Appropriateness of healthdirect referrals to the emergency department compared with self-referrals and GP referrals.

OBJECTIVE: To assess the appropriateness of healthdirect referrals to the emergency department (ED) and compare these to self-referrals and general practitioner referrals. DESIGN AND SETTING: Prospective observational study conducted at the Royal Perth Hospital ED from August 2008 to April 2009, using the healthdirect database to cross check healthdirect advice with ED data. PATIENTS: Consecutive patients at triage, identified as healthdirect-referred, self-referred or GP-referred (720 patients per group). MAIN OUTCOME MEASURE: Appropriateness of referrals, using an a-priori definition. RESULTS: The healthdirect-referred patients were significantly younger than self-referred and GP-referred patients (mean age, 41.6 years v 45.5 years and 50.1 years, respectively; P < 0.01), more likely to be female (60.3% v 43.8% and 46.4%, respectively; P < 0.01) and more likely to attend the ED out of hours (64.0% v 45.8% and 21.0%, respectively; P < 0.01). Self-referred patients had the highest acuity profile (P < 0.01). The proportions of referrals that were assessed as being appropriate were: healthdirect-referred, 72.9% (95% CI, 69.7%-76.2%); self-referred, 73.8% (95% CI, 70.5%-77.0%); and GP-referred, 89.7% (95% CI, 87.5%-91.9%). Of the 534 calls that could be traced back to the healthdirect database, 280 (52.4%) represented patients who attended the ED despite a contrary recommendation. CONCLUSIONS: GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.

A critique of the Montagnier evidence for the HIV/AIDS hypothesis.

In 1983 Luc Montagnier and his colleagues claimed to have discovered a novel retrovirus presently known as human immunodeficiency virus (HIV). By 1984 HIV was almost universally accepted to be the cause of AIDS. However, 20 years later, HIV cannot account for the phenomena for which the retroviral hypothesis was proposed, namely, Kaposi's sarcoma, decrease in T4 lymphocytes and thus the opportunistic infections in AIDS patients which were assumed to be the direct results of this decrease. Agents other than HIV to which patients belonging to the AIDS risk groups are exposed cause decrease in T4 cells. Neither have the main predictions of the HIV hypothesis been fulfilled. HIV seropositivity in the developed countries still remains restricted to the original high risk groups, no HIV vaccine exists, and no successful animal model has been developed. In this communication, we critically analyse the evidence which in 1983 was claimed to prove the existence of HIV. The phenomena which Montagnier and his colleagues considered proof for the existence of HIV are detection of reverse transcriptase activity; the presence of retrovirus-like particles in the culture; immunological reactivity between proteins from the culture supernatant which, in sucrose density gradients, banded at the density of 1.16 g/ml ("purified virus") and antibodies in a patient's (BRU) serum. Reverse transcriptase activity can be found in viruses other than retroviruses and in all normal cells. Reverse transcription can be brought about not only by the enzyme reverse transcriptase but also by normal, cellular DNA polymerases. Retrovirus-like particles are ubiquitous in cultures not infected with retroviruses, especially in conditions employed by Montagnier et al. From the reaction between proteins in the "purified virus" and antibodies in the patient serum Montagnier concluded that the proteins were HIV proteins and the antibodies were HIV antibodies. Since all antibodies are polyspecific, from such a reaction it is not possible to define the origin of even one reactant let alone both. Even if this were possible, since Montagnier's "purified virus" did not contain particles with the "morphology typical of retroviruses", the proteins cannot be retroviral. We conclude that, these phenomena are non-specific to retroviruses and thus cannot be considered proof for the existence of a unique retrovirus HIV.

Telephone triage in Western Australia.

We describe the development and operations of the first large-scale Australian medical telephone triage centre. Studies have commenced to evaluate efficacy and safety of the service, as well as gauge the impact on demand for healthcare services.