ABSTRACT
Background: In April 2020, the diagnostic criteria for gestational diabetes mellitus (GDM) changed in Queensland, with the goal of reducing exposure of pregnant women to COVID-19. Methods: A retrospective clinical audit was conducted at a regional hospital to compare the incidence of GDM, and specific maternal and neonatal outcomes four months before and after the change in guidelines was implemented. Results: Less than 50% of diagnostic tests were performed according to new guidelines. There was a non-significant increase in the incidence of GDM (13.3% to 15.3%), and pharmacological treatments. Instrumental deliveries (p = 0.01) and shoulder dystocia (p = 0.04) increased following the change in guidelines. There were no differences in the incidence of elective and emergency caesarean delivery, macrosomia and fetal weight. Maternal pre-pregnancy body mass index (BMI) was higher in the COVID-19 GDM cohort (p = 0.02). Conclusions: Despite the change in guidelines, there was a non-significant increase in the incidence of diagnosis of gestational diabetes.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students' opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: Routinely administered surveys of fifth year medical student' experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: Data from 219 surveys showed a reduction in the opportunity to perform "a cervical screen test" (p<0.001), "a mental health assessment" (p=0.006), "assess the risk of suicide" (p=0.004) and "bladder catheterisation" (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: "a mental health assessment" (p=0.026) and "an ECG" (p=0.035). Conclusions: The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students' opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: : Routinely administered surveys of fifth year medical student' experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: : Data from 219 surveys showed a reduction in the opportunity to perform "a cervical screen test” (p<0.001), "a mental health assessment” (p=0.006), "assess the risk of suicide” (p=0.004) and "bladder catheterisation” (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: "a mental health assessment” (p=0.026) and "an ECG” (p=0.035). Conclusions: : The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.
ABSTRACT
Background: In April 2020, the diagnostic criteria for gestational diabetes mellitus (GDM) changed in Queensland, with the goal of reducing exposure of pregnant women to COVID-19. Methods: A retrospective clinical audit was conducted at a regional hospital to compare the incidence of GDM, and specific maternal and neonatal outcomes four months before and after the change in guidelines was implemented. Results: Less than 50% of diagnostic tests were performed according to new guidelines. There was a non-significant increase in the incidence of GDM (13.3% to 15.3%), and pharmacological treatments. Instrumental deliveries (p = 0.01) and shoulder dystocia (p = 0.04) increased following the change in guidelines. There were no differences in the incidence of elective and emergency caesarean delivery, macrosomia and fetal weight. Maternal pre-pregnancy body mass index (BMI) was higher in the COVID-19 GDM cohort (p = 0.02). Conclusions: Despite the change in guidelines, there was a non-significant increase in the incidence of diagnosis of gestational diabetes.
ABSTRACT
In his speech for the 1945 Nobel Prize, Fleming warned that misuse of penicillin could lead to bacteria becoming resistant.2 The first reports of Staphylococcus aureus resistance to penicillin had already appeared in the 1940s.3>4 Australian hospital and community laboratory data show rising levels of resistance of commonly encountered pathogens for commonly used antibiotics.5 In 2019, for Escherichia coli, up to 45% resistance was reported for ampicillin/ amoxicillin and 10.9% for amoxicillin/ clavulanic acid.5 Methicillin resistance has been found in 22% of S. aureus infections in Australia.1 Organisms that are multi-drug resistant and extensively drug resistant, where multiple classes of antibiotics have become ineffective, have become commonplace. Bacterial resistance develops rapidly in an individual after they take antibiotics and can persist for up to 12 months.6 In that time, individuals can spread the resistant bacteria to others, creating a problem not only for themselves but also for their families and communities.6 Development of resistance has been clearly linked to the consumption of antibiotics;7 therefore, reducing antibiotic prescribing and reserving antibiotics for infections for which they have a proven benefit can slow the development of resistance.8 Use of antibiotics Most antibiotics used in the healthcare context are prescribed by general practitioners (GPs).5>9-11 Although in Australia in recent years the consumption of antibiotics has been declining, in 2019 more than 26 million antibiotic prescriptions were dispensed, approximately one for each Australian. MedicineInsight is a large-scale database of longitudinal de-identified electronic health records from more than 660 general practices.13 The Registrar Clinical Encounters in Training (ReCEnT) database captures approximately 500,000 recordings of general practice registrars' patient encounters at different times during their training.14 Analyses from both sources show that for cough/acute bronchitis, a condition for which guidelines clearly do not recommend antibiotics,15 in 2016-17 patients received an antibiotic prescription in 81.4% (MedicineInsight) and 72.2% (ReCEnT) of cases.10'16 McCullough et al calculated that for acute respiratory infections, antibiotics are prescribed at rates between four and nine times higher than those recommended by Therapeutic Guidelines.17 Although many contextual factors play a part in GPs' prescribing decisions, in these cases, antibiotics are not only ineffective but are also harmful to patients. Hospitalisations for adverse effects of antibiotics are a problem worldwide,18 and even a single dose of antibiotics can alter the individual's microbiome for up to a year, affecting the person's immune system and general health.19 All these factors add to the risk of harm related to inappropriate prescribing.20 Patient outcomes of low antibiotic prescribing rates It is important to retain a focus on appropriateness of prescribing to ensure safety and quality of patient care.
ABSTRACT
Impetigo affects millions of children worldwide. Most guidelines recommend antibiotics as first-line treatment; however, topical antiseptics present a potentially valuable, understudied, antibiotic-sparing treatment for mild impetigo. We aimed to determine the feasibility of a randomised controlled trial (RCT) comparing efficacy of soft white paraffin (SWP), hydrogen peroxide (H2O2) and mupirocin for mild impetigo. Participants were recruited from general practices and randomly assigned one of three treatments. Size and number of lesions were measured at the initial consultation and day six. Post-recruitment, interviews with general practitioners were transcribed and themes identified to determine protocol acceptability, recruitment barriers and avenues to improve delivery. Two participants received SWP (n = 1) and mupirocin (n = 1). Both commenced oral antibiotics following failure of assigned topical treatment in which lesions increased in size or number. Recruitment barriers included reduced presentation of impetigo due to COVID-19, pre-treatment with existing at-home medications and moderate/severe infection. Childcare centers and pharmacies were identified as alternative venues to improve the recruitment rate. Valuable insight was gained into the practicality of conducting a RCT of impetigo treatments in general practice. Future trials should consider recruiting outside of general practice clinics to capture patients at earlier, more mild stages of infection. Further investigation into the prevalence and impact of use of at-home expired antibiotics may be beneficial.
ABSTRACT
BACKGROUND AND OBJECTIVES: vaccine injections are a common cause of iatrogenic pain and anxiety, contributing to non-compliance with scheduled vaccinations. With injection-related pain being recognised as a barrier to vaccination uptake in both adults and children, it is important to investigate strategies to effectively reduce immunisation pain. This prospective randomised controlled trial investigated the effects of applying an ice pack on vaccine-related pain in adults. METHODS: medical students receiving the flu vaccination were randomised to receive an ice pack (intervention) or placebo cold pack (control) at the injection site for 30 s prior to needle insertion. Immediate post-vaccination pain (VAS) and adverse reactions in the proceeding 24 h were recorded. RESULTS: pain scores between the intervention (n = 19) and control groups (n = 16) were not statistically significant (intervention: median pain VAS = 7.00, IQR = 18; control: median pain VAS = 11, IQR = 14 (p = 0.26). There were no significant differences in the number of adverse events between the two groups (site pain p = 0.18; localised swelling (p = 0.67); bruising p = 0.09; erythema p = 0.46). DISCUSSION: ice did not reduce vaccination-related pain compared to cold packs. COVID-19 related restrictions impacted participant recruitment, rendering the study insufficiently powered to draw conclusions about the results.
ABSTRACT
THE COVID-19 pandemic highlights the key role of general practice in Australian health service delivery, especially for our most vulnerable patients.1 While terms such as 'index case' (defined as the first identified case in a group of related cases of a particular communicable or heritable disease) and 'cascade testing' (the extension of genetic testing to individuals at risk of inheriting a pathogenic variant previously identified in a biological relative) have long been associated with genetic testing for hereditary conditions among families, the recent increased public awareness of and experience with epidemiological concepts such as contact tracing offers new potential to improve detection and management of familial hypercholesterolaemia (FH) in the community.On 1 May 2020, new Medicare Benefits Schedule (MBS) item numbers relating to genetic testing for FH were introduced in Australia,2 offering a timely opportunity for general practice to collaborate with lipid specialists to facilitate improved detection and management. While an infectious disease such as COVID-19 cannot be directly compared with inherited conditions such as FH, lessons learned from the pandemic and developments in remote consulting can be applied to the management of FH.