Community pharmacies in Nepal serve both rural and urban populations and are an integral part of the Nepalese healthcare system. These community pharmacies are run by non-pharmacist professionals with orientation training on pharmacology and drug dispensing. Graduate pharmacists’ involvement in community pharmacy will help with patient counselling, dispensing of medication and promotion of safe and appropriate medicine use. Nepal has an organised pharmacovigilance system which incorporates adverse drug reaction (ADRs) from hospitals and tertiary care centres but not from the community. Involvement of pharmacists in community pharmacy will help in ADR reporting and, monitoring at community level and will help in promoting medication safety in the community. This article describes the community pharmacovigilance program in Nepal and the prospects for community pharmacists.
Community Pharmacy; Adverse Drug Reaction; Pharmacist; Nepal
Endophthalmitis is a serious post-traumatic ocular complication that can lead to loss of vision. We report a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an unusual organism, Brevibacterium casei . The patient was successfully treated with intravitreal antibiotics like ceftazidime and vancomycin, along with topical cefazolin and tobramycin. Brevibacterium casei can be added to the list of rare bacteria causing endophthalmitis and should be kept in mind by clinicians as a potential source of pathology.
Ocular complications; Endophthalmitis; Brevibacterium casei
Neonatal sepsis is a leading cause of neonatal mortality. Congenital heart disease accounts for additional risk of sepsis in neonates. Here we report a case of Down’s syndrome with late onset neonatal sepsis associated with multiple superficial skin abscesses simulating staphylococcal infection. The baby was empirically treated with vancomycin. Subsequently, multidrug resistant Klebsiella pneumoniae was detected from both pus and blood culture. Change to appropriate antibiotic resulted in clinical recovery. Although sepsis is one of the major ailments in neonates, atypical presentations of neonatal sepsis in Down’s syndrome patients are underreported. Here we highlight the atypical presentation of Klebsiella sepsis and the importance of early antibiogram in such cases.
Down’s syndrome; Klebsiella pneumoniae; Extended spectrum beta-lactamase; Neonatal sepsis
Patient decision aids (PDAs) help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs’ design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.
Patient decision aids; shared decision making; health innovation
Mycoplasma pneumoniae is common agent causing community acquired pneumonia in children. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a five-year-old child with massive pleural effusion and empyema secondary to Mycoplasma pneumonia infection. This potential yet rare source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.
Mycoplasma pneumoniae; Pleural Effusion; Empyema
Lamin A/C gene-related cardiomyopathy is associated with progressive heart failure and malignant arrhythmias. Current guidelines advise the use of implantable defibrillators to prevent arrhythmogenic sudden cardiac death only in situations where there is evidence of severe left ventricular dysfunction. We describe a case of a woman with genetically confirmed Lamin C deficiency with preserved left ventricular function in whom an implantable defibrillator was inserted and within a month of implantation was used to terminate symptomatic ventricular tachycardia.
Lamin A and C deficiency; Dilated Cardiomyopathy; Sudden Cardiac Death
A major focus of the medical school curriculum is to ensure medical students are well prepared prior to entering clinical rotations, which includes the compulsory surgical rotation.
The objective of this research was to design and formally evaluate a set of real-life surgical workshops aimed at better preparing medical students for their clinical rotation in surgery. These workshops would be incorporated into the pre-clinical medical school curriculum.
Dedicated surgical workshops were introduced into the preclinical component of the Bachelor of Medicine/Bachelor of Surgery (MBBS) program at our University in 2009. These workshops encompassed training in the clinical skills needed in the perioperative and wider hospital setting. A survey comprising of eight to nine ranked questions (utilising a five-point Likert Scale) as well as three short answer questions was administered to the medical students after they completed their compulsory surgical clinical rotation.
The overall response rate to the survey evaluating the surgical workshops was 79% (123/155). The mean of the ranked questions ranged from 4.05 to 4.89 which indicated that the students found the workshops useful. When evaluating the short answer questions (via topic coding), additional information was provided that supported and explained the survey findings and also included suggestions for improvements.
The findings of the medical student survey demonstrated the value of incorporating dedicated preparatory surgical workshops in the medical school pre-clinical curriculum. However, further research is warranted to determine if this inclusion translated into improved student performance during the clinical surgical rotation.
Medical student preparation; surgical rotation; simulation
Endomyocardial fibrosis (EMF) is a progressive type of restrictive cardiomyopathy. It affects inflow portion of right and/or left ventricle and apex. It is a neglected tropical disease. Here we report a rare case of right ventricular endomyocardial fibrosis. A 70-year-old female presented to us with history suggestive of right-sided heart failure of two months duration. There was no eosinophilia. Chest X-ray showed cardiomegaly. Echocardiogram showed dilated right atrium and obliteration of the apex of the right ventricle. A diagnosis of Right ventricular Endomyocardial fibrosis was made. She was treated with diuretics and anticoagulants and she improved.
Endomyocardial Fibrosis; Restrictive cardiomyopathy; Right heart failure
This paper explores the role of empathy within new product development from the perspective of human-centred design. The authors have developed a range of empathic design tools and strategies that help to identify authentic human needs.
For products and services to be effective, they need to satisfy both functional and emotional needs of individuals. In addition, the individual user needs to feel that the product and/or service has been designed ‘just for them’, otherwise they may misuse, underuse or abandon the product/service. This becomes critical with a product such as a Zimmer frame (walker), when it fails to resonate with the patient due to any stigma the patient may perceive, and thus remains unused.
When training young designers to consider the wider community (people unlike themselves) during the design process, it has proven extremely valuable to take them outside their comfort zones, by seeking to develop empathy with the end user for whom they are designing. Empathic modelling offers designers the opportunity to develop greater insight and understanding, in order to support more effective design outcomes. Sensitising designers to the different ways that individuals complete daily tasks has helped to diminish the gap between themselves and others (e.g. people with disabilities).
The authors intend for this paper to resonate with health care providers. Human-centred design can help to refocus the designer, by placing the individual end user’s needs at the heart of their decision-making.
Empathy; human-centred design; research strategies; shared language; authentic human behaviour
Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Innovation; primary health care; health promotion
Software development is hard enough for specialist software companies to get right. For people outside the industry it can be a minefield full of hidden surprises. This articles hopes to explain why software development is so hard, how to go about approaching a software development project, and how to get the best out of any collaboration with a development team. It should be read by anyone who is considering developing a software product, including websites, from a non-development.
Software development; Agile methodology; Software product
Comprehensive health promotion in Western Australia has been conducted from the point of views of policy development, promotion, education and service delivery. Much of this recent work has been focused on supporting workplaces – but there has yet to be any real focus on the design of the actual physical workplace environment from a health promotion perspective.
This paper is aimed at highlighting the gap in health promotion knowledge by addressing how the disciplines of architecture and health promotion can work together to challenge the regulations that dictate design practice and ultimately bridge that gap for long-term change. The overarching aim is to undertake further evidenced-based research that will inform best practice in the planning and design of workplaces to reduce sedentary behaviour and increase opportunities for physical activity.
Within this wide objective this paper focuses in particular on the idea of stairs-versus-lift movement strategies within office buildings. By examining building design guidelines from a health promotion perspective we expose a central dichotomy, where health promotion posters say “Take the stairs instead” whereas the language of building design suggests that the lift is best.
From a design point of view, the National Codes of Construction (NCC), formally known as the Building Codes of Australia (BCA), the essential technical regulation for all building design and construction, primarily addresses the concepts of ‘egress’ and ‘travel distance’ for escape in the event of fire, and building access in terms of universal access. Additionally, The Property Council of Australia’s Guide to Office Building Quality prioritises lift performance criteria along with the quality and experience of lift use as a major grading factor. There is no provision in either set of standards for staircase quality and experience.
The stairs, despite being promoted as better life choice for better health, is not promoted through these building codes nor, consequently, through the building design in actuality. It is proposed that health promotion strategies could be coupled with design-led movement strategies in workplace design so that the promotional language, such as “take the stairs instead”, is balanced by the design language of the building.
Workplace; design; stairs; health promotion; sedentary behaviour
Building alliances with industrial designers offers health innovators a unique pathway to create new modes to serve their patients. Cross-pollination of ideas from the earliest stages of development in interdisciplinary research and development teams including major stakeholders and designers can lead to more meaningful and impactful innovations.
A shift in future healthcare from cure to prevention will rely more heavily upon the individual. The home environment will house consumer medical devices that will carry out basic monitoring of the individual. While technologies are currently being developed to support this trend, there is a gulf that exists between the often-complex interfaces required by the highly specific functionality of products and the emotional needs of the target user. If a target user ‘feels’ a product was designed ‘just for them’ they are more likely to develop an emotional bond with that product. This manifests itself in the user engaging and interacting with the product. If a product, regardless of its high functionality, does not resonate with the user, this tends to result in product underuse, misuse and possible abandonment. When those products are related to a course of medical rehabilitation or treatment, these results could be translated to ‘more compliant’ and ‘less compliant’ and ultimately can impact upon how a person heals.
Industrial designers focus on ensuring that both the functional and emotional needs of mainstream users as well as technical-expert-users are met. Design research provides the opportunity to bridge the gap between the functional requirements and the less tangible unmet needs of the user by exploring authentic human behaviour.
This paper presents case studies of collaborative, interdisciplinary teams employing human-centred design and empathic research strategies (incorporating shared language, collaboration, ethnography, empathy and empathic modelling) to create real solutions that are responding to real needs of real users.
The future is interdisciplinary. The future is bright.
Human-centred design; research strategies; emotional needs; authentic human behaviour
This editorial will consider the challenge of innovation for healthcare from three perspectives: the general practitioner (GP), the patient and the policy maker. The knowledge, attitudes and beliefs of each, respectively, are likely to affect the type of innovation adopted in practice. Each stakeholder has priorities and needs that must be reflected in the design and implementation of innovations.
The development of innovations for clinical practice warrants active engagement of clinicians in the research process. This requires attention to factors that serve as incentive to participate. The explanation for the success of factors that encourage practitioners to participate in research can be found in sources of satisfaction and dissatisfaction with clinical practice. It is also important to consider intrinsic incentives such as common and troublesome clinical presentations that are related to workload or unsatisfactory clinical encounters. This review will consider each of these factors and suggest ways in which clinicians, especially general practitioners, may be invited to assist on research projects.
Research; general practice; innovation; workload
The ability to communicate to others and express ourselves is a basic human need. As we develop our understanding of the world, based on our upbringing, education and so on, our perspective and the way we communicate can differ from those around us. Engaging and interacting with others is a critical part of healthy living. It is the responsibility of the individual to ensure that they are understood in the way they intended.
Shared language refers to people developing understanding amongst themselves based on language (e.g. spoken, text) to help them communicate more effectively. The key to understanding language is to first notice and be mindful of your language. Developing a shared language is an ongoing process that requires intention and time, which results in better understanding.
Shared language is critical to collaboration, and collaboration is critical to business and education. With whom and how many people do you connect? Your 'shared language' makes a difference in the world. So, how do we successfully do this? This paper shares several strategies.
Your sphere of influence will carry forward what and how you are communicating. Developing and nurturing a shared language is an essential element to enhance communication and collaboration whether it is simply between partners or across the larger community of business and customers. Constant awareness and education is required to maintain the shared language. We are living in an increasingly smaller global community. Business is built on relationships. If you invest in developing shared language, your relationships and your business will thrive.
Language; communication; creativity; design coaching; empathy
Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of “health smart cards” that carry vital patient medical information in the form of a “credit card” or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.
Health innovation; patient safety
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Despite efforts to tackle CVD, its prevalence continues to escalate in almost every country. The problem requires an exploration of novel ways to uncover solutions. Health innovations that embrace new knowledge and technology possess the potential to revolutionize the management of CVD. Using findings from published studies on CVD, researchers generated innovations in the areas of global risk assessment, home and remote monitoring and bedside testing. The use of pharmacogenetics and methods to support lifestyle changes represent other potential topics for innovations. Gaps in existing knowledge and practice of CVD provide opportunities for the development of new ideas, practices and technology. However, healthcare professionals need to be cognisant of the limitations of health innovations and advocate for safeguarding patients’ wellbeing.
Health innovations; cardiovascular diseases
Significant amounts of medical data are being archived, in the hope that they can be analysed and provide insight. A critical problem with analysing such data is the amount of existing knowledge required to produce effective results.
This study tests a method that seeks to overcome these problems with analysis, by testing it over a large set of archived lung function test results. A knowledge base of lung function interpretation expertise has been compiled and serves as a base for analysis.
A user examines the dataset with the assistance of the knowledge discovery tool. Two pertinent respiratory research questions are analysed (the relative correlation between diffusing capacity and FEV1 or FVC bronchodilator response, and the effects of BMI on various parameters of lung function), and the results compared and contrasted with relevant literature.
The method finds interesting results from the lung function data supporting and questioning other published studies, while also finding correlations that suggest further areas of research.
While the analysis does not necessarily reveal groundbreaking information, it shows that the method can successfully discover new knowledge and is useful in a research context.
Lung function; knowledge discovery; knowledge acquisition; data mining; MCRDR
Skeletal metastases in oncology patients are identified by Bone scan and/Positron Emission Tomography (PET) scan. But developing countries in the world still lack adequate numbers of these imaging facilities.
Since Magnetic Resonance Imaging (MRI) is widely available as compared to bone scan or PET scan; a double blind study was undertaken to see if whole body imaging with MRI can give an idea of skeletal metastases.
Diffusion weighted whole body Magnetic Resonance Imaging with background body signal suppression (DWIBS) was performed using 1.5 Tesla (T) MRI on histopathologically proven cases of carcinoma of breast within two months of mastectomy and followed up after a year of surgery. Similarly bone scan was also performed in these patients.
DWIBS MRI demonstrated the presence and extent of bone metastases in 10 out of a total 18 patients included in study while bone scan could demonstrate them in only three cases. A highly significant difference between proportions of the skeletal metastases detected by whole body DWIBS-MRI than that by bone scan at one year follow-up. (i.e. p<0.01, z=2.66) was seen.
DWIBS MRI scores high in demonstrating skeletal metastases. Further comparative studies are necessary to evaluate if DWIBS can replace bone scan or PET scan.
Skeletal Metastases; DWIBS MRI; Bone scan; PET scan; Cancer imaging; Onco Imaging; Whole Body Imaging
A group of individuals who share common beliefs form a culture in which they communicate their values and attributes about certain aspects of society. Sex education remains one of the early teachings that humans experience irrespective of the race or level of development of a given society. However, different cultures perceive sex education differently due to differences in attitudes and beliefs, leading to significant diversity in the management of sex education among different societies across the globe. Many studies have found that in a traditional society with a homogeneous culture, the foremost reason for the different approaches to sex education is related to traditional values, in addition to other factors such as religion and political belief. In order to improve sex education, and consequently, sexual health in a modern multicultural society such as Australia, it becomes imperative to identify the inconsistency in beliefs about sex education among individuals with different cultural backgrounds in the Australian population. In this report, the author highlights similarities and differences in the methods employed by certain cultures of the Australian population. The report considers the different cultural environments of specific societies, the prevalence of sex education in these societies and how culture influences the prevalence. The concluding thoughts reflect on the success of the education programs in Australia, based on the idea that resolving the problems of sex education needs support from a number of bodies within Australian society.
Sex education; multiculturalism; sexual health
Diabetes Mellitus (DM) is a chronic disease that carries a significant disease burden in Australia and worldwide. The aim of this paper is to identify current barriers in the management of diabetes, ascertain whether there is a benefit from early detection and determine whether LDF has the potential to reduce the disease burden of DM by reviewing the literature relating to its current uses and development. In this literature review search terms included; laser Doppler flowmetry, diabetes mellitus, barriers to management, uses, future, applications, vasomotion, subcutaneous, cost. Databases used included Google Scholar, Scopus, Science Direct and Medline. Publications from the Australian government and textbooks were also utilised. Articles reviewed had access to the full text and were in English.
Diabetes Mellitus; Laser Doppler Flowmetry; Vasomotion; Pre-diabetes.