Aim: To outline the socio-demographic characteristics, the means of arrival, management and referral pathways for mental health presentations to the Emergency Department (ED) where the main reason for presentation is self-harm. Methods: A retrospective study conducted in a metropolitan hospital in Sydney. Sampled data were collected from mental health presentations to the ED for the month of May in 2005, 2006 and 2007. The data collected included patient demographics as well as management, referral and follow-up outcomes. Results: There were 606 patients in the sampled data (99.3% of all mental health presentations). The gender distribution of the patient cohort was 63:37 (male n=380 and female n=226) and the average age was 36 ± 16.7 years. Two hundred and three (33.5%) patients had self-harmed and 403 (66.5%) had other mental health problems. Self-harm patients’ mode of arrival included ambulance (38.4%), self-presentations (36.5%), police (14%), and other. Self-harmers were mainly admitted to Psychiatric Emergency Care Centre (PECC) (28%) or discharged home (51.7%). More than one third (35.5%) of self-harm patients did not receive adequate follow-up. Conclusion: Important variations between self-harm patients and other mental health patients were identified in their management and referral outcomes from the ED. Clinicians need to ensure that optimal patient care is provided through appropriate follow-up of every self-harm patient post-discharge from hospital.

Palliative care provides assistance for people living with a terminal medical condition, for which the primary goal of treatment is improving quality of life. There are numerous barriers to the provision of palliative care. There is little research into barriers to the provision of palliative care and little with an Australian context. This research explores barriers to palliative care in Australia through questionnaires and interviews with stakeholders. One hundred and one questionnaires were given to South East Palliative Care (SEPC) community nursing and allied health staff, general practitioners and aged care facility staff. Five interviews were conducted with representatives from SEPC, Palliative Care Australia and two aged care facilities. Most agreed that palliative care was essential in the community, hospital and aged care setting. Four major themes were identified from interviews: 1.) Education & stigma barriers; 2.) Communication barriers; 3.) Aged care barriers; and 4.) General practice barriers. Inadequate prescriptions of pain medication were a significant issue. These themes were supported by questionnaire data, with 25.6% identifying education and 28.2% identifying resources as major barriers. Knowledge of palliative care was poor in both aged care staff and GPs, only 8.3% and 38.5% respectively answering all palliative care questions correctly, compared to 64.2% amongst SEPC staff. The study addresses a deficit in previous research, identifying barriers to palliation in aged care. The data collected has potential for further research or interventional approaches to improve the provision of palliative care for Australians.

Background: Based on research demonstrating the many benefits of breastfeeding, it is recommended babies be exclusively breastfed from birth to at least six months of age. However, despite these known benefits, many women choose to bottle feed or cease breastfeeding before six months. Aim: To survey women in order to determine factors associated with their attitudes and choice to bottle feed or breastfeed their children, with the aim of identifying areas to target education to improve breastfeeding rates or duration. Methods: Anonymous surveys were distributed to a convenience sample of 106 adult female patients selected from a suburban general practice. MS-Excel and Epi Info 3.5.3 software package were used for data management. Chi square was used for analysis. Results: The response rate was 94.3% (n=100). There were trends suggesting an association between income and the respondents’ choices (p=0.26); and income and the respondents’ mothers’ choices (p=0.51). Respondents were significantly more likely to choose the feeding method their own mother used (p=0.01). Discussion: Income and respondents’ mothers’ choice regarding breastfeeding were identified as factors possibly associated with respondents’ attitudes and choice. Hence awareness of individual family dynamics may assist in targeting prenatal education to help increase rates of breastfeeding. A large proportion of respondents chose to bottle feed and also believed that the bottle was as good as breastfeeding. The needs of this group also need to be met. Conclusion: To increase breastfeeding rates, individualised prenatal education as well as supporting women through their breastfeeding problems is a likely requirement.

Aim: Computer-aided learning (CAL) is considered comparable to traditional media for undergraduate radiology teaching. Previous studies have often compared the efficacy of traditional media to onsite CAL use, yet real world usage of CAL is likely to occur in offsite settings. This study aims to compare usage and learning outcomes of a chest radiology CAL in onsite and offsite settings. Methods: Participants were fourth year medical students (n=52) at the National University of Singapore (NUS) undertaking one week radiology rotations. Students were randomly allocated to complete a web-based chest radiology CAL onsite, or offsite at a time and place of choice. Pre- and post-tests were taken to measure knowledge gain, and a questionnaire was used to explore student usage and preferences.

Results: The onsite CAL group demonstrated significant knowledge gain (+15.8%, p<0.05) whilst the offsite group did not (+5.8%, p>0.05). However, the difference between the groups was not statistically significant (p=0.069). Total time spent and completion of the program was similar between the two groups. Yet, questionnaire results showed that the offsite group multitasked more and appeared to have poorer concentration. A majority of students from both groups preferred the convenience of offsite CAL use over onsite CAL use.

Conclusion: A significant difference between the test groups was not observed, although there was a trend toward onsite CAL use being more effective. In planning CAL teaching, particularly for offsite use, educators need to provide sufficient support and integration for an optimal outcome.

Introduction

Chest radiology is important for acute and emergency management, and is therefore an essential learning component of undergraduate radiology teaching. [1] However, studies show that chest radiology competency amongst graduating medical students is poor. [2,3] Poor competency is attributed to lack of formal teaching of radiology in the curriculum. [2,3] Worldwide, radiology teaching is compromised by limited formal teaching in a hectic curriculum, and competing demands on radiologists. [4,5]

Computer aided learning (CAL) has been advocated as a potential tool to alleviate some of the limitations in radiology teaching. [6] CAL is time and cost effective for educators, [7] and especially useful in an image rich specialty such as radiology. To evaluate the effectiveness of CAL for transferring knowledge gain, previous studies have undertaken media comparisons between CAL and traditional learning, such as lectures or tutorials. Individual studies in radiology and non-radiology medical education [8,9] demonstrate that overall, knowledge gain with CAL is comparable to …

Figure 1. Comparison of Nissl stained and Calbindin-D28k immunostained sections. (a) Calbindin immunopositive PCs clearly visible along the PC layer. (b) PCs not visible in Nissl stained section.

Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive disease which causes skeletal muscle wasting in males, resulting in premature death during their early to mid 20s. Males with DMD carry defects in the gene encoding for dystrophin, a protein important in ensuring sarcolemmal stability. Dystrophin has also been implicated in disruption to Purkinje cells in the cerebellum. This disruption to cerebellar Purkinje cells has been proposed to be involved in reducing the IQ of affected boys. Aim: To compare Purkinje cell number and distribution in mutant mdx and normal mice. Methods: Cerebellar slices from both mutant (n=4) and normal (n=4) mice were prepared and stained. The number of Purkinje cells in each slice was estimated by three different cell counting techniques. Counting methods were as follows: firstly, the actual number of Purkinje cells per lobe; secondly, a randomised estimate where five random sections of the Purkinje cells layer were selected, counted and averaged; thirdly, an estimated maximum possible count, where three segments from the Purkinje cell layer with the highest density of cells were used to estimate Purkinje cell population. Results: No statistical significance in Purkinje cell numbers between the two groups was found. However, there was a trend towards a decrease in the median number of Purkinje cells in the mutant group, particularly in lobules 3, 4/5, 6 and 10. Conclusion: The study findings suggest a decrease in Purkinje cell number in mdx mice. The small sample size of this study precludes definitive statistical analysis of Purkinje cell numbers in either group. These findings demonstrate a need for larger mouse-model studies to accurately assess differences in cell numbers between the two groups. Given that the greatest difference in cell numbers was demonstrated in lobules 3 and 4/5, the authors suggest that DMD may affect the cerebellum during the maturation of these lobules. Importantly, a reduced Purkinje cell population may be implicated in the intellectual morbidity in boys with DMD.

Abstract

As the prevalence of those seeking health information online rises, the potential for information overload and misinformation increases. This study aims to evaluate and explore the Internet’s role as a health information source, specifically for university students. In total, 120 university students were surveyed for their behaviours and attitudes when accessing online health information. Of the respondents, 61% had used the Internet as a personal health information source at least once in the past and 34% do so at least once a month. In comparison with other common information sources, the Internet was the third most commonly used (41%) behind General Practitioners (73%) and family and friends (60%). Despite this frequency of use, only 5% of participants regarded the Internet to be very accurate, while 27.5% had found health information on the Internet to be misleading. Online health advice had delayed appropriate medical treatment at least once for 28% of participants.  Both information inaccuracy and treatment delay pose risks to health outcomes. The findings from this research provide a useful starting point for future research into Australian Internet health information seeking behaviour.

Abstract

Aim: To survey the diagnoses and discharge status of the ophthalmic presentations to a general emergency department (ED). To compare the ED diagnosis with the ophthalmologist diagnosis of referred patients. Methods: A retrospective analysis of all the ophthalmic presentations to the Gosford District Hospital from 1 January 2005 to 31 December 2005 was carried out. All referrals to and admissions by ophthalmologists were reviewed for the final diagnosis. These outcomes were compared to the initial ED diagnosis. Results: There were 509 ophthalmic presentations to the ED in 2005: 51% had corneal trauma, 14% had an unspecified red or painful eye, 9% had an unspecified eye injury and 5% had blurred vision. Most patients were discharged without referral. Twenty-two percent of patients were referred to an ophthalmologist. Four percent were admitted and transferred to Sydney Eye Hospital. In those who were referred, 13% did not have records at the specified ophthalmologist, 24% were not recorded to which specialist they were referred and 26% had significantly different specialist opinion. Conclusions: More than half of ED ophthalmic presentations were for corneal trauma and only 22% of patients were referred to an ophthalmologist, while most were treated solely in the ED or referred to general practice. Potentially vision-threatening misdiagnoses included three cases of iritis, three of keratitis and two of retinal artery occlusion. ED diagnoses of corneal problems matched exactly with ophthalmic opinion. Interestingly, recording of the visual acuity occurred in only 27% of cases.

Abstract

This study investigates the activity and expression of lactate dehydrogenase (LDH) in idiopathic pulmonary arterial hypertension (IPAH) patients. IPAH is a rare and highly fatal disease with a median life expectancy at diagnosis of only 2.8 years. Ideally a simple blood test for biomarkers could simplify the physician’s diagnostic work-up, resulting in earlier diagnosis and successful institution of therapy. Recent publications suggest IPAH may behave like cancer, with monoclonal proliferation and a shared pathway of mitochondrial dysfunction. LDH is often upregulated in cancers, and a similar elevation is suspected in IPAH. Discovering similar patterns of flux in the cellular bioenergetics of IPAH and cancer would support the emerging theory that IPAH has a ‘cancer phenotype’. Quantitative proteomic analysis of fourteen lung tissue homogenate samples (seven lobectomy, seven IPAH) was performed using liquid chromatography – tandem mass spectrometry (LC-MS/MS). The lung samples, as well as 30 plasma samples (ten normal, 20 IPAH) were analysed for LDH fractional isoenzyme activity and expression. A pyruvate-to-lactate spectrophotometric activity assay was performed on the 44 samples, followed by LDH isoenzyme separation on thin-layer agarose gel and densitometric analysis. A significant link exists between IPAH and increased plasma and lung levels of LDH-1 (P = 0.0114 and 0.0262 respectively on Mann-Whitney U test). Receiver Operating Characteristic analysis demonstrated plasma LDH-1 had biomarker sensitivity and specificity of 80%. Measuring plasma LDH-1 appears clinically useful in diagnosing IPAH. This work supports the re-evaluation of IPAH as a cancer-like disease and suggests a new biomarker.

Winner of the Co-Op Bookshop Prize for Best Academic Article in this issue of the AMSJ

Abstract

Background: Over-running operating lists are a common cause of same-day cancellations of surgery, while under-running operating lists are a common cause of wasted health resources due to the fixed costs of operating suites. The predominant cause of operating lists running off-schedule is not known, but it is believed that if due to booking problems, it should be possible to predict when a list will over- and under-run. Aims: To understand the prevalence of cancellations, over- and under-running operating lists in a regional Queensland hospital, and to test whether over- and under-running lists can be predicted. Methods: A sample of 120 operating lists was prospectively obtained and each list timed from start to finish. A predicted duration was calculated for each list by summing the average durations for each of the operations on the list (including anaesthetic and turn-over durations), derived from past surgical records. Results: Twenty-eight percent of lists suffered a cancellation, of which 79% were predicted to over-run their scheduled duration. Of the lists that did not suffer a cancellation, 45% over-ran, of which 84% were predicted; and 37% under-ran, of which 84% were predicted. Conclusion: The large proportion of predicted over- and under-runs support the hypothesis that booking problems are the main causes of operating lists running off-schedule, as opposed to other factors affecting surgical duration that the model would not have accounted for. This suggests that operating lists running off-schedule can potentially be avoided. Further study is warranted to investigate the reasons behind over- and under-booking.