How are junior doctors managing patients with self-limiting illnesses at their first presentation? A video vignette study

Purpose: To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness. Methods: Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients’ current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants’ beliefs and attitudes about ordering tests in the context of self-limiting illness. Results: Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended by the experts in most cases. Presentations that focused mainly on symptoms (eg, in cases with bowel habit disturbance and fatigue) resulted in more tests being ordered. A test not recommended by experts was ordered on 54.9% of occasions. With regard to attitudes to test ordering, junior doctors were strongly influenced by social norms. The number of questionable tests ordered in this survey of 366 consultations has a projected cost of $17 000. Conclusions: This study suggests that there is some evidence of questionable test ordering by these participants with significant implications for costs to the health system. Further research is needed to explore the extent and reasons for test ordering by junior doctors across a range of clinical settings

Who knows what \u27healthy weight\u27 looks like?

Background: Obesity is a global epidemic. The World Health Organization (WHO) reports that worldwide obesity has nearly tripled since 1975. In 2016, more than 1.9 billion adults were overweight and had corresponding increases in well-recognised, associated chronic diseases. Aims: This study aimed to explore whether the general population is able to identify a healthy BMI and accurately perceive their own BMI using a visual scale. Method: A cross-sectional, population-based survey of 103 participants were shown a visual scale of computer-generated images representing different BMIs and asked to identify: (1) which images represented a healthy body weight; (2) which image best represented their body; and (3) whether they thought they were a healthy or unhealthy body size. Conclusion: Overweight participants were significantly less likely to correctly identify their own BMI on a visual scale (38.9 per cent,

Where\u27s my what? A survey of anatomical knowledge in a community in Western Melbourne

Background and Aims: This study aimed to explore if members of the public could identify the location of major body organs as well as pain associated with major organ pathologies. Method: A survey of 100 participants was conducted in Melbourne, Australia. Participants were invited to mark the location of two internal organs and the site of pain for two pathologies on a manikin. Five anatomical questions and four clinical scenario questions were randomised prior to data collection. Photographs of participant responses were compared to responses of a doctor, and if a site within the same area was identified the participant was deemed correct. Results: Correct identification of body organ site was poor at 34 per cent (±6.6%; CI 95%) and only slightly better for the location of pain related to clinical pathologies at 39 per cent (±6.8%; CI 95%). Respondents were more likely to identify the location of the heart, or pain associated with a myocardial infarction; 51.2 per cent (±15.3%; CI 95%) and 79.6 per cent (±10.7%; CI 95%), respectively. A minority, 18.6 per cent (±11.6%; CI 95%), were able to locate the gallbladder, and fewer still, 6.4 per cent (±7%; CI 95%), identified the location of pain due to cholelithiasis (gallstones). Conclusion: Most respondents failed to identify the major organs or the likely location of pain for related pathologies. Limited anatomical knowledge is reflected in the literature, however, these results were poorer than previous studies suggest. These data have implications for help-seeking behaviour and may be a factor in delayed presentation for serious pathology

Patterns of sickness absence from a secondary hospital in Melbourne: A 10-year longitudinal study

Background/aims: There has been significant concern in recent years regarding increases in absenteeism in the healthcare sector, leading to lost productivity and projected workforce shortages. This study aimed to identify patterns of sickness absence over a 10-year period in a single-site secondary hospital in Melbourne, Australia. Methods: Data regarding sickness absences were extracted from anonymised payroll records from 2007 to 2016. The patterns of sickness absence analysed included seasonality, amount of leave and category of leave. These were explored both for individuals and in the aggregate. Results: Compared to the Australian average of 9.7 days, this cohort of employees took less sick leave, averaging at 8.81 days each. As a group, a consistent proportion of staff took no sick leave, 1–3 days, 4–6 days, or 7–9 days each year in the 10-year timespan. Only a small proportion took more than 9 days of sickness leave per year. Conclusions: The pattern of leave-taking was consistent for the group as a whole, however, individual leave patterns vary

Epidemiology of soccer‐related head injury in children 5–14 years in Victoria, Australia

Aim: Our aim was to use epidemiological data to determine the incidence of soccer‐related head injuries in children aged 5–14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia. Methods: ED presentation and hospital admission de‐identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer‐related head injury data to determine the incidence of this injury among these children. Results: The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011–2012 to 2015–2016). The 10–14‐years age group presented with more head injuries than the 5–9‐years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with ‘sport as a whole’. Conclusions: The low incidence of soccer‐related head injuries presenting to an ED or admission to hospital is consistent with international findings

How does the duration of consults vary for upper respiratory tract infections in general practice where an antibiotic has been prescribed?

Background: There is limited data on the duration of consults resulting in the prescription of antibiotics for upper respiratory tract infections (URTIs) in general practice. Objective: To explore how demographic factors influence consult duration where antibiotics have been prescribed for URTI in Australian general practice. Methods: 2985 URTI-specific presentations were identified from a national study of patients who were prescribed an antibiotic after presenting to general practice between June and September 2017. Consult duration was analysed to assess for any variation in visit length based on demographic factors. Results: The overall median consult duration was 11.42 minutes [interquartile range (IQR) 7.95]. Longer consult duration was associated with areas of highest socio-economic advantage where patients living in postcodes of Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) Quintile 5 (highest 20% on the IRSAD) had significantly longer consults [median 13.12 (IQR 8.01)] than all other quintiles (P \u3c 0.001). Females [11.75 (IQR 8.13)] had significantly longer consults than males [10.87 (IQR 7.57); P \u3c 0.001]. Clinics based in State C and State F had significantly shorter consults when compared with all other included states and territories (P \u3c 0.001) and shorter consult duration was associated with visits on Sundays [median 8.18 (IQR 5.04)]. Conclusion: There is evidence for the association of demographic and temporal factors with the duration of consultations for URTIs where an antibiotic has been prescribed. These factors warrant further research

Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: An observational study using smartphone technology

Background: Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics. Objective: To document the symptom profile of patients receiving antibiotics for URTIs in Australian general practice using smartphone technology and online surveys. Methods: In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied. Patients completed the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) 3 and 7 days after visiting their general practitioner (GP). Results: Six hundred fourteen URTI-specific patients responded to at least one symptom survey (RR 15%). The majority of patients reported moderate to mild symptoms at 72 hours [median global symptom severity score 37 (IQR 19, 59)] post-GP visit which reduced to very mild symptoms or not sick by day 7 [11 (IQR 4, 27)]. Patients receiving antibiotics for URTI reported the same level of symptom severity as patients in previous studies receiving no treatment. Conclusions: The recovery of most patients within days of receiving antibiotics for URTI mimics the trajectory of patients with viral URTIs without treatment. Antibiotics did not appear to hasten recovery. Monitoring of patients in this context using smart phone technology is feasible but limited by modest response rates

A process for developing standards to promote quality in general practice

Background: Since 1991, the Royal Australian College of General Practitioners (RACGP) Standards for general practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. Objective: The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. Method: A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP Board. Results: Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. Conclusion: The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care

Who knows what ‘healthy weight’ looks like?

This study aimed to explore whether the general population can identify a healthy BMI and accurately perceive their own BMI using a visual scale. Overweight people were much less likely to identify their own BMI correctly and were also most likely to incorrectly think that they are a healthy size

Initial adherence of EPEC, EHEC and VTEC to host cells

Initial adherence to host cells is the first step of the infection of enteropathogenic Escherichia coli (EPEC), enterohaemorrhagic Escherichia coli (EHEC) and verotoxigenic Escherichia coli (VTEC) strains. The importance of this step in the infection resides in the fact that (1) adherence is the first contact between bacteria and intestinal cells without which the other steps cannot occur and (2) adherence is the basis of host specificity for a lot of pathogens. This review describes the initial adhesins of the EPEC, EHEC and VTEC strains. During the last few years, several new adhesins and putative colonisation factors have been described, especially in EHEC strains. Only a few adhesins (BfpA, AF/R1, AF/R2, Ral, F18 adhesins) appear to be host and pathotype specific. The others are found in more than one species and/or pathotype (EPEC, EHEC, VTEC). Initial adherence of EPEC, EHEC and VTEC strains to host cells is probably mediated by multiple mechanisms