Series: Volume 1, Issue 1 2010

This is the inaugural issue of the Australian Medical Student Journal.

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Categories
Review Articles

Complementary and alternative medicine use among children with asthma in Australia

Abstract

Aim: To explore current complementary and alternative medicine (CAM) use by children with asthma in Australia. Methods: The results of an audit of CAM use by one of the authors (AMD) in 212 parents of children with a history of asthma, recruited from three different settings (outpatient clinic at a tertiary paediatric hospital, metropolitan and rural practices) were compared to three published studies of CAM use in children with asthma in Australia, as identified by literature review. Results: The prevalence of CAM use amongst children with asthma in Australia is 45-61%. Common CAM modalities used include chiropractic methods, vitamins and minerals, homeopathy/naturopathy, spiritual/psychological modalities and diet therapy. CAM was used more commonly in female children and those with persistent asthma, poor control of symptoms or using high doses of medication. Importantly, only a small number of parents report their child’s CAM use to their doctors. Conclusion: Recent surveys of CAM use among children with asthma in Australia demonstrate a high prevalence which has important implications for those managing paediatric asthma.

Categories
Review Articles

An overview of respiratory disease in Indigenous communities: A comparison to the wider Australian population

Abstract

Aim: The objective of this article is to compare the differences in long term health outcomes between Indigenous and non-Indigenous populations with respect to respiratory disease. In order to gain a deeper understanding of the knowledge presented regarding differences in Indigenous and non-Indigenous health, the epistemological grounds for the study will be considered. Methods: A literature review was conducted. The data for this review was assembled through searching Medline, Informit, PubMed and the Indigenous Healthinfonet for English language peer- reviewed publications containing the keywords: respiratory disease, Indigenous, rural and Queensland. Thirty-two documents were selected. Results: Respiratory disease is distributed disproportionately and occurs with peculiar frequency among Indigenous Australians. Key health indicators such as the disability adjusted life year highlight the inequality between Indigenous and non-Indigenous Australians in terms of health outcomes, although to a much lesser extent than in the past. Conclusions: An innovative approach to public health has seen Indigenous communities become more actively engaged in medical care. Of particular note is the increasing frequency with which Indigenous health workers are being integrated into rural practice to follow up patients and bridge cultural and societal gaps. Environmental antecedents are important contributors to health which may be responsible for the high burden of disease seen in many Indigenous communities. These challenges must be addressed as part of a new public health drive to bring health equality to all Australians.

Categories
Review Articles

Novel approaches to cancer therapeutics

Abstract

Advancements in our understanding of the biology of cancer have progressed dramatically over the past decade. The application of cutting-edge molecular profiling techniques analysing the cancer genome is elucidating an appreciable amount of information. This data is now being integrated into a catalogue that is providing researchers with a revolutionary roadmap of the molecular mechanisms behind cancer. Recent accomplishments in cancer research are also being introduced into the clinic through the development of innovative diagnostic technologies and targeted therapies. Lessons from the past, along with novel therapeutic approaches being developed today, have stimulated an optimistic promise for tomorrow’s fight against cancer.

Categories
Review Articles

Ovarian carcinoma: Classification and screening challenges

Removal of a large ovarian tumour

Abstract

Primary ovarian cancer is the leading cause of death from gynaecological malignancy and the sixth most common cause of cancer death in Australian women. Our understanding of the underlying pathophysiology of epithelial ovarian cancers is incomplete, which poses difficulties for screening, diagnosis and treatment. This review summarises the current knowledge and debate regarding classification of epithelial ovarian cancers, including a proposed new classification system. Current screening methods and the evidence behind them are also presented. The outcomes of large, ongoing trials are awaited to provide more conclusive evidence regarding the effectiveness of screening for ovarian cancer.

Categories
Review Articles

Minimally invasive mitral valve repair: A new surgical option for mitral insufficiency

Long-shafted instruments in use during mitral valve repair

Abstract

Minimally invasive mitral valve repair (MIMVR) is a relatively new alternative to median sternotomy for valvular heart surgery, and has become increasingly appealing due to its improved cosmetic results and more rapid recovery time. Patients suffering mitral valve disease are increasingly turning to their medical practitioners for advice regarding this procedure. It is the aim of this article to provide a review of MIMVR to allow students and doctors to better understand this recent development in cardiac surgical therapy.

Categories
Case Reports

Use of retrograde intra-operative cholangiogram for detection and minimisation of common bile duct injury

Intraoperative cholangiogram during a laproscopic cholecystectomy

Abstract

Iatrogenic bile duct injury (BDI) is a known complication of laparoscopic cholecystectomy with serious consequences for the health of the patient. Intra-operative cholangiogram (IOC) has been shown to reduce the incidence of a major BDI, and is currently used routinely by the majority of surgeons in Queensland. This case report details the use of a ‘retrograde IOC’ for the detection of a BDI after inadvertent cannulation of the common bile duct (CBD). Application of this method has the potential to improve patient outcomes in two ways. Firstly, by limiting the degree of damage to the CBD, it may facilitate a simpler and more successful repair. Secondly, it provides a method of laparoscopic confirmation of BDI and, where laparoscopic hepaticojejunostomy is available, can entirely prevent the need for an open procedure.

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Original Research Articles

The Internet as a health information source for university students

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.

Categories
Original Research Articles

A survey of the ophthalmic presentations and their outcomes to a general hospital Emergency Department over twelve months

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.

Categories
Original Research Articles

Investigation of lactate dehydrogenase isoenzymes as candidate biomarkers of idiopathic pulmonary arterial hypertension

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.

Categories
Original Research Articles

Can we predict when operating lists will finish in a regional Queensland hospital?

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.