Category: Review Articles

Categories
Review Articles

Balance and gait stability following sports-related concussion

Background: Concussion is an injury that is associated with many sports, in particular ice hockey, martial arts and the various codes of football. Concussion alters the stability of a person and as stability is vital when playing sports, the consequences of undiagnosed and untreated concussions are enormous. Aim: To look at various methods used to assess posture and stability in athletes, and their use in making safe return to play decisions after a sport-induced concussion. Methods: A search was conducted through PubMed, using the terms ‘concussion’ and ‘sport.’ Article titles were initially screened by the author and if the title seemed to be relevant to the purpose of the review, the abstract of the article was then screened for relevance. Results: Concussion negatively impacts upon an athlete’s cognitive and motor functioning. Cognitive testing has previously been assessed and is currently used; however it has been shown that cognitive function may return before motor functioning. The time taken to recover the motor component is usually between three to ten days; however, this varies considerably between athletes. Balance and gait testing are a means of objectively assessing the stability of an athlete and have proved to be particularly useful in monitoring the recovery of an athlete after suffering concussion. Conclusion: Balance and gait testing are means of objectively assessing the stability of an athlete. Although their use is applicable to many situations, they have proved to be of particular usefulness in monitoring the recovery of an athlete after suffering concussion. Through their use, the subjectivity of the assessment is being eliminated, ensuring informed and supported decision-making regarding the safe return to play.

 

Categories
Review Articles

Early impact of rotavirus vaccination

Background: Rotavirus is the most common cause of severe gastroenteritis in children and two vaccines to prevent rotavirus infection have been licensed since 2006. The World Health Organisation recommends the inclusion of rotavirus vaccination of infants in all national immunisation programs. Aim: To review current literature evaluating the global impact of rotavirus immunisation programs over the first two years of their implementation. Methods: A MEDLINE search was undertaken to identify relevant observational studies. Results: Eighteen relevant studies were identified which had been carried out in eight countries. Introduction of the vaccine was associated with a reduction in all-cause gastroenteritis hospitalisation rates of 12- 78% in the target group and up to 43% in older groups ineligible for the vaccine. Hospitalisation rates for confirmed rotavirus cases ranged between 46-87% in the target group. Mortality from all-cause gastroenteritis was reduced by 41% and 45% in two countries studied. Conclusions: Early research evaluating rotavirus immunisation programs suggests significant decreases in diarrhoeal disease rates extending beyond the immunised group. Further monitoring will allow vaccine performance to be optimised and for the long-term effect of vaccination programs to be assessed.

Categories
Review Articles

Prevention of rheumatic heart disease: Potential for change

Rheumatic heart disease (RHD), an autoimmune reaction to an infection of rheumatogenic group A streptococcus bacteria, is characterised primarily by progressive and permanent heart valvular lesions, although other parts of the heart may be affected. Despite an overall decrease in the incidence of RHD in developed countries, it remains a pertinent health issue with high rates in developing countries and amongst certain Indigenous populations in industrialised countries. Primary, secondary and tertiary strategies for the prevention of rheumatic heart disease exist, as do numerous barriers to such strategies. A review of the literature, incorporating its epidemiology and pathophysiology, demonstrates that interventions at various stages of the disease may reduce the collective burden of disease.

Categories
Review Articles

Prostate cancer: Past, present and future Australian initiatives for improving men’s health

Abstract

Prostate cancer is the most common internal cancer in Australian men. Whilst recent trends demonstrate stabilising incidence and decreasing mortality rates, it remains a major health burden for Australian men and requires continued action. This report outlines the status of prostate cancer in Australia’s health care system, both past and present, and analyses the effectiveness of healthcare campaigns used to generate awareness. The aim is to assess awareness, perception and public behaviour toward this disease, as well as to impart Australia’s strategies on improving public knowledge in this area.

Methods: A comprehensive search of English language literature was conducted. Articles were limited to those relating to prostate cancer in Australia. Additionally, websites of various prostate cancer awareness campaigns or organisations were evaluated, based on a comprehensive list provided by the National Men’s Health Policy Submissions Document. [1]

Results: One hundred and ninety-five relevant journal articles were found, which were subsequently evaluated independently by three authors. Of these, 56 fit the inclusion criteria.

Conclusion: Development in knowledge, awareness and attitudes toward prostate cancer has been significant over the past few years. However, despite prostate cancer being a major health burden for Australian men, there are still misconceptions and a lack of awareness amongst the general population. The combination of prostate cancer specific organisations such as the Prostate Cancer Foundation of Australia, campaigns and events such as ‘Movember’ and ‘Be a Man,’ health promotion in schools, universities and workplaces, as well as the development of a national men’s health policy can only further serve to advance prostate cancer awareness.

Categories
Review Articles

On the nature of the alcohol-based hand rub and its use for hand hygiene in medicine and healthcare

Abstract

Hand hygiene (HH) is today recognised as being the most important factor in preventing the spread of infections; however, adequate compliance with this remains unacceptably low amongst healthcare workers (HCWs). One of the leading products in the push for successful HH is the alcohol-based hand rub (ABHR), which currently exists as a ubiquitous item in healthcare facilities. This review amalgamates the current understanding of ABHRs, presenting an overview of important issues including its correct usage and insights into HH. Aimed at Australian HCWs and students, a small yet significant amount of attention is devoted to Hand Hygiene Australia – one of the leading authorities in this subject area. It may be concluded that the ABHR is an effective hand disinfectant that also improves HH compliance, and is thus highly recommended for use in healthcare settings.

Categories
Review Articles

Stethoscopes as vectors of infections

Aim: To conduct a review of the literature to evaluate whether stethoscopes constitute a clinically significant vector of healthcareassociated infection, and to explore the behaviour, attitudes and beliefs about stethoscope hygiene amongst medical students. Methods: Section one: PubMed was searched for empirical studies written in English, published before 1 May 2010, dealing with colonisation rates of stethoscopes and self-reported frequency of stethoscope cleaning by healthcare staff. Thirty-one articles were systematically reviewed. Section two: Qualitative and quantitative cross-sectional study of medical students. A convenience sample of seventeen undergraduate medical students in years two, three and four were asked a series of thirteen questions exploring their knowledge, practice of and attitudes towards stethoscope hygiene. Results: The diaphragm and bell of stethoscopes are colonised with micro-organisms on average 87.3% of the time. On average, 14% of stethoscopes carry MRSA, and 16.5% carry gram-negative species. On average, 58.8% of doctors clean their stethoscope annually or never. Fifty-nine percent of students surveyed had never cleaned their stethoscope. Only 29% of students had ever been advised about stethoscope hygiene. Eighty-two percent of students felt senior colleagues had influenced their attitude (positive or negative) toward stethoscope hygiene. Conclusions: Stethoscopes potentially represent a moderate-to-high risk of infection transmission, particularly in vulnerable settings, yet stethoscope hygiene is rarely considered or practiced by doctors and medical students. Improving stethoscope hygiene in practice requires addressing the lack of formal education on the subject and the shortage of positive role models.

Categories
Review Articles

Preventing vertical hepatitis B transmission across all borders: A review of current concepts

Aim: The aim of this review is to emphasise the global significance of Hepatitis B (HBV) and its vertical transmission, and to summarise the current status of preventative strategies. Methods: A literature review was carried out. PubMed, The Cochrane Collaboration and Medline were searched for both primary studies and reviews pertaining to vertical HBV transmission, its prevention and barriers to prevention. Key words used included “HBV,” “Hepatitis B,” “vertical transmission,” “mother to child transmission,” “prevention” and “epidemiology.” Results: HBV is a major cause of death from liver cancer and liver failure. HBV is the ninth leading cause of death internationally and accounts for up to 80% of the world’s primary liver cancers. In highly endemic areas, 75% of chronic HBV is acquired by vertical transmission (mother to child transmission at birth), or by horizontal transmission in early childhood. The earlier in life the disease is acquired, the greater the adverse consequences. Available therapies for preventing mother to child transmission are very effective and include multiple doses of HBV vaccine and usually, HBV immunoglobulin. However, up to 10% of infants acquire HBV despite this standard prophylaxis. Whether anti-viral agents should be given to mothers with a high viral load to prevent transmission remains controversial. Conclusion: HBV is an extremely important global public health issue. Prevention of vertical transmission is the most important preventative strategy and current prophylactic therapies are highly effective. Emerging approaches for mothers with a high viral load require further investigation to determine whether they are effective and safe. Developing countries face the issues of cost, access and education to apply prevention strategies, while developed countries need processes to ensure adherence to established recommendations.

Categories
Review Articles

Causes of death in neonatal intensive care units

Introduction

Of the approximately 130 million babies born each year, an estimated four million babies die in the neonatal period. Globally, the main causes of death are estimated to be preterm birth (28%), severe infections (26%) and asphyxia (23%). [1] New South Wales (NSW) is the most populous state in Australia with approximately 86,000 births per year. In 2006, 6,044 babies in NSW were registered to neonatal intensive care units (NICUs), representing 2.3% of total live births in that year. [2] Gestational age is highly correlated with birth outcomes including mortality. Each extra week of time spent in utero increases an infant’s chances of survival significantly, and by 27 weeks of pregnancy, over 90% of infants will survive.

There are significant differences between common causes of death in the pre-term population (less than 37 weeks gestation) and the term population (37+ weeks gestation). The most notable difference is an approximate five-fold increase in deaths caused by congenital neurological malformations in the term population compared with the pre-term population [3]. Premature infants have a considerably higher chance of dying than full-term infants. However, improved neonatal care, particularly the widespread use of surfactant replacement and antenatal steroids, has almost halved neonatal mortality in many parts of the world. [1] Between 1985 and 1991 in the United States, the overall neonatal mortality rate declined from 5.4 to 4.0 per 1,000 live births. An understanding of causes of neonatal death and changes in mortality rates is critical for prenatal counselling, decision making, quality control and further improvement in management.

In NSW, newborn infants are admitted to NICUs under the following criteria: gestational age less than 32 weeks, birth weight less than 1,500 grams, need for mechanical ventilation for four hours or more, continuous positive airways pressure for four hours or more and/or major surgery, defined as opening of the body cavity.

Newborns admitted to NICUs are cared for by a highly specialised team of medical, nursing and allied health staff. Despite the level of sickness and intensity of morbidities of NICU patients, mortality rates are relatively low. Neonatal mortality rate is defined as the number of neonatal deaths per 1,000 live births and includes all deaths of infants within 28 days after birth. Each neonate who dies in the NICU represents not only a financial cost to the community but more importantly, a significant emotional stress and grief for the involved parents and staff…

Categories
Review Articles

Approach to the acute abdomen during pregnancy

Abstract

Many physiological changes in pregnancy may affect the presentation of abdominal pain in the pregnant patient. Rapid diagnosis and management is required to prevent dire complications for both mother and fetus. Most radiological investigations are not harmful to the developing fetus and can avoid unnecessary and potentially detrimental explorative surgery. The role of laparoscopy in the pregnant patient is increasingly being established, particularly in centres with this surgical expertise.

Categories
Review Articles

The significance of aphasia in neurological cancers

Abstract

Aphasia associated with brain tumours has previously been regarded as essentially equivalent to the aphasia of stroke, and as a deficit unlikely to affect a patient’s prognosis. Recent research challenges such hypotheses. Tumour-related aphasias are commonly anomic aphasias, and hence pathologically distinct from classic post-stroke aphasias. Accordingly, many rules from the world of stroke cannot be readily translated to the management of tumour-related aphasia. Furthermore, aphasia may be an important clinical prognostic parameter in neuro-oncology. Tumour-related aphasia is associated with an increased risk for developing depression, poorer coping and reduced survival time. It is important that health professionals are aware of the unique pathology and prognostic significance of neuro-oncological aphasia, and of strategies available for its relief.