Extra-axial haemorrhage in a patient with Alport syndrome after epidural anaesthesia.

Extra-axial haemorrhage following epidural anaesthesia is extremely rare. We present the case of an 18-year-old G1P0 woman with Alport syndrome who had a ventouse delivery for failure to progress that was complicated by a postpartum tonic-clonic seizure. Clinically, and confirmed radiologically, the patient was found to have experienced an extra-axial haemorrhage (extradural and subdural haemorrhage) secondary to a cerebrospinal fluid leak caused by a dural puncture during epidural anaesthesia. Differentiating between postdural puncture headache, subdural haemorrhage and extradural haemorrhage can be extremely challenging, but it is important to consider these rare conditions when evaluating patients presenting with postpartum headache and seizure.

Understanding quality use of medicines in refugee communities in Australian primary care: a qualitative study.

BACKGROUND: Although refugee health issues are increasingly experienced in primary health care, few studies have explored the quality use of medicines in refugee communities even though access to and quality use of medicines is a key component of care delivery. AIM: To identify strategies to support the quality use of medicines in refugee communities. DESIGN AND SETTING: Qualitative study with primary healthcare providers and refugee health leaders in Brisbane, Australia. METHOD: Semi-structured interviews were conducted with refugee health leaders, pharmacists, practice nurses, and GPs. Data were recorded and transcribed. Thematic analysis was used to identify key barriers and facilitators for the quality use of medicines. RESULTS: Five barriers, including communication and language barriers, limited health literacy and financial cost, and four facilitators, including better coordination between healthcare providers and improved healthcare provider training, were identified. This study provides a rich exploration relating to medication use and examines the engagement between pharmacists and refugees, highlighting some communication concerns. It recognises the supportive role of the practice nurse and offers practical strategies for improving community knowledge about safe medicines use. CONCLUSION: This preliminary study builds on previous studies investigating refugee health access and health literacy. It offers new understandings towards enhancing quality use of medicines in refugee communities and practical insights to assist the targeting of resources for future interventions.