Yield of adenomas and colorectal cancers within 5 years of a negative colonoscopy: are the guidelines guiding?

Background: Screening for colorectal cancers outside the recommended guidelines presents a considerable burden to resource management in many public hospitals. The aim of this study is to evaluate the frequency, indications and outcomes for repeat colonoscopy performed within 5 years of a negative colonoscopy.

Methods: A retrospective review of all colonoscopies at Nambour Hospital in 2008 was performed to identify those with a negative colonoscopy.

Diagnostic errors in older patients: a systematic review of incidence and potential causes in seven prevalent diseases.

Background: Misdiagnosis, either over- or underdiagnosis, exposes older patients to increased risk of inappropriate or omitted investigations and treatments, psychological distress, and financial burden.

Objective: To evaluate the frequency and nature of diagnostic errors in 16 conditions prevalent in older patients by undertaking a systematic literature review.

Data Sources And Study Selection: Cohort studies, cross-sectional studies, or systematic reviews of such studies published in Medline between September 1993 and May 2014 were searched using key search terms of "diagnostic error", "misdiagnosis", "accuracy", "validity", or "diagnosis" and terms relating to each disease.

How do outcomes compare between women and men living with HIV in Australia? An observational study.

Unlabelled: Background Gender differences vary across geographical settings and are poorly reported in the literature. The aim of this study was to evaluate demographics and clinical characteristics of participants from the Australian HIV Observational Database (AHOD), and to explore any differences between females and males in the rate of new clinical outcomes, as well as initial immunological and virological response to antiretroviral therapy.

Methods: Time to a new clinical end-point, all-cause mortality and/or AIDS illness was analysed using standard survival methods.

Review article: Staff perception of the emergency department working environment: Integrative review of the literature.

Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs.

Nephrology training in Australia and New Zealand: A survey of outcomes and adequacy.

Background: Advanced training programmes in nephrology should provide broad exposure to all aspects of nephrology. In Australia and New Zealand (ANZ), the Advanced Training Committee in Nephrology oversees training, and recent increases in trainee numbers have led to concern about dilution of experience.

Aim: To investigate early career paths of nephrologists in ANZ and determine the adequacy of training by comparing self-determined competency and skill relevance among recently graduated nephrologists.

Efficacy and safety of tofacitinib following inadequate response to conventional synthetic or biological disease-modifying antirheumatic drugs.

Objectives: Biological disease-modifying antirheumatic drugs (bDMARDs) have shown diminished clinical response following an inadequate response (IR) to ≥1 previous bDMARD. Here, tofacitinib was compared with placebo in patients with an IR to conventional synthetic DMARDs (csDMARDs; bDMARD-naive) and in patients with an IR to bDMARDs (bDMARD-IR).

Methods: Data were taken from phase II and phase III studies of tofacitinib in patients with rheumatoid arthritis (RA).

The Effect of Exit-Site Antibacterial Honey Versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial.

Unlabelled: ♦

Background: The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. ♦

Methods: A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185).

An unusual skin lesion caused by Lasiodiplodia theobromae.

We describe a case of subcutaneous infection as a result of traumatic implantation caused by the fungus Lasiodiplodia theobromae. It was isolated in multiple swabs from the foot of an active healthy male. The fungus was identified by traditional mycology culture methods though this was slow with much time required for sporulation on only one of the agars used.

Is seborrhoeic dermatitis associated with a diffuse, low-grade folliculitis and progressive cicatricial alopecia?

An association between adult scalp seborrhoeic dermatitis and cicatricial hair loss has not previously been convincingly established. This study seeks to demonstrate a unique relationship between a clinically identifiable chronic scalp dermatitis-folliculitis with the characteristic histological features of low-grade inflammatory fibrosing alopecia, resulting in a distinctive progressive cicatricial alopecia which we believe is prevalent and hitherto unrecognised, and befits the description of seborrhoeic folliculitis. The clinical, epidemiological and histopathological features of seborrhoeic folliculitis are demonstrated to establish its unique status among the disorders of adult diffuse cicatricial alopecia.

Multiple lichen planus-like keratoses: Lichenoid drug eruption simulant and under-recognised cause of pruritic eruptions in the elderly.

We present six cases of multiple eruptive lichen planus-like keratoses (LPLK), occurring in older individuals predominately confined to previously solar exposed areas. Diagnosis was often confounded by the frequent histological reporting of 'lichenoid drug reaction' (LDR), despite many of the patients being unmedicated. We review the literature regarding eruptive LPLK and reflect on their etiology, clinical aspects, management and importantly their clinicopathological differentiation from LDR.

In vitro evaluation of an ultrasonic cardiac output monitoring (USCOM) device.

Non-invasive cardiac output monitoring techniques provide high yield, low risk mechanisms to identify and individually treat shock in the emergency setting. The non-invasive ultrasonic cardiac output monitoring (USCOM) device uses an ultrasound probe applied externally to the chest; however limitations exist with previous validation strategies. This study presents the in vitro validation of the USCOM device against calibrated flow sensors and compares user variability in simulated healthy and septic conditions.

Simple Nutrition Screening Tool for Pediatric Inpatients.

Background: Pediatric nutrition risk screening tools are not routinely implemented throughout many hospitals, despite prevalence studies demonstrating malnutrition is common in hospitalized children. Existing tools lack the simplicity of those used to assess nutrition risk in the adult population. This study reports the accuracy of a new, quick, and simple pediatric nutrition screening tool (PNST) designed to be used for pediatric inpatients.

Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing.

The prospect of an 'antimicrobial perfect storm' in the coming decades through the emergence and proliferation of multi-resistant organisms has become an urgent public health concern. With limited drug discovery solutions foreseeable in the immediate future, and with evidence that resistance can be ameliorated by optimisation of prescribing, focus currently centres on antibiotic use. In hospitals, this is manifest in the development of stewardship programs that aim to alter doctors' prescribing behaviour.

A review of the number and severity of injuries sustained following a single motocross event.

Background: Competitive and recreational motocross is an increasingly popular sport in Australia and worldwide. Children as young as 4-year-old can participate in this activity. It is recognised that this is a high risk sport despite the use of protective equipment and developments in course design.

Mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique that allows lung cancer nodal staging and biopsy of parabronchial and paratracheal tissue. Its simplicity, high diagnostic yield, ability to diagnose both benign and malignant conditions, and exceedingly low complication rate has resulted in rapid widespread adoption by surgeons and physicians. EBUS-TBNA-related complications, however, do occur and need to be considered when assessing the risk-benefit profile of performing the procedure, and if the patient represents with unexpected symptoms after the procedure.

Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial.

Background: There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus.

Older workers: an exploration of the benefits, barriers and adaptations for older people in the workforce.

The continuation of older people in the paid workforce is regarded as beneficial for both the economy and older workers. While there have been attempts to encourage older people to continue working, little is understood about older workers' perspectives. This qualitative study explored the lived experiences and perceptions of paid workers aged 60 years and older with the aim of understanding why older people continue to work and the barriers and facilitators they encounter.

Paediatric motorbike injuries: do children riding motorbikes get the same injuries as those riding bicycles?

Background: Health workers have the impression that injuries sustained by children on motorcycles are more severe and debilitating than those of children on bicycles. This was not reflected by data collected for a statewide trauma registry: the two groups looked very similar at first glance.

Methods: A retrospective chart review audit was carried out to further collect clinical data that might be deemed to be consequential to patients, their families and the health system, to see if this initial finding was reproduced.

New for old? Risperidone long-acting injection in older patients.

Objective: To describe six older patients who were treated with risperidone long-acting injection, and to discuss the role of this medication in a psychogeriatric setting.

Method: Case series.

Results: Of the six patients trialled on risperidone long-acting injection, two remain on this treatment.