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Objective: Manual data-entry of handwritten laboratory test requests into electronic information systems has implications for data accuracy. This study sought to identify the types and number of errors occurring for handwritten serology test requests received from outpatient clinics.Methods: A 15-day audit at a serology laboratory in Sydney, Australia, compared the content of all transcribed serology outpatient test requests in the laboratory information system with the handwritten request form.Results: One or more errors were detected in 67/627 (10.7%) audited requests (N=68 errors). Fifty-one of the errors (75.0%) were transcription errors: the wrong test was transcribed in 40/68 cases (58.8%) – ten of these occurred when the abbreviations ‘HBsAb’ and ‘HBsAg’ were confounded for one another – and transcribed requests were missing a test in 11/68 cases (16.2%). The remaining 17 non-transcription errors (25.0%) described request forms not signed by the ordering clinician, mislabelled specimens, and wrong tests due to computer algorithm errors.Conclusions: Manual data-entry of handwritten serology requests is an error-prone process. Electronic ordering has the potential to eliminate illegible handwriting and transcription errors, thus improving data accuracy in hospital information systems.

Background Good hand hygiene can prevent healthcare-associated infections. The observer effect is the tendency of research participants to behave differently from the way they otherwise would when aware of being studied. This effect may be associated with improved hand hygiene compliance when utilised in the prior advertisement of auditing. Methods An observational study was carried out between 1 June 2012 and 31 August 2012 at the Liverpool Hospital, an 877-bed tertiary teaching hospital in south-western Sydney, Australia, to determine the association between prior notification of hand hygiene auditing by recognisable observers and compliance rates and to evaluate the acceptability of such a practice. Surveys regarding the general acceptability of hand hygiene auditing were conducted, followed by advertised and unadvertised audits over the study period. Participants were made aware of being audited by prior notice and conspicuous identification signs. Results The auditors recorded 2080 moments over 3 months, of which 462 (22.2%) were done with prior notification. A significant improvement in overall hand hygiene compliance from 82.3% to 87.9% (P=0.004) was found. Subgroup analysis revealed improved compliance for the moments ‘before patient contact’ (71.8% to 81.3%; P=0.018) and ‘after patient contact’ (85.8% to 93.8%; P=0.019). Over 60% of healthcare workers rated hand hygiene as a high priority in daily work and 55% or more regarded weekly auditing as being acceptable. Conclusion Advertised auditing is associated with an increase in the overall hand hygiene adherence rate as well as in the subgroups ‘before’ and ‘after patient contact’ and appears to be acceptable to healthcare workers. This association requires validation with multicentre randomised controlled trials.

ABSTRACTMatrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) was evaluated prospectively in a diagnostic laboratory. Nine hundred twenty-seven organisms were tested in triplicate; 2,351/2,781 (85%) species and 2,681/2,781 (96%) genus identifications were correct. Known issues such as the misidentification of alpha-hemolytic streptococci as Streptococcus pneumoniaewere easily corrected. Identifications cost AUD$0.45 per isolate and were available in minutes. MALDI-TOF MS is rapid, accurate, and inexpensive.

The study objective was to determine the concordance of intraocular pressure (IOP) in glaucoma suspects (GS) and normal tension glaucoma (NTG) patients.

This paper outlines the history of Australia's federal electoral machinery, and describes the current structure and functions of the Australian Electoral Commission.1

The incidence of enterovirus D68 (EV-D68) in New South Wales, Australia, is unknown. As part of a state-wide surveillance program, enterovirus positive diagnostic specimens were assessed from patients presenting to hospitals with respiratory and meningitis syndromes from August 2018 to November 2019.

Somatic symptoms are viewed as part of a larger configuration of emotional and attitudinal responses that must be brought into consciousness and expressed to completion for healing and change to occur. The principle of completion in somatic work is discussed and examples of how this principle is expressed in the several levels of the bodymind are given. Several different aspects of the process of embodiment are summarized. The concept of a conscious body is introduced and a description of how the experience of embodiment can embrace physical, emotional and spiritual levels is presented.

Electrical stimulation of the brain of unanesthetized, freely moving adult Mallard ducks (Anas platyrhynchos) produced response patterns characteristic of the aggressive and escape behaviors of this species. Aggressive reactions were classified into three categories: (a) directed attacks on a companion; (b) defensive threat display automatisms characteristic of a cornered bird but lacking attack behaviors; and (c) the rabrab and inciting vocalizations associated with aggressive encounters but unaccompanied by other responses associated with attack or escape. Five categories of fear-like reactions were distinguished: (a) sneak-into-cover reactions characterized by attempts to hide under objects and a strong preference for shelter; (b) crouch-flat reactions in which the birds would stretch out flat on the floor or surface of the water; (c) directed escape reactions characterized by a variety of response topographies but all oriented toward the window or shelter; (d) undirected escape reactions characterized by rushing or flying responses but lacking orientation; and (e) alarm vocalizations unaccompanied by other fear-like responses. Testing of the stimulation-produced reactions under a variety of environmental conditions indicated that many of the reactions (e.g., directed attack, sneak-into-cover) were dependent on specific stimuli for their performance, while other reactions (e.g., threat display automatisms) showed consistent thresholds and response topographies in a variety of situations. Aggressive reactions were elicited from the archistriatum and from wide areas in the diencephalon. Sites producing escape reactions were located primarily in diencephalic and midbrain regions. Evidence was presented suggesting that the different patterns of escape behaviors have different neuroanatomical distributions.

ABSTRACTStreptococcus pyogenesisolates from a tropical region and a subtropical region of Australia with high and low incidences of severe streptococcal diseases, respectively, were analyzed for speA, speB, and speCgene distributions and NAD-glycohydrolase expression. No direct correlation of these characteristics with a propensity to cause invasive diseases was observed.

IntroductionTuberculous meningitis (TBM) accounts for <1% of all tuberculosis (TB) presentations. Paradoxical reactions (PR) in non-HIV patients are a common manifestation of anti-tuberculosis therapy characterised by clinico-radiological deterioration. We report a case series of TBM admissions to our institution, including two cases with corticosteroid-refractory PR who responded to adjuvant cyclosporin.MethodsRetrospective review of 12 HIV-negative patients admitted to Liverpool Hospital, Sydney (2005–2017) with laboratory and/or radiologically confirmed TBM.ResultsMedian age 40 (range 22–81 years), 7 males. Eleven patients were of Asia-Pacific origin. All eleven presented with central nervous system manifestations and 1 had preceding miliary TB. Nine patients had extra-cranial TB involvement, including 8 with past or current pulmonary disease. Cerebrospinal fluid (CSF) TB PCR/culture was positive in 10 patients. One patient had multi-resistant TB. PR of TBM developed in 5 patients despite concomitant corticosteroids in 4. Two cases had refractory PR.Case 1. 22 year old Vietnamese male presented with 6 week history of progressive headache and neck stiffness. CSF demonstrated 61 WCC (75% neutrophils), protein 2.67 g/L (n<0.45), glucose 2.1 mmol/L. Despite concomitant anti-tuberculosis and high-dose corticosteroid treatment, he developed worsening headaches and altered mentation with interval MRI brain increase in size and number of tuberculomas, hydrocephalus, and left thalamic infarction. Cyclosporin was added with gradual improvement and ultimately good outcome.Case 2. 47 year old Filipino male presented with 3 week history of headache and neck stiffness and 3 day history of fever, dysarthria and diplopia. MRI brain showed basal meningitis, hydrocephalus and left putaminal infarction. CSF demonstrated 245 WCC (35% neutrophils), protein 0.68 g/L, glucose 1.8 mmol/L. Despite concomitant anti-tuberculosis and corticosteroid treatment, the patient developed PR-induced worsening hydrocephalus necessitating ventriculo-peritoneal shunting. Cyclosporin was added with gradual PR resolution.ConclusionOur case series highlights the importance of concomitant corticosteroids in TBM and the potential role of cyclosporin in refractory PR.