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Background: Intrapartum chemoprophylaxis for group B streptococcus (GBS) carriers reduces the risk of early-onset neonatal GBS infection. For women with β-lactam allergy, either erythromycin or clindamycin are administered. Recent reports worldwide suggest that GBS resistance to these antibiotics is increasing. Aims: To compare erythromycin and clindamycin resistance phenotypes in invasive neonatal GBS isolates across New Zealand and Australia over the past two decades and to determine whether regional variation in resistance patterns exist. Method: Invasive neonatal GBS isolates were collected from laboratories across New Zealand ( n = 107) and Australia ( n = 74) over two time periods (1992-1994 and 2002-2004 in New Zealand; 1982-2001 and 2002-2006 in Australia) and subjected to standard antibiotic susceptibility testing. A nested sub-study in New Zealand examined antibiotic susceptibilities of 112 maternal colonising GBS isolates during 2003-2004. Results: Erythromycin resistance among invasive neonatal GBS isolates increased across both countries over the past decade, with similar rates of resistance in New Zealand (9%) and Australia (6%) in recent years. New Zealand erythromycin-resistant GBS isolates commonly displayed cross-resistance to clindamycin. Also, there were significantly higher rates of isolated clindamycin resistance in GBS isolates from New Zealand than Australia ( P = 0.034). Maternal GBS isolates from New Zealand showed similar resistance patterns to neonatal isolates. Conclusion: Erythromycin and clindamycin resistance among invasive neonatal GBS isolates has emerged in both New Zealand and Australia over the past decade and is consistent with global trends in GBS resistance patterns. Although regional variations exist, these findings should be considered when implementing intrapartum GBS prevention strategies. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine the effect of gestational diabetesmellitus on maternal circulating levels ofC3a,C4a and C5a. Methods Anaphylatoxin C3a, C4a and C5a levels were measured in maternal and cord plasma from 42 women with normal glucose tolerance and 40 women with gestational diabetes at the time of term elective Caesarean section. Maternal plasma C3a, C4a and C5a concentrations were determined by enzyme-linked immunoassay. Results Maternal C3a and C4a concentrations were significantly lower in women with gestational diabetes compared with women with normal glucose tolerance at the time of term delivery (P < 0.05, Student's t-test).There was, however, no difference in maternal circulating C5a levels between the two groups. Additionally, there was no difference in C3a, C4a and C5a levels in cord plasma obtained from women with normal glucose tolerance and those with gesational diabetes. However, a significant positive correlation was observed between maternal and cord complement split levels. Conclusions Gestational diabetes is characterized by lower levels of C3a and C4a in thematernal circulation at the time of term Caesarean delivery. [ABSTRACT FROM AUTHOR]

Departments of Emergency Medicine (DEM) have experienced increased demand largely because of the aging population. This project aimed to assess the impact of a specialist aged care pharmacist (ACP) on the efficiency and effectiveness of care of older patients seeking emergency treatment. Eligible patients presenting to the DEM of Bundaberg Hospital (Australia), aged ≥65 years with a chronic condition, or ≥70 years without a chronic condition, and an Australian Triage Category score of ≥2, were alternately allocated to either the ACP (for medication reconciliation and medication review roles, along with patient education and referrals where warranted), or continued management by the DEM doctor (control group). A total of 199 patients were included (intervention, n = 101; control, n = 98), with no significant difference in mean age or gender distribution. While the ACP-managed group demonstrated a significantly greater length of stay than the control group, some confounding was likely. The ACP demonstrated greater vigilance than usual care in ensuring completeness and accuracy in charted medication orders. The ACP also provided timely clinical review for medication-related problems, with 81 issues identified for 73 admitted patients, and 24 issues among the 28 discharged patients. Qualitative data were strongly supportive, valuing and accepting of the ACP role. This study provides evidence, on balance, supporting the integration of an ACP in the DEM assessing elderly patients. Further research of this role using longer sampling, in multiple sites and with economic analysis is recommended. [ABSTRACT FROM AUTHOR]

The physical impact of in  vitro fertilisation (IVF) is not well explored. The aim of this prospective controlled longitudinal study was to examine the impact of 11 symptoms during an entire long down regulation (LDR) cycle and to determine the effect of the mean recombinant follicle stimulating hormone (RecFSH) dose and ovarian responsiveness of patients and outcome had on reported symptoms. The severity of symptoms was measured using a daily questionnaire to determine a total summary score (TSS) for each symptom, a summary symptom score (SSS) based on all TSS and a mean daily severity for each symptom. Outcome was determined by beta human chorionic gonadotroophin (ββ-hCG) test result. 79.1%% of women undertaking LDR IVF cycles had significant physical symptoms. Treatment symptom severity peaked at oocyte retrieval, with prominent symptoms including bloating, abdominal pain/cramps and fatigue. No relationship was found between outcome, RecFSH dose and ovarian responsiveness with reported symptoms. In conclusion, IVF places a real physical burden on women should be encouraged to reduce undertaking LDR cycles. The impact of the symptoms, particularly the increase in severity leading up to day of oocyte retrieval suggests that women may be warned to reduce stress and activities during this time. [ABSTRACT FROM AUTHOR]

Aim: To determine the impact of a pharmacist intervention on patient-guided diuretic dose adjustment in ambulatory patients with heart failure. Method: Patients with heart failure were randomised to usual care or usual care plus pharmacist intervention and followed for 3 months. Pharmacist intervention focused on patients improving self-care, recognising symptoms of fluid retention, measuring weight daily and self-adjusting diuretic dose using frusemide. The primary outcome was the number of appropriate weight-titrated frusemide dose adjustments. Secondary outcomes included the number of patients who correctly self-adjusted their frusemide dose, hospital readmissions due to fluid overload, heart failure-related knowledge and understanding, and quality of life (using validated tools). Results: 70 patients were recruited: 35 usual care (control) and 35 usual care plus pharmacist intervention. The average number of appropriate weight-titrated frusemide dose adjustments per patient per month in the control group was 0.32 ± 0.08 and in the intervention group was 0.85 ± 0.13 (p = 0.006). Hospital readmissions due to fluid overload was 31% in the control and 14% in the intervention groups (p = 0.04). There were significant differences between the groups regarding appropriate self-adjusted frusemide doses, heart failure-related knowledge and understanding, and quality of life. Conclusion: A pharmacist intervention improved the ability of heart failure patients to self-adjust their diuretic dose by using a flexible dosing regimen based on weight, resulting in quality of life improvement and a decrease in hospital readmissions due to fluid overload. [ABSTRACT FROM AUTHOR]

Panadol Extend (PEx) is an over-the-counter, modified-release formulation of paracetamol. Each 665 mg tablet contains 69% slow-release and 31% immediate-release paracetamol. In simulated human overdose, PEx exhibits lower and later peak serum concentrations and a lower area-under-the-curve (AUC) than comparable doses of immediate-release paracetamol (APAP-IR). The lower AUC might result from incomplete absorption of paracetamol or simultaneous metabolism with absorption. Do differences in pharmacokinetics (PK) between PEx and APAP-IR result from incomplete absorption or simultaneous absorption and metabolism of paracetamol? Cross-over study of 80 mg/kg of PEx or APAP-IR in nine volunteers. Serial plasma paracetamol, glucuronide, sulphate and cysteine metabolite estimates performed over 24 h. Peak plasma concentration (Cmax), AUC time to peak concentration (Tmax) and elimination half-life (t) were compared. PEx exhibited significantly lower paracetamol Cmax (252.33 µmol/L vs 565.56 µmol/L, P= 0.0421), AUC (2133 µmol/h/L vs 2637 µmol/h/L, P= 0.0004) and delayed Tmax (2.889 h vs 1.389 h, P= 0.0189) than APAP-IR. Sulphate metabolite PK parameters for both preparations, PEx vs APAP-IR, showed similar AUC (1369 µmol/h/L vs 1089 µmol/h/L), Tmax (3.889 h vs 4.444 h), Cmax (95.889 µmol/L vs 95.889 µmol/L) and t (3.895 h vs 3.810 h). Glucuronide metabolite concentrations revealed that PEx produced a lower Cmax (257.44 µmol/L vs 335.22 µmol/L, P= 0.0239) than APAP-IR. All other pharmacokinetic parameters were similar. Cysteine metabolite was not detected. There were minor differences between the PK parameters of the two major paracetamol metabolites of these two preparations in simulated overdose. The variability in paracetamol AUC seen between the two preparations in moderate overdose might be explained by concurrent metabolism of paracetamol during slower absorption with PEx. [ABSTRACT FROM AUTHOR]

To compare the change in visual analogue scale (VAS) pain ratings over 24 h following mechanical corneal abrasion between patients receiving sixth hourly drops of either 5% homatropine or placebo. A triple blind randomized controlled trial was conducted on a convenience sample of eligible consenting adults who were randomized to receive either sixth hourly 5% homatropine (active) or 0.5% hypromellose (placebo) eye drops. VAS pain ratings were performed at 0, 6, 12, 18 and 24 h whereas the study drug was instilled at 0, 6, 12 and 18 h. The primary outcome was attainment of a clinically significant reduction in pain on the VAS (>20 mm decrease) from enrolment to each time point. There were no significant differences in baseline variables or VAS pain ratings at any time point between those in the homatropine ( n= 20) and placebo ( n= 20) groups. The percentages of patients reporting a >20 mm VAS decrease at 12 h were 50% (95% CI -27.2-72.8) and 60% (95% CI -36.1-80.9) for the homatropine and placebo groups, respectively. We found no significant difference in pain score reductions between the two groups but some level of therapeutic benefit is not excluded. [ABSTRACT FROM AUTHOR]

Objective: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre-diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre-diabetes in the Australian ED population. Methods: Prospective cross-sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40 000 patients annually. A convenience sample of adult patients was screened with finger-prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre-diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons. Results: Seven hundred and twenty-five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9-21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre-diabetes was present in eight (17.8%; 95% CI 9.0-31.6%) and T2DM in six (13.3%; 95% CI 5.9-26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors. Conclusions: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with as much as half our population possibly affected. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger-prick fasting blood glucose through a patient's general practitioner for diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the current availability, uses and credentialing processes of emergency clinician performed ultrasound (EDUS) in Australian ED. Methods: Cross-sectional survey of Australian ED that are accredited for advanced training. Results: Ninety-four per cent of respondents (67/71, 95% confidence interval [CI] 86–98%) reported availability of EDUS. Availability was similar in both major referral and non-major referral ED. The most common uses for EDUS were focused abdominal sonography for trauma in 93% (62/67, 95% CI 83–97%), vascular access procedures in 90% (60/67, 95% CI 80–95%) and abdominal aortic aneurysm assessment in 88% of respondents (59/67, 95% CI 78–94%). Of the 67 departments with EDUS availability, 60% (40/67, 95% CI 48–71%) had a credentialing process. Of the major referral group 80% (20/25, 95% CI 61–91%) had a credentialing process compared with 52% (20/42, 95% CI 33–62%) in the non-major referral group. Conclusion: Emergency department ultrasound is widely available in Australia. Only 60% of surveyed ED had a credentialing process in place for EDUS. This may be of concern given the current Australasian College for Emergency Medicine policy regarding EDUS. [ABSTRACT FROM AUTHOR]

The article presents a study that aimed to describe the local outcomes with major lower limb amputation (LLA) in the Prince of Wales Hospital (POWH) in terms of morbidity, rehabilitation potential, discharge destination, and function in New South Wales between 1994 and 2006. The study found that of 190 patients, 135 were assessed to have a rehabilitation potential and 55 were transferred to nursing homes after stabilization. It discovered that many patients suffered from would infection.

OBJECTIVE: This study aims to investigate the impact of tobacco smoking on longer-term outcomes following a first episode of psychosis. METHODS: Data on 193 individuals were collected as part of a prospective follow-up visit of a cohort of patients after a mean of 7.5 years (SD = 0.8) after first treatment presentation. Primary outcome measures were positive and negative psychotic symptoms, depressive symptoms, quality of life, and global functioning at the 7.5 year follow-up. RESULTS: Using unadjusted analyses, smoking status was linked to male gender, longer duration of untreated psychosis, more problem illicit drug use, and problem alcohol use. After adjustment for these potential confounders, smoking at baseline was not associated with poorer long-term outcomes on the primary outcome variables of interest but was associated with drug and alcohol abuse or dependence. CONCLUSIONS: These findings suggest that smoking does not appear to be associated with worse clinical and functional outcomes in psychosis. (Journal of Dual Diagnosis, 6:212-234, 2010) [ABSTRACT FROM AUTHOR]

The use of standardised patients (SPs) and computer based simulations (CBSs) has been suggested as a method of providing students in the health sciences with basic clinical skills without relying on extensive support from external clinics. This study used a questionnaire to determine if 25 first-year audiology students from an audiology program in a large Australian university felt their interactions with SPs and CBSs had improved their ability to interact with clients and perform a basic audiometric assessment. These students reported their interactions with the SPs significantly ( p < .01) improved their performance in 10 out of 10 areas of client interaction and their interactions with the CBS significantly ( p < .01) improved their abilities in 6 out of 8 areas of basic audiometry. They also reported that the SPs' portrayals of the cases and the content of the simulated cases were realistic, although further preparation for interacting with the SPs was desirable. Overall, these results support the continued investigation of SPs and CBSs as potential methods of training and assessing Australian audiology students in the areas of client interaction and basic audiometry. [ABSTRACT FROM AUTHOR]