PMC3920469  PMID: 24567764
Urinary tract infection; Asymptomatic bacteriuria; Uropathogens; Diabetic patients; E. coli
16.  Pharmacy practice and its challenges in Yemen 
Background
Pharmacy practice in Yemen was established in 1875 in Aden.
Objectives
To describe pharmacy practice as it currently exists in Yemen, the challenges the profession faces, and to recommend changes that will improve pharmaceutical care services.
Methods
This study has two parts. Part 1 comprised a literature search performed between May and July 2011 to identify published studies on pharmacy practice in Yemen. Full text papers, abstracts, and reports in Arabic or English between 1970 and 2011 were reviewed. Part 2 consisted of a qualitative study with face-to-face interviews with a representative sample of pharmacists, staff from the Ministry of Public Health and Population (MoPHP), and patients.
Results
The analysis revealed several issues that plague pharmacy practice in Yemen:
Fewer than 10 per cent of pharmacists working in pharmacies and drug stores are graduates of governmentrecognised colleges.
Most Yemeni pharmacists are dissatisfied with their work conditions and opportunities.
Medicines are expensive and hard to access in Yemen, and counterfeit medicines are a serious problem.
Few regulations and standards exist for pharmacists and pharmaceutical care.
Pharmaceutical marketing plays an important role in marketing and selling products in Yemen.
A dearth of standards, regulations, and laws are hurting pharmacy practice in the country and potentially endangering peoples’ lives.
Conclusion
In order to improve pharmacy practice in Yemen, many changes are needed, including updating the pharmacy curriculum taught, implementing industry standards for pharmacy practice, implementing and reinforcing laws, and integrating pharmacists more fully in the healthcare industry. Additionally, the quality of the pharmacy workforce needs to be improved, and there needs to be increased awareness by the public, physicians, other healthcare professionals, and policy makers about the value of pharmacists.
doi:10.4066/AMJ.2014.1890
PMCID: PMC3920470  PMID: 24567762
Pharmacy practice; workforce; satisfaction; challenges; recommendations and Yemen
17.  Hepatitis C, a silent threat to the community of Haryana, India: a community-based study 
Background
Hepatitis C is a global public health problem. As many as 12 million people may be chronically infected in India and most are unaware of it.
Aims
To determine the incidence of hepatitis C in the Ratia block of the Fatehabad district, Haryana, India.
Method
This cross-sectional study was carried out by house-tohouse visits over 2 weeks. After obtaining written consent, a blood sample was drawn from suspected cases by a laboratory technician maintaining all necessary safety precautions and sterilization.
Results
Of the samples, 1,630 (22.3 per cent) were found to be positive for hepatitis C by ELISA, 253 (15.5 per cent) patients were previously hepatitis C positive, and adults (21–60 years) were affected maximally (70.0 per cent).
Conclusion
The study emphasises the need for public awareness campaigns at various levels and prevention of HCV infection. It also suggests the need to develop and strengthen evaluation methodology for the Integrated Disease Surveillance Project (IDSP).
doi:10.4066/AMJ.2014.1883
PMCID: PMC3920471  PMID: 24567761
Hepatitis C; HCV; community
18.  An uncommon cause of ascites: spontaneous rupture of biliary cystadenoma 
Biliary cystadenomas are cystic hepatic tumours of biliary origin. Cystadenomas are often slow-growing benign tumours, but always harbour the risk of malignant transformation. Cystadenomas are often asymptomatic, but may present with abdominal pain and distension. Though suspected with cross-sectional abdominal imaging, definitive diagnosis almost always requires histology. Spontaneous rupture of cystadenoma had been reported three times in the medical literature to date, all presenting with peritonitis. Here we report a case of spontaneous intraperitoneal rupture of biliary cystadenoma presenting as ascites without peritonitis.
doi:10.4066/AMJ.2014.1875
PMCID: PMC3920472  PMID: 24567760
Nonparasitic hepatic cyst; abdominal pain; cystic neoplasm; leaking cyst
19.  Quality of patient health information on the Internet: reviewing a complex and evolving landscape 
Background
The popularity of the Internet has enabled unprecedented access to health information. As a largely unregulated source, there is potential for inconsistency in the quality of information that reaches the patient.
Aims
To review the literature relating to the quality indicators of health information for patients on the Internet.
Method
A search of English language literature was conducted using PubMed, Google Scholar and EMBASE databases.
Results
Many articles have been published which assess the quality of information relating to specific medical conditions. Indicators of quality have been defined in an attempt to predict higher quality health information on the Internet. Quality evaluation tools are scoring systems based on indicators of quality. Established tools such as the HONcode may help patients navigate to more reliable information. Google and Wikipedia are important emerging sources of patient health information.
Conclusion
The Internet is crucial for modern dissemination of health information, but it is clear that quality varies significantly between sources. Quality indicators for web-information have been developed but there is no agreed standard yet. We envisage that reliable rating tools, effective search engine ranking and progress in crowd-edited websites will enhance patient access to health information on the Internet.
doi:10.4066/AMJ.2014.1900
PMCID: PMC3920473  PMID: 24567763
Internet; health; patient information; quality evaluation
20.  Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia 
Background
Patient satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patient 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 explore the association between socio-demographic and other study variables and patient satisfaction level.
Method
A cross-sectional study was conducted using selfadministered 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 per cent. In this study, only approximately half of the participants (n=198, 45.5 per cent) 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 per cent) and were competent and sympathetic (n=231, 53.1 per cent). Almost half of the participants (n=215, 49.5 per cent) agreed that the doctors took their problems seriously. Only 174 (40 per cent) participants agreed that doctors had spent enough time on their consultation session. Some respondents (n=266, 61.2 per cent) 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 patient 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 patient satisfaction level. Other factors that influenced 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.
doi:10.4066/AMJ.2014.1936
PMCID: PMC3920474  PMID: 24567765
Patient satisfaction; quality of service; healthcare services; Malaysia
21.  Repeatable antibiotic prescriptions: an assessment of patient attitudes, knowledge and advice from health professionals 
Background
Previous Australian research has identified that general practice software systems appear to be associated with an increase in repeatable antibiotic prescriptions. Such prescriptions potentially facilitate the use of antibiotics without medical consultation and may be inconsistent with attempts to promote prudent use of antimicrobials.
Aims
We sought to assess knowledge and attitudes to antibiotics amongst patients presenting with a repeatable prescription; and the provision of supporting advice from healthcare professionals regarding use of these repeats.
Method
Six community pharmacies across Tasmania invited patients presenting with a repeatable antibiotic prescription to participate in the study. Participants were asked to complete a questionnaire and return this to the research team in a pre-paid envelope.
Results
Fifty-seven of 244 (23 per cent) surveys were returned. Regarding provision of advice on use of the repeat, 14 (25 per cent) of respondents stated that they were given no advice by the prescriber and 19 (30 per cent) no advice from the pharmacist. Five (9 per cent) were given no advice from either prescriber or pharmacist. One-third of respondents indicated that they would keep the repeat for future use and around three-quarters perceived no major safety concerns with antibiotics.
Conclusion
Further research is needed, however, this small study suggests that provision of information to patients regarding appropriate use of repeatable antibiotic prescriptions is suboptimal. This coupled with existing patient knowledge and attitudes may contribute to inappropriate use of antibiotics.
doi:10.4066/AMJ.2014.1871
PMCID: PMC3920475  PMID: 24567759
Antibiotic; prescription; repeat; patient; knowledge; attitude
22.  Detection of metallo-beta-lactamase producing Pseudomonas aeruginosa in intensive care units 
The Australasian Medical Journal  2013;6(12):686-693.
Background
Metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa has emerged as a threat to hospital infection control, due to its multi-drug resistance, especially in intensive care units (ICUs).
Aims
This study was carried out to detect MBL producing P. aeruginosa isolates from medical and surgical ICUs, to compare and evaluate different phenotypic methods currently in use and to determine antibiograms.
Method
A prospective study was undertaken to detect MBLs in P. aeruginosa isolates obtained from various clinical samples. A total of 49 strains were recovered from patients admitted in inpatient wards and ICUs, and screened for imipenem resistance by Kirby Bauer disk diffusion method. Detection of MBLs was further done by imipenem-EDTA disk synergy test and combined disk test.
Results
Out of 49 isolates, 11 isolates (22.4 per cent) were imipenem resistant. All 11 imipenem resistant P. aeruginosa strains, when further tested, were positive for MBL production by combined disk test, but, only eight showed positive results by imipenem-EDTA disk synergy test.
Conclusion
MBL production was the main resistance mechanism in the 11 carbapenem resistant P. aeruginosa isolates collected, with multidrug resistance associating significantly with MBL production in P. aeruginosa from our institution.
doi:10.4066/AMJ.2013.1824
PMCID: PMC3877850  PMID: 24391679
Metallo-beta-lactamases; infection control; Pseudomonas aeruginosa; Multidrug resistance
23.  Spontaneous coronary artery dissection causing myocardial infarction in an 18-year-old man: A case report 
The Australasian Medical Journal  2013;6(12):694-696.
Spontaneous coronary artery dissection (SCAD), an uncommon cause of myocardial infarction, typically affects a younger, otherwise healthy population. There are currently no known direct causes of this condition, although some correlations have been noted. Commonly found in women, the asymptomatic presentation in men is very rare. Herein, we report the case of an 18-year-old man who presented to our institution with asymptomatic myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. Until now, there is no specific guideline for SCAD. Choice of treatment should be tailored to the clinical condition of each individual patient.
doi:10.4066/AMJ.2013.1897
PMCID: PMC3877851  PMID: 24391680
spontaneous coronary artery dissection; myocardial infarction; young age; asymptomatic
24.  Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India 
The Australasian Medical Journal  2013;6(12):697-700.
Background
Acinetobacter species are gram-negative coccobacilli belonging to the group of Non-Fermenting Gram-Negative Bacilli, which are ubiquitous in nature. They cause outbreaks in intensive care units and healthcare settings, and are becoming increasingly drug resistant.
Aims
To determine the prevalence of multi-drug resistant Acinetobacter species from various clinical samples.
Method
Clinical samples were processed as per standard microbiological techniques. Antibiotic susceptibility testing was carried out on all the Acinetobacter isolates by Kirby- Bauer disc diffusion method as per CLSI guidelines.
Results
A total of 122 Acinetobacter spp. were isolated. 110 (90.16 per cent) were from inpatients, and 12 (9.83 per cent) were from outpatients. Out of 122 isolates, 44 (36.06 per cent) were from the ICU. The majority of the isolates, 47 (38.52 per cent), were from pus samples followed by 25 (20.49 per cent) from endotracheal tube aspirate. Out of 122 isolates, 87 (71.31 per cent) were multi-drug resistant of which 15 (12.29 per cent) were resistant to all drugs tested.
Conclusion
Acinetobacter infections associated with multi-drug resistant and pan-resistant strains have emerged as important nosocomial pathogens in our setting.
doi:10.4066/AMJ.2013.1901
PMCID: PMC3877852  PMID: 24391681
Acinetobacter; multi-drug resistance; clinical samples
25.  Comparing performance of Tabriz obstetrics and gynaecology hospitals managed as autonomous and budgetary units using Pabon Lasso method 
The Australasian Medical Journal  2013;6(12):701-707.
Background
Considering governmental scrutiny and financial constraints in medicine, the need for improved performance, which can provide acceptable care for medical consumers, leads to the conduct of new managerial methods to improve effectiveness.
Aims
This study aimed to compare performance indicators of obstetrics and gynaecology teaching hospitals in Tabriz.
Method
A longitudinal, retrospective study was conducted to compare performance indexes of Tabriz obstetrics and gynaecology teaching hospitals during 2010-2012. Al-Zahra is Tabriz’s central teaching hospital in obstetrics and gynaecology that is authorised under a board of trustees as an autonomous hospital and Taleghani hospital is managed under centralised administration. Study variables included: Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Bed Turnover Ratio (BTR). The data was extracted via the Hospital Information Systems (HIS) within the hospitals' admission and discharge units. Pabon Lasso model was used to assess hospital performance. Data was analysed and graphs were plotted using the SPSS-17 software package.
Results
According to study findings, overall ALOS in Al-Zahra hospital is 3.15 (2.15) days (1.88 (0.97) days for prenatal wards and 6.13 (0.97) days for neonatal wards) and ALOS in Taleghani Hospital is 3.37 (3.09) days (1.74 (0.14) days for perinatal wards and 5.96 (3.55) days for neonatal wards). In this regard, Al-Zahra hospital holds the maximum BOR with 86.92 per cent and the minimum BOR was attributed to Taleghani hospital at 68.44 per cent (P<0.001). Study findings indicate that BOR in neonatal wards is greater than prenatal wards. On the other hand, BOR in Al-Zahra is greater than Taleghani (P<0.001), whereas BOR trend shows an increasing pattern in both hospitals.
Conclusion
Results of this study showed that the performance of Al- Zahra Hospital is better than Taleghani Hospital. These two hospitals are similar in different aspects except Al-Zahra is under a board of trustees and Taleghani is not. We should also consider that Al-Zahra Hospital has more facilities than Taleghani.
doi:10.4066/AMJ.2013.1903
PMCID: PMC3877853  PMID: 24391682
Performance; Obstetrics and Gynaecology hospital; Pabon Lasso; Administration Models; Autonomisation

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