The Pacific Emergency Medicine Mentoring Program: A model for medical mentoring in the Pacific region.

Objective: To describe the development and implementation of a Pacific medical mentoring programme and to evaluate the programme after the first year.

Methods: The mentoring programme was adapted from Australasian College for Emergency Medicine resources and involved Australian emergency physicians mentoring Pacific Island Country doctors. Using a prospective, cross-sectional survey of all participants, researchers collected data that were analysed for content using deductive and inductive methods.

Speech and language therapy approaches to managing primary progressive aphasia.

The term primary progressive aphasia (PPA) describes a group of neurodegenerative disorders with predominant speech and language dysfunction as their main feature. There are three main variants - the semantic variant, the nonfluent or agrammatic variant and the logopenic variant - each with specific linguistic deficits and different neuroanatomical involvement. There are currently no curative treatments or symptomatic pharmacological therapies.

Protocol: Using N-of-1 tests to identify responders to melatonin for sleep disturbance in Parkinson's disease.

Background: 40% of Parkinson's Disease (PD) sufferers experience insomnia, impacting health and quality of life for patients and family members, especially carers. There is little evidence that current treatments are effective.

Objectives: To determine the effectiveness of melatonin in reducing insomnia in 44 individuals with PD using N-of-1 trials.

Intermittent Preventive Treatment of Malaria in Pregnancy: Assessment of the Sulfadoxine-Pyrimethamine Three-Dose Policy on Birth Outcomes in Rural Northern Ghana.

Background: Intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) decreases placental parasitaemia and improves birth outcomes. Currently, WHO recommends three or more doses of SP given during antenatal care (ANC), spaced one month apart after 16 weeks of gestation till delivery. This study determined the level of uptake of SP and its association with birth outcomes in rural northern Ghana.

MRI for high ankle sprains with an unstable syndesmosis: posterior malleolus bone oedema is common and time to scan matters.

Purpose: Early clinical examination combined with MRI allows accurate diagnosis of syndesmosis instability after a high ankle sprain. However, patients often present late. The aims of the current study were to describe MRI characteristics associated with syndesmosis instability and to test the hypothesis that MRI patterns would differ according to time from injury.

What every endoscopist should know about decontamination.

Carbapenemase-resistant Enterobacteriaceae (CRE) has been implicated in an alarming increase in the incidence of endoscopy-associated infections and deaths worldwide. Public Health England acknowledges that the rapid spread of CRE bacteria poses an increasing threat to public health and modern medicine here in the UK. As endoscopists, we assume that the endoscope we are handed has been appropriately decontaminated, but how many of us can honestly say that we understand the process and the pathway by which the instruments we use are reprocessed? Do we understand the associated risks if the pathway fails and our part in supporting the teams responsible for this critical role? Successful decontamination of endoscopes is everyone's business, and this article outlines what every endoscopist should know about decontamination.

Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology.

Background: Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function.

Purpose: To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy.

Chronic Kidney Disease in New Zealand Māori and Pacific People.

Chronic kidney disease (CKD) disproportionately affects Māori (the indigenous people of New Zealand [NZ]) as well as Pacific people, particularly from Samoa, Tonga, and Fiji. As New Zealand is home to the largest population of Pacific people, New Zealand and the Pacific Islands fulfil the definition of a CKD 'hotspot'. Although diabetic nephropathy is the major cause of CKD, with disproportionately higher rates in NZ Māori and Pacific people, there is increasing evidence that there is a familial predisposition to CKD that is not due to diabetes.

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana.

Background:  Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.

Aim:  The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.

Lexical retrieval treatment in primary progressive aphasia: An investigation of treatment duration in a heterogeneous case series.

Word-finding difficulty is typically an early and frustrating symptom of primary progressive aphasia (PPA), prompting investigations of lexical retrieval treatment in PPA. This study aimed to investigate immediate treatment gains following two versus four weeks of treatment, item generalisation, and maintenance of gains with ongoing treatment in a single case series of eight individuals with heterogeneous PPA presentations (three non-fluent/agrammatic, two logopenic, two semantic, and one mixed PPA). Three individuals made initial gains in picture naming and maintained them over 6 months or more with ongoing treatment.

Impact of scribes on emergency medicine doctors' productivity and patient throughput: multicentre randomised trial.

Objectives: To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput.

Design: Randomised, multicentre clinical trial.

Setting: Five emergency departments in Victoria used Australian trained scribes during their respective trial periods.

The Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis, a multicentre observational study (ARISE FLUIDS observational study): Rationale, methods and analysis plan.

Objective: There is uncertainty about the optimal i.v. fluid volume and timing of vasopressor commencement in the resuscitation of patients with sepsis and hypotension.

Radiation Exposure Optimisation During AF Ablations Utilising the Cryoballoon Ablation System.

Background: Radiation risk minimisation during cardiac catheterisation, particularly atrial fibrillation (AF) ablation procedures, requires a multifaceted approach involving both technique and technology.

Objective: To evaluate radiation dose associated with cryoballoon compared to conventional radiofrequency (RF) AF ablation procedures.

Methods: Consecutive patients undergoing AF ablation were collected in a single-centre registry.

Telemental Health in Low- and Middle-Income Countries: A Systematic Review.

Introduction: The rising incidence of mental illness and its impact on individuals, families, and societies is becoming a major public health concern, especially in resource-constrained countries. Consequently, there is an increasing demand for mental health services in many middle- and low-income countries (LMIC). Challenges such as inequality in access, lack of staff and hospital beds, and underfunding, often present in the LMIC, might in part be addressed by telemental health services.

Predictors of 24-h mortality after inter-hospital transfer to a tertiary medical intensive care unit.

Purpose: To identify variables associated with 24-h mortality after inter-hospital transfer.

Materials And Methods: Single center retrospective study of adult patients transferred to a tertiary care medical ICU between 1 January 2010 and 15 April 2014. Demographic, clinical, physiologic, and laboratory data were collected.

Investigation of group A Streptococcus immune responses in an endemic setting, with a particular focus on J8.

Sustained control of group A Streptococcus (GAS) infections in settings of poverty has proven to be challenging, and an effective vaccine may be the most practical long-term strategy to reduce GAS-related disease burden. Candidate GAS vaccines based on the J8 peptide have demonstrated promising immunogenicity in mice, however, less is known about the role of J8 antibodies in the human immune response to GAS infection. We analysed the stimulation of J8 antibodies in response to infection, and the role of existing J8 antibodies in protection against subsequent infection, using data collected in the Fijian population: (1) cross sectional population serosurvey; (2) paired serum collection for assessment of M-specific and J8 antibody responses; and (3) longitudinal assessment of GAS infection and immunity.

Prevalence of penile curvature: a population-based cross-sectional study in metropolitan and rural cities in Australia.

Objective: To evaluate the prevalence of penile curvature and health-seeking behaviour in Australian men.

Patients And Methods: A population-based, cross-sectional anonymous web-based survey was designed, and men aged between 35 and 75 years in major and rural metropolitan cities across Australia were invited to participate. Respondents were screened for self-reported symptoms of penile curvature and their impact on various psychosexual domains.

Long-Term Results Following Repair for Degenerative Mitral Regurgitation - Analysis of Factors Influencing Durability.

Background: The majority of patients with degenerative mitral regurgitation (DMR) are amenable to reconstructive procedures. There is debate regarding factors that influence long-term durability with respect to repair technique, valve remodelling and progressive myxomatous change.

Methods: A total of 685 patients with DMR underwent mitral valve repair by a single surgeon between 1991 and 2011 with follow-up completed at 31 December 2016.

Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana.

Background: Despite their potential health and social benefits, adoption and use of improved cookstoves has been low throughout much of the world. Explanations for low adoption rates of these technologies include prices that are not affordable for the target populations, limited opportunities for households to learn about cookstoves through peers, and perceptions that these technologies are not appropriate for local cooking needs. The P3 project employs a novel experimental design to explore each of these factors and their interactive effects on cookstove demand, adoption, use and exposure outcomes.

Dravet syndrome in South African infants: Tools for an early diagnosis.

Purpose: Dravet syndrome (DS) is a well-described, severe genetic epileptic encephalopathy with an increased risk of SUDEP. The incidence and genetic architecture of DS in African patients is virtually unknown, largely due to lack of awareness and unavailability of genetic testing. The clinical benefits of the available precision medicine approaches to treatment emphasise the importance of an early, correct diagnosis.

End-stage kidney disease in Fiji.

Background: Chronic kidney disease is now a leading cause of death in Fiji. The country lacks even basic statistics about the incidence of end-stage kidney disease (ESKD) and presents significant challenges to conducting clinical research.

Aim: To estimate the incidence and characteristics of ESKD in Fijian adults.

Treatment for spoken and written word retrieval in the semantic variant of primary progressive aphasia.

This study investigated whether a treatment programme for spoken word retrieval, supplemented with written naming, was beneficial for an individual with right-hemisphere dominant semantic variant of PPA (svPPA). Assessment and treatment were delivered remotely through Skype. Treatment consisted of two phases of lexical retrieval therapy (Repetition and Reading in the Presence of a Picture: RRIPP), with and without written responses (Phases 1 and 2 respectively), and a third treatment phase based on the procedures of Conceptual Enrichment (COEN) therapy.

Randomised controlled trial showed that neonates received better pain relief from a higher dose of sucrose during venepuncture.

Aim: We compared the effect of two different doses of sucrose on neonatal pain scores during venepuncture.

Methods: This randomised crossover study focused on neonates born weighing more than 1000 g from December 2014 to June 2016, who received neonatal intensive care at two hospitals: one in Empangeni, South Africa, and one in Trondheim, Norway. During two consecutive venepuncture procedures, 27 neonates from South Africa and 26 neonates from Norway were randomised to receive 0.