In this pilot study, we explored current attitudes and deprescribing practices of clinicians in a large regional health service through a mixed methods approach. Respondents included doctors, pharmacists and nurse practitioners, who outlined three themes including professional and organisational contexts, disconnect between goals and practices and factors influencing deprescribing.
The COVID-19 pandemic significantly disrupted lower limb diabetes care. We aimed to map trends in diabetes-related lower limb amputation and hospitalisation rates through the COVID-19 pandemic.
We performed a retrospective cohort study of all individuals who underwent a lower limb amputation for a diabetes-related foot complication from 2018 to 2021 at the Royal Melbourne Hospital, a quaternary hospital in Australia. Hospitalisation rates with a diabetes-related foot complication were collected for comparison. The start of the COVID-19 epoch was defined as 16 March 2020, when a state of emergency was declared in Melbourne.
During the study period, 360 lower limb amputations for diabetes-related foot complications were performed in 247 individuals. The median monthly number of amputations remained stable prior to and during the COVID-19 epoch; there was a median of 8.0 amputations per month (interquartile range (IQR) = 6.5–11) before COVID-19, compared to 6.5 amputations (IQR = 5.0–8.3) during the COVID-19 epoch (P = 0.23). Hospitalisation with a diabetes-related foot complication significantly increased from a median monthly rate of 11 individuals (IQR = 9.0–14) before COVID-19 to 19 individuals (IQR = 14–22) during the COVID-19 epoch (p < 0.001).
Despite increased hospitalisations for diabetes-related foot complications during COVID-19, there was not a corresponding increase in amputation rates. Face-to-face care of diabetes-related foot complications was prioritised at this centre and may have contributed to stable amputation rates during the pandemic.
International students account for a significant proportion of medical graduates Australia-wide, and most opting to remain in Australia for their first year of practice (Internship). Hence, understanding this particular demographic's perspectives is crucial for curriculum and workforce planning. Despite this, very few studies have addressed this demographic, and none have explored the impact of the COVID-19 pandemic on international medical students specifically.
A qualitative design was used to explore the perspectives of final-year international medical students at an Australian medical school as they prepared for transition to internship during the COVID-19 pandemic.
Participants engaged in a semi-structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis.
Seven out of 34 final-year international medical students at the University of Adelaide participated. The main themes identified were that isolation was magnified, institutional support was lacking and that uncertainty was challenging. The pandemic did not deter participants from pursuing an Australian internship, as Australia was considered a desirable place for internship compared to their home countries.
While the COVID-19 pandemic exacerbated the situation, many of the challenges identified by international students already existed. Issues such as social isolation, racial discrimination, financial hardship and lack of institutional support have been prevalent for decades. Insights from this study reveal a need to improve the medical school experience. Australian Universities have a responsibility to ensure fair treatment of international students by training faculty, implementing support programmes and ensuring an inclusive and culturally safe learning environment.
Primary aldosteronism (PA) is the most common secondary endocrine cause of hypertension with familial hyperaldosteronism type 1 (FH-1), a rare heritable subtype. Timely identification of FH-1 is important because of an increased risk of vascular events in affected individuals and because it provides the opportunity to guide appropriate treatment. Genetic testing is recommended if onset is at a young age (<20 years), there is a family history of PA or early cerebrovascular events occur.
To assess national rates of testing for FH-1, whether this varied over time and by region.
De-identified data were obtained on genetic testing performed for FH-1 from 1 April 2010 to 30 October 2023 (163 months) from the Canterbury Health Laboratories database, the sole national testing laboratory for FH-1.
A total of 147 tests were performed, of which 19 (12.9%) were positive. Eleven of the positive tests were requested by one region. Testing rates varied from 0.00 to 0.63 per 100 000 people per annum. Most tests were requested by endocrinology services. Testing increased over time from an average of 4.6 tests per annum in the first 5 years of the period studied to 17.7 tests in the most recent 5 years. Limitations include lack of ethnicity data, information on testing indications and testing rates for other familial PA subtypes.
Testing for FH-1 has increased over time but remains low. Testing for familial forms of PA should be considered in those in whom PA was diagnosed at a young age or with a suggestive family history.
The optimal selection process for basic physician trainees (BPTs) is unclear.
To assess an adult BPT selection process, including a standardised recruitment interview assessing clinical decision-making and situational judgement.
A retrospective multi-year cohort study of applicants who were selected for interview during the annual recruitment for 2011–2015 clinical years in an adult basic physician training network in NSW. The predictive capacity of the final recruitment assessment score was compared with success in the Royal Australasian College of Physicians (RACP) adult medicine clinical examination within 2 years.
Four hundred thirty-six applicants were selected for interview (84–91 in each year). Summary mean post-interview scores ranged from 1.25 to 10, with the median ranging between 7 and 8. Median scores were higher in those who passed the examination than those who did not (7.75 vs 6.43, P < 0.0001). Those who did not sit for the examination in the relevant year or never sat for the examination had similar median scores (7 vs 6.75, P = 0.11). Those not deemed eligible for recruitment were less likely to pass the clinical examination within 2 years than those on the eligibility list (odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.25–0.57). Applicants with mean scores lower than 8 were less likely to pass than those in the top band (8.1–10); scores between 6.1 and 8 OR 0.42 (95% CI = 0.26–0.68), 4.1–6 OR 0.23 (95% CI = 0.13–0.41) and 2.1–4 OR 0.24 (95% CI = 0.10–0.60).
The predictive capacity of the selection process for success in the RACP clinical examination within the minimum time period is high.
Potentially harmful polypharmacy is a growing public health concern. This article aims to evaluate the effectiveness of a structured Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) framework.
We recruited patients at metropolitan hospitals for a randomised controlled trial with 12 months of follow-up. The intervention included a comprehensive medicines history, multidisciplinary meeting and medicines review prior to discharge, with engagement with the participants' general practitioner extending after discharge. The primary outcome was the change in the number of regular medicines used at 12 months from baseline. A cost consequence was performed to estimate costs per participant during the study period.
There were 98 participants enrolled in the study. The number of regular medicines was significantly reduced from baseline in both groups (−1.7 ± 4.3, t = 2.38, P = 0.02 in the control group vs −2.7 ± 3.6, t = 4.48, P = 0.0001 in the intervention group), although there was no statistical difference detected between the two groups (1.0 (SE 0.9), t = 1.03, P = 0.31). The intervention was estimated to cost AU$644.17 and was associated with cost savings of AU$552.53 per participant in sustained reduced medicines cost. Health outcomes and healthcare costs were similar in both groups.
Medicines were significantly reduced in both groups, with a trend to a larger reduction in medicines at 12 months in the intervention group. The intervention cost was approximately offset by sustained reduced medicines cost, although these results should be regarded cautiously because of the absence of significance in the differences in outcomes between groups.
Colour-vision deficiency is common among medical students, doctors and their patients. Although it can influence choice of careers, it can also put patient safety at risk if not recognised and adapted to early in a health professional's working life. Simple recommendations to support medical students, doctors and their patients are provided to support better health outcomes.
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