Shared decision making between registrars and patients : web based decision aids

BACKGROUND: Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients. METHOD: Interviews were conducted with registrars to explore their attitudes to shared decision making. Following an educational intervention, registrars were asked to adopt shared decision making within their consultations using DAs as appropriate. The registrars were interviewed again to explore their experiences and any barriers to the process. RESULTS: Registrars had positive views about the shared decision making process but required more training. They had mixed opinions about the use of DAs and identified several barriers to their use. They felt that they had learned from the project and process without necessarily wanting to pursue the use of DAs as interactive tools, preferring to use them as educational resources

Topical antibiotics to prevent surgical site infection after minor surgery in primary care

Background: Surgical site infection (SSI) after minor surgery in primary care can compromise cosmetic outcomes, delay wound healing and increase costs. In addition to efficacy, adverse effects must be considered when considering antibiotic prophylaxis. There is no prior published literature regarding the proportion of general practitioners (GPs) who use topical antibiotics as SSI prophylaxis following minor surgery. Objectives: To identify the proportion of GPs in a regional center in Queensland, Australia who apply topical antibiotics to wounds prevent SSIs after minor surgery. Method: A database of 90 GPs was established, and they were invited to complete a questionnaire. Results: The response rate was 62% (56/90). Topical antibiotics prophylaxis was reported as being used always or sometimes in routine practice by 18% (10/56) of participants after both skin lesion excision and repair of lacerations. In the context of high-risk situations, on the other hand, use was higher. They were more likely to be used in high-risk situations, most frequently in diabetic patients(41.0% [23/56]) and immunocompromised patients (46.5% [26/56]). Conclusions: Evidence-based prescribing of antibiotics is vital. Topical antibiotic prophylaxis is often prescribed excessively after clean dermatological surgery, however, in our sample of GPs, only 18%used topical antibiotics always or sometimes in their practice

The effect of COVID-19 on medical student clinical skill practice and self-perceived proficiency

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

Feasibility study for a randomised controlled trial for the topical treatment of impetigo in Australian General Practice

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

Immunisation rates of medical students at a tropical Queensland university

Abstract: Although medical students are at risk of contracting and transmitting communicable diseases, previous studies have demonstrated sub-optimal medical student immunity. The objective of this research was to determine the documented immunity of medical students at James Cook University to important vaccine-preventable diseases. An anonymous online survey was administered thrice in 2014, using questions with categories of immunity to determine documented evidence of immunity, as well as closed-ended questions about attitudes towards the importance of vaccination. Of the 1158 medical students targeted via survey, 289 responses were included in the study (response rate 25%), of which 19 (6.6%) had documented evidence of immunity to all of the vaccine-preventable diseases surveyed. Proof of immunity was 38.4% for seasonal influenza, 47.1% for pertussis, 52.2% for measles, 38.8% for varicella, 43.7% for hepatitis A, and 95.1% for hepatitis B (the only mandatory vaccination for this population). The vast majority of students agreed on the importance of vaccination for personal protection (98.3%) and patient protection (95.9%). In conclusion, medical students have sub-optimal evidence of immunity to important vaccine-preventable diseases. Student attitudes regarding the importance of occupational vaccination are inconsistent with their level of immunity. The findings of this study were used to prompt health service and educational providers to consider their duty of care to manage the serious risks posed by occupational communicable diseases

A randomised controlled trial of ice to reduce the pain of immunisation-the ICE Trial

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

The effect of promoting current local research activities on large monitors on the population’s interest in health related research – a randomized controlled trial

OBJECTIVE: The objectives of this study were threefold: to estimate people’s interest in health-related research, to understand to what extent people appreciate being actively informed about current local health-related research and to investigate whether their interest can be influenced by advertising local current health-related research using large TV monitors. DESIGN: Randomized controlled trial using a stepped wedge design. SETTING: The emergency department waiting room at two public hospitals in northern Queensland, Australia. PARTICIPANTS: Waiting patients and their accompanying friends and relatives in the emergency department waiting room not requiring immediate medical attention. INTERVENTIONS: A TV monitor advertising local current health-related research. MAIN OUTCOME MEASURES: Odds ratio for the effect of intervention on changing the interest in health-related research compared to a control group while adjusting for gender, age and socioeconomic standard

Knowledge and perspectives of the new National Cervical Screening Program: a qualitative interview study of North Queensland women—'I could be that one percent'

Objectives To investigate women’s understanding and attitudes towards the National Cervical Screening Program (NCSP) and to explore methods to improve screening participation. Design Semi- structured face- to- face interviews were conducted through convenience and snowball sampling. Thematic analysis occurred using the interpretivist framework. Setting A private general practice in North Queensland. Participants Women between the ages of 18 and 74 who attended the general practice were eligible to participate. Fourteen women between 20 and 58 years old were interviewed. results Participants were concerned that the new NCSP would miss cancer due to longer screening intervals and reliance on primary human papilloma virus (HPV) testing. They believed that young women are at increased risk of cervical cancer, due to perceived HPV vaccine ineffectiveness and parent objection to vaccination. Most participants were not agreeable to self- sampling and preferred their doctor to perform screening. Personal and practitioner beliefs influenced a woman’s screening participation. Personal factors include being healthy for themselves and their family, previous abnormal smears and family history of cancer. Emphasis was placed on feeling ‘comfortable’ with their practitioner which included patient rapport and gender preference. Proposed methods to improve cervical screening included education programmes, advertising campaigns, general practitioner interventions and improving accessibility. Conclusions It is apparent that women are hesitant about the new NCSP. However, when provided with additional information they were more amenable to the changes. This highlights the need to improve awareness of cervical screening and the new NCSP

Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial

Objectives: There is limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatological surgery, and there is no consensus for its use in higher-risk cases. The objective of this study was to determine the effectiveness of a single oral preoperative 2g dose of cephalexin in preventing SSI following flap and graft dermatological closures on the nose and ear. Design: Prospective double-blinded, randomised, placebo controlled trial testing for difference in infection rates. Setting: Primary care skin cancer clinics in North Queensland, Australia, were randomised to 2 g oral cephalexin or placebo 40–60min prior to skin incision. Participants: 154 consecutive eligible patients booked for flap or graft closure following skin cancer excision on the ear and nose. Intervention: 2 g dose of cephalexin administered 40–60min prior to surgery. Results: Overall 8/69 (11.6%) controls and 1/73 (1.4%) in the intervention group developed SSI (p=0.015; absolute SSI reduction 10.2%; number needed to treat (NNT) for benefit 9.8, 95%CI 5.5 to 45.5). In males, 7/44 controls and 0/33 in the intervention group developed SSI (p=0.018; absolute SSI reduction 15.9%; NNT for benefit 6.3, 95%CI 3.8 to 19.2). SSI was much lower in female controls (1/25) and antibiotic prophylaxis did not further reduce this (p=1.0). There was no difference between the study groups in adverse symptoms attributable to highdose antibiotic administration (p=0.871). Conclusion: A single oral 2 g dose of cephalexin given before complex skin closure on the nose and ear reduced SSI

Adherence to secondary prevention of rheumatic fever and rheumatic heart disease in young people: an 11-year retrospective study

Objectives: To evaluate the secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Townsville region, Australia. Methods: Adherence to benzathine benzylpenicillin G (BPG) was determined for 196 children and young adults aged under 22 years between January 2009 and December 2019, and factors associated with BPG adherence were analysed. Secondary outcomes included attendance at specialist reviews and echocardiograms. Results: Adequate adherence (80%) to regular BPG injections was met by 51.1% of the cohort. Adequate BPG adherence more likely occurred for those that attended the Paediatric Outreach Clinic (OR4.15, 95%CI:2.13-8.05) or a school delivery program (OR1.87, 95%CI:1.11-3.45). People with moderate/severe RHD had greater BPG adherence (OR1.76,95%CI:1.00-3.10). People in rural/remote areas were less likely to have adequate BPG adherence compared to urban counterparts (OR0.31, 95%CI:0.15-0.65). Adherence to echocardiography was 66% and specialist review attendance was 12.5–50%. Conclusion: Half of the cohort in the Townsville region received adequate BPG prophylaxis to prevent ARF/RHD. Although rates were relatively higher than those reported in other Australian regions, health delivery goals should be close to 100%. Low attendance at specialist services was reported. Implication for public health: Delivery models with dedicated services, case management and family support could improve BPG adherence in individuals with ARF/RHD. Further resources in rural and remote areas are needed