Cutaneous or umbilical endometriosis is a rare entity that is often overlooked because of chronic abdominal pain. We present a case of umbilical hernia that presented to the general surgeons due to chronic abdominal pain and nodule in the umbilicus, which was clinically diagnosed as umbilical papilloma.
A 48-year old multiparous Caucasian woman presented with painful nodule in the umbilicus for two and half years. The nodule was excised and the histopathological diagnosis was umbilicus endometriosis.
Umbilical endometriosis is a very rare disease but should be considered as a differential diagnosis in women presenting with umbilical swelling.
Endometriosis; Umbilical endometriosis; Papilloma
We report a case of laryngeal tuberculosis in a 47-year-old Korean man. Laryngeal tuberculosis is rare and currently accounts for less than 1% of all cases of tuberculosis. Clinical features of laryngeal tuberculosis include hoarseness, odynophagia and dyspnoea. Macroscopically, laryngeal tuberculosis may mimic laryngeal carcinoma, chronic laryngitis or laryngeal candidiasis. The diagnosis is often delayed due to a low index of clinical suspicion and hence may pose a significant public health risk. Laryngeal tuberculosis should be considered in the differential diagnosis of patients who present with any form of laryngeal lesion.
Larynx; Tuberculosis; Diagnosis
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.
The e-patient revolution increasingly enables patients to self diagnose and self educate, influencing decisions affecting their health. This poses a challenge for both patients and health care professionals due to the highly variable and often poor quality information available on the internet.
This study aims to measure the current internet usage in patients attending outpatient clinics, in both a public and private setting. All patients were recruited whilst consulting orthopaedic surgeons.
We developed a 29 question survey which asked questions related to patient demographics, general internet usage and internet usage related to the patient’s orthopaedic condition. Patients were recruited for the public cohort during Western Health outpatient clinics and for the private cohort during private surgical consults in the waiting rooms of eight surgeons’ clinics.
A total of 400 surveys were completed; 200 in both the private and public cohorts of the study. Of all surveyed participants, 79% (n = 316) had access to the internet. Of people who had access to the internet 65.2% (n = 206) used the internet to investigate their orthopaedic condition. 29.6% (n = 61) of participants asked their surgeon questions related to information they had read on the internet. Of patients that had access to the internet 36.1% (n = 114) used the internet to research their surgeon.
Patients are commonly using the internet as an information resource, in spite of the highly variable quality of this information. This highlights the need for patient information websites which reflect the current standards of clinical practice.
Online medical information; Internet use; Patient’s awareness; orthopaedics
Gyrate atrophy is a rare metabolic disease with autosomal recessive inheritance pattern characterised by hyperornithinemia and typical ocular findings. This report presents a 17-year-old intellectually challenged girl consulting for a progressive fall of visual acuity with night blindness. Fundus examination showed patches of chorioretinal atrophy with typical scalloped borders and peri vascular pigmentation in the equatorial region. Fundus fluroscein angiography revealed characteristic staining pattern. Other ocular associations included myopia and posterior sub capsular cataract. Progressive systemic proximal myopathy was one of the associated features. Dietary supplementation of vitamin B6 was advised.
Chorioretinal gyrate atrophy; myopia; posterior sub capsular cataract; myopathy
In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.
The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.
The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.
Evidence-based health care; guidelines; palliative care; aged care; community care
There is gap in the literature regarding the current practice of diabetes management of the elderly in Australia and its compliance with available Australian diabetes practice guidelines.
The aims of this study were to describe the pharmacological management of elderly residents with diabetes living in aged care facilities and to identify areas for improvement in the current management as recommended by the current diabetes management guidelines in Australia.
Residents with diabetes from three rural aged care facilities were identified by nursing staff. A cross-sectional medical record audit was carried out to obtain data of residents diagnosed with diabetes.
Thirty-four medical records were audited from three aged care facilities.Data including demographics, medical histories and medications were collected and analysed.
This study had two key findings; Firstly, it showed that about a third of residents with type 2 diabetes are managed with diet only. Secondly, of the residents who are managed with medications, less than half of those audited (41%) were managed according to the current diabetes guidelines in terms of pharmacological treatment which included anti- hypertensive, lipid lowering and anti- platelet therapies. Of those patients with a history of CVD, all were receiving an antihypertensive medication, 71% were not managed for their lipids and 20% were not on any prophylactic anti- platelet therapy.
Management of patients with diabetes living in rural aged care facilities is inconsistent with the current management guidelines. Educational interventions targeting health professionals and patients might be beneficial to increase compliance with the current diabetes guidelines.
Type 2 diabetes; Pharmacological management; diabetes guidelines; elderly; aged care facilities
We describe a 32-year-old lady who was admitted with a urinary tract infection following vacuum-assisted delivery. She was diagnosed with Enterococcus faecium related emphysematous cystitis, bladder gangrene and rupture necessitating emergency laparotomy and partial cystectomy. She had a repeat laparotomy nine days later due to continuing bladder necrosis on cystoscopy. The patient stayed in hospital for over two months due to complications including hospital acquired Klebsiella pneumonia, adult respiratory distress syndrome and malnutrition. Discharge occurred one week after an ileal conduit and ileostomy were performed.
Emphysematous cystitis; bladder rupture; gangrenous cystitis
Globally, it is estimated that 170 million people are living with hepatitis C and between three and four million are newly infected annually. In Australia, around 1% of people are living with chronic hepatitis C, with two-thirds of these being men.
This research aimed to determine the impact of hepatitis C treatment on partners of patients using in-depth exploratory techniques.
Four infected men and their partners (n= 8 participants) and three service providers were recruited and interviewed separately to identify the needs of female partners supporting patients with Hepatitis C. Discussion was based on the experiences of female partners during the treatment phase of male hepatitis C patients.
All participants recognised a need for greater assistance for partners of hepatitis C treatment patients. It was also recognised that strong social support improved treatment outcomes and helped to maintain the survival of family relationships during the intensive treatment phase.
Although this research was limited by size, it provides valuable insights into ways to enhance hepatitis C management outcomes beyond traditional medical treatment regimes, for example through formal partner support.
Caregivers/caring; coping and adaptation; partners; hepatitis C.
Chondrosarcomas of the hand are very rare, constituting less than 0.5% of all chondrosarcomas. Metacarpal involvement and juxtacortical location are still rarer. We report a case of periosteal chondrosarcoma of metacarpal bone in a 38-year-old man, who presented with swelling of the left hand. He underwent extended ray amputation with removal of the entire left third metacarpal bone. Histopathological and radiological features of the tumour are described. Recognition of periosteal chondrosarcoma and its differentiation from other surface bone tumours is very important because the prognosis is excellent after adequate local surgery.
Periosteal chondrosarcoma; juxtacortical; metacarpal
Understanding the viewer impact of the prime time television cooking show, MasterChef Australia , may help us to communicate more positively received messages about food and eating.
Media; health communication; food; pleasure
Routine and continuous electronic monitoring of foetal heart rate (FHR) in labour has become an established obstetric practice in high-risk pregnancies in industrialised countries. However, the same may not be possible in non-industrialised countries where antenatal care is inadequate with a large number of high-risk pregnancies being delivered in crowded settings and inadequate health care provider to patient ratios.
The objective of this study was to evaluate the predictive value of the admission cardiotocogram (CTG) in detecting foetal hypoxia at the time of admission in labour and to correlate the results of the admission CTG with the perinatal outcome in high-risk obstetric cases.
This was a prospective observational study conducted in the labour and maternity ward of a hospital in Gangtok, India, during the period 2008 to 2010. The study included high-risk pregnant women, admitted via the emergency or outpatient department with a period of gestation ≥36 weeks, in first stage of labour with foetus in the cephalic presentation. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions.
One hundred and sixty patients were recruited. The majority of women were primigravida in the 21-30 years age group. About 42% patients were postdated pregnancy followed by pregnancy-induced hypertension (PIH) (15.6%) and premature rupture of membranes (PROM) (11.3%) as the major risk factors. The admission CTG were ‘reactive’ in 77%, ‘equivocal’ in 14.4% and ‘ominous’ in 8.7% women. Incidence of foetal distress, moderate-thick meconium stained liquor and neonatal intensive care unit (NICU) admission was significantly more frequent among patients with ominous test results compared with equivocal or reactive test results on admission. Incidence of vaginal delivery was more common when the test was reactive.
The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in ‘triaging’ foetuses of high-risk obstetric patients in non-industrialised countries with a heavy workload and limited resources.
Cardiotocography; admission test; foetal distress; foetal hypoxia; perinatal outcome.
Carotid artery stenosis is a disabling disease in all age groups. Elderly people are more prone to recurrent strokes due to advancing age and multiple co-morbidities. Treatment options for symptomatic carotid stenosis in the very elderly are the same as in younger patients although with a higher operative risk. We describe a successful case of carotid artery stenting in a nonagenarian with symptomatic carotid artery stenosis, a subgroup for whom treatment options are rarely discussed in guidelines.
Carotid artery stenosis; nonagenarian; carotid artery stenting
Achromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection.
Achromobacter xylosoxidans; pneumonia; adrenal insufficiency
Surgical site infections are the most common nosocomial infection among surgical patients. Patients who experience surgical site infections are associated with prolonged hospital stay, rehospitalisation, increased morbidity and mortality, and costs. Consequently, surgical antimicrobial prophylaxis (SAP), which is a very brief course of antibiotic given just before the surgery, has been introduced to prevent the occurrence of surgical site infections. The efficacy of SAP depends on several factors, including selection of appropriate antibiotic, timing of administration, dosage, duration of prophylaxis and route of administration. In many institutions around the globe, evidence-based guidelines have been developed to advance the proper use of SAP. This paper aims to review the studies on surgeons' adherence to SAP guidelines and factors influencing their adherence. A wide variation of overall compliance towards SAP guidelines was noted, ranging from 0% to 71.9%. The misuses of prophylactic antibiotics are commonly seen, particularly inappropriate choice and prolonged duration of administration. Lack of awareness of the available SAP guidelines, influence of initial training, personal preference and influence from colleagues were among the factors which hindered the surgeons' adherence to SAP guidelines. Immediate actions are needed to improve the adherence rate as inappropriate use of SAP can lead to the emergence of a strain of resistant bacteria resulting in a number of costs to the healthcare system. Corrective measures to improve SAP adherence include development of guidelines, education and effective dissemination of guidelines to targeted surgeons and routine audit of antibiotic utilisation by a dedicated infection control team.
Surgeon; adherence; compliance; surgical antimicrobial prophylaxis; antibiotic
A 41-year-old Asian-Indian male presented with recurrent episodes of jaundice over the past six months. Physical examination was normal, barring mild icterus. Laboratory parameters revealed indirect hyperbilirubinemia. Further evaluation yielded a diagnosis of severe nutritional vitamin B12 deficiency. Indirect hyperbilirubinemia was ascribed to ineffective erythropoiesis. Underlying Gilbert's syndrome was ruled out by provocative testing with lipid-restricted diet. Presentation of severe vitamin B12 deficiency with isolated hyperbilirubinemia without concomitant major haematologic or neurologic dysfunction is unusual and potentially underdiagnosed. Awareness of this possibility can permit early diagnosis of vitamin B12 deficiency and forestall development of severe haematologic and neurologic sequelae.
Recurrent jaundice; indirect hyperbilirubinemia; vitamin B12 deficiency; ineffective erythropoiesis
The demand for elective joint replacement (EJR) surgery for degenerative joint disease continues to rise in Australia, and relative to earlier practices, patients are discharged back to the care of their general practitioner (GP) and other community-based providers after a shorter hospital stay and potentially greater post-operative acuity. In order to coordinate safe and effective post-operative care, GPs rely on accurate, timely and clinically-informative information from hospitals when their patients are discharged. The aim of this project was to undertake an audit with GPs regarding their preferences about the components of information provided in discharge summaries for patients undergoing EJR surgery for the hip or knee.
GPs in a defined catchment area were invited to respond to an online audit instrument, developed by an interdisciplinary group of clinicians with knowledge of orthopaedic surgery practices. The 15-item instrument required respondents to rank the importance of components of discharge information developed by the clinician working group, using a three-point rating scale.
Fifty-three GPs and nine GP registrars responded to the audit invitation (11.0% response rate). All discharge information options were ranked as ‘essential’ by a proportion of respondents, ranging from 14.8–88.5%. Essential information requested by the respondents included early post-operative actions required by the GP, medications prescribed, post-operative complications encountered and noting of any allergies. Non-essential information related to the prosthesis used. The provision of clinical guidelines was largely rated as ‘useful’ information (47.5–56.7%).
GPs require a range of clinical information to safely and effectively care for their patients after discharge from hospital for EJR surgery. Implementation of changes to processes used to create discharge summaries will require engagement and collaboration between clinical staff, hospital administrators and information technology staff, supported in parallel by education provided to junior medical staff.
General practitioner; joint replacement surgery; discharge; hospital; communication
The Chronic Dental Disease Scheme (CDSS) is the first public dental policy in Australia to attract Medicare benefits for dental services.
This study examines the utilisation of a new federal method of funding dental care in Australia and provides an insight into the implications of government dental programs. The program titled; Chronic Dental Disease Scheme, provided government-subsidised dental care for people suffering from a chronic medical condition.
A retrospective analysis of activity data using the relevant item numbers were extracted from the open source Medicare Benefits Schedule database (MBS) for years 2007-2009.
During the study period, a total of approximately five million dental services were provided. There was a disproportionate use of services between jurisdictions. The highest proportion (66%) of services was provided in the state of New South Wales (NSW) with Victoria second (22%). The adjusted value of care provided as a proportion of comprehensive examinations ranged from $1937 in the northern territory (NT) to $2900 in NSW. The value of care per dentist ranged from nearly $80 000 down to less than $1000 and the value of care per adult of the population ranged between $53 and $1 across Australia. The highest was always in NSW and the lowest always being the NT. Fixed prosthodontics (reconstruction) accounted for the significant costs associated with the program.
The scheme has been utilised above its budget estimate with prosthodontics accounting for the majority of expenses. Treatment plans differed between jurisdictions. The increase in utilisation of the scheme was coincident with periods of increased in subsidy and remuneration and has been postulated to be a main driver for its utilisation rather than the improvement in chronic health.
Dental Public Health; Computational Mathematics; Monte Carlo
As part of our research team's knowledge transfer and exchange (KTE) initiatives, we developed a six-minute video-clip to enable productive deliberations among technology developers, clinicians and patient representatives. This video-clip summarises in plain language the valuable goals and features that are embedded in health technology and raises questions regarding the direction that should be taken by health care innovations. The use of such video-clips creates unique opportunities for face-to-face deliberations by enabling participants to interact and debate policy issues that are pivotal to the sustainability of health care systems. In our experience, we found that audiovisual-elicitation-based KTE initiatives can fill an important communication gap among key stakeholders: pondering, from a health care system perspective, why and how certain kinds of medical technologies bring a more valuable response to health care needs when compared to others.
Health Technology; Values; Health Care Systems; Audiovisual-elicitation-based Methodology; Knowledge Transfer and Exchange.
For eye diseases, such as glaucoma and age-related macular degeneration (ARMD), involved in long-term degeneration procedure, longitudinal comparison of retinal images is a common step for reliable diagnosis of these kinds of diseases.
To provide a retinal image registration approach for longitudinal retinal image alignment and comparison.
Two image registration solutions were proposed for facing different image qualities of retinal images to make the registration methods more robust and feasible in a clinical application system.
Thirty pairs of longitudinal retinal images were used for the registration test. The experiments showed both solutions provided good performance for the accurate image registrations with efficiency.
We proposed a set of retinal image registration solutions for longitudinal retinal image observation and comparison targeting a clinical application environment.
Retinal image registration; Glaucoma; ARMD; clinical decision support