No abstract available.
Education, Medical* ; Humans ; New South Wales*

PURPOSE: The biases that may influence objective structured clinical examination (OSCE) scoring are well understood, and recent research has attempted to establish the magnitude of their impact. However, the influence of examiner experience, clinical seniority, and occupation on communication and physical examination scores in OSCEs has not yet been clearly established. METHODS: We compared the mean scores awarded for generic and clinical communication and physical examination skills in 2 undergraduate medicine OSCEs in relation to examiner characteristics (gender, examining experience, occupation, seniority, and speciality). The statistical significance of the differences was calculated using the 2-tailed independent t-test and analysis of variance. RESULTS: Five hundred and seventeen students were examined by 237 examiners at the University of New South Wales in 2014 and 2016. Examiner gender, occupation (academic, clinician, or clinical tutor), and job type (specialist or generalist) did not significantly impact scores. Junior doctors gave consistently higher scores than senior doctors in all domains, and this difference was statistically significant for generic and clinical communication scores. Examiner experience was significantly inversely correlated with generic communication scores. CONCLUSION: We suggest that the assessment of examination skills may be less susceptible to bias because this process is fairly prescriptive, affording greater scoring objectivity. We recommend training to define the marking criteria, teaching curriculum, and expected level of performance in communication skills to reduce bias in OSCE assessment.
Australia ; Awards and Prizes ; Bias (Epidemiology) ; Curriculum ; Humans ; New South Wales ; Occupations ; Physical Examination

OBJECTIVES: An official guideline must be prepared for legalizing the doctor-patient telemedicine system based on the evaluations of the ongoing telemedicine demonstration project performed by the Korean government. In this study, critical items of the Korean telemedicine guideline are suggested based on the guidelines of developed countries. METHODS: To investigate the telemedicine guidelines of developed countries, a keyword of 'telemedicine guidelines' was used for Google search to find out US, Australian, and Japanese guidelines. The common items included in two or more of the followings were screened: US Core Operational Guidelines for Telehealth Services Involving Provider-Patient Interactions, the Australian New South Wales (NSW) Agency for Clinical Innovation Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW, and the Japanese Guidelines for the practice of home telemedicine. RESULTS: A total of 22 common items of the following four domains, which could be used for the Korean guideline were screened: the common features in overall considerations (6 items), the common features in clinical considerations (6 items), the common features in technical considerations (5 items), and the common features in privacy considerations (5 items). These 22 items were suggested as the critical items of the Korean telemedicine guideline. CONCLUSIONS: The screened 22 items of the telemedicine guideline must be further organized for details. Additional studies and professional opinions on the telemedicine cases and on the guidelines of developed countries are required to establish the Korean guideline in the near future.
Asian Continental Ancestry Group ; Developed Countries ; Health Care Reform ; Humans ; Korea* ; New South Wales ; Privacy ; Remote Consultation ; Telecommunications ; Telemedicine*

PURPOSE: This paper is derived from a larger study of nurses perceptions of their role as patient educators. The focus is to examine nurses performance in patient education in relation to issues of their perceived responsibility and their ability to prioritize patient education. METHOD: A multiple-method survey design, using a questionnaire and in-depth interviews, is used to produce a comprehensive picture of the research problem examined. RESULT: The findings suggest that although nurses consider patient education as an integral part of their care, they fail to deliver as much as they desire in the face of work constraints. Nurses patient education activities are mainly informal and reactional, in which case they can be easily regarded as a low priority when faced with time constraints. CONCLUSION: The findings suggest that there is a need for systematic approaches that enable the inculcation of patient education into routine daily care.
*Task Performance and Analysis ; *Patient Education ; *Nursing Staff, Hospital ; *Nurse's Role ; New South Wales ; Middle Aged ; Male ; Humans ; *Health Knowledge, Attitudes, Practice ; Health Care Surveys ; Female ; Adult

BACKGROUND: Inhalation of asbestos fibers can lead to adverse health effects on the lungs. This study describes lung function profiles among individuals with nonmalignant asbestos-related disorders (ARDs). METHODS: The study population was from the Workers' Compensation (Dust Diseases) Board of New South Wales, Sydney, Australia. Lung function measurements were conducted in males with asbestosis (n = 26), diffuse pleural thickening (DPT; n = 129), asbestosis and DPT (n = 14), pleural plaques only (n = 160) and also apparently healthy individuals with a history of asbestos exposure (n = 248). Standardized spirometric and single-breath diffusing capacity for carbon monoxide (DLCO) measurements were used. RESULTS: Mean age [standard deviation (SD)] was 66.7 (10.3) years for all participants. Current and ex-smokers among all participants comprised about 9.0% and 54.8%, respectively. Median pack-years (SD) of smoking for ex- and current-smokers were 22.7 (19.9). Overall 222 participants (38.6%) and 139 participants (24.2%) had forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) measurements < 80% predicted, and 217 participants (37.7%) had FEV1/FVC results < 70%. A total of 249 individuals (43.8%) had DLco values < 80% predicted and only 75 (13.2%) had DLco/VA results < 80% predicted. A total of 147 participants (25.6%) had peak expiratory flow (PEF) measurements < 80% predicted. The presence of ARDs lowered the lung function measurements compared to those of healthy individuals exposed to asbestos. CONCLUSION: Lung function measurement differs in individuals with different ARDs. Monitoring of lung function among asbestos-exposed populations is a simple means of facilitating earlier interventions.
Asbestos ; Asbestosis ; Australia ; Carbon Monoxide ; Forced Expiratory Volume ; Humans ; Inhalation ; Lung* ; Male ; New South Wales ; Smoke ; Smoking ; Vital Capacity ; Workers' Compensation

INTRODUCTIONThe aim of the present study was to assess the prevalence of vitamin D deficiency and toxicity, the frequency of 25-hydroxyvitamin D (25[OH]D) testing, and 25(OH)D variations with respect to patient gender, patient age and season in New South Wales, Australia.

METHODSA retrospective analysis of pathology records was performed to ascertain patient age, patient gender, sample collection date, plasma or serum 25(OH)D levels, calcium and parathyroid hormone (PTH) levels, and test numbers between 2001 and 2010. Linear regression with Bonferroni correction was used to calculate and compare age-adjusted mean 25(OH)D levels. Relationships of 25(OH)D with PTH and calcium were tested using Spearman's rank correlation.

RESULTS25(OH)D testing increased by 730% over the ten-year study period. In 2010, many men (33%) and women (40%) were, to some degree, vitamin D deficient (≤ 50 nmol/L). Vitamin D toxicity was rare, with only one instance noted. 25(OH)D levels correlated positively with calcium and negatively with PTH levels. 25(OH)D levels decreased with age. In 2010, 25(OH)D levels were highest in February and lowest in September/October. Cyclical variation was observed for 25(OH)D levels between 2006 and 2010.

CONCLUSIONWe found that vitamin D deficiency was prevalent in both men and women, with a higher prevalence in the latter, despite the substantial increased demand for 25(OH)D testing in our population over the decade. Vitamin D deficiency was associated with elevated PTH levels. Vitamin D toxicity was rare and only observed once during our study period. 25(OH)D levels decreased with age and varied with season, with the highest levels observed in late summer and the lowest in early spring.

Calcium ; metabolism ; Female ; Humans ; Linear Models ; Male ; Medical Records ; New South Wales ; Parathyroid Hormone ; metabolism ; Prevalence ; Retrospective Studies ; Seasons ; Sex Factors ; Treatment Outcome ; Vitamin D ; toxicity ; Vitamin D Deficiency ; epidemiology

BACKGROUND: Tick anaphylaxis is a potentially fatal outcome of improper tick removal and management. OBJECTIVE: To investigate whether killing ticks in-situ with ether-containing sprays or permethrin cream, before careful removal by the mouthparts could reduce this risk. METHODS: This was a prospective study at Mona Vale Hospital Emergency Department (ED) in Sydney, New South Wales, over a 6-month period during the peak tick season of 2016. Tick removal methods, allergic/anaphylactic reactions were recorded for patients presenting with ticks in situ or having already removed the ticks themselves. Primary endpoint was allergic/anaphylactic reaction after tick killing/removal. RESULTS: One hundred twenty-one patients met study inclusion criteria. Sixty-one patients (28 known tick-hypersensitive) had ticks killed with Wart-Off Freeze or Lyclear Scabies Cream (5% w/w permethrin) before removal with fine-tipped forceps or Tick Twister. Three patients (2 known tick-hypersensitive) had allergic reactions (5%), none anaphylactic. The 2 known hypersensitive patients suffered reactions during the killing process and the third patient had a particularly embedded tick meaning it could not be removed solely by mouthparts. Fifty patients presented to the ED posttick removal by various methods, none using either fine-tipped forceps or Tick Twister, of which 43 (86%) experienced allergic reactions – 2 anaphylactic. Five patients suffered allergic reactions before presentation despite no attempt at kill or removal, but ticks had likely been disturbed by some other method. Five patients had live ticks removed in ED – 3 refused killing and had no reaction despite 1 having known hypersensitivity; 2 had ticks on eyelids contraindicating killing, 1 with known hypersensitivity but both had allergic reactions post removal. CONCLUSION: Results support killing ticks in-situ before careful removal by mouthparts to reduce allergic/anaphylactic reactions although further research is still required.
Anaphylaxis ; Cross-Sectional Studies ; Emergency Service, Hospital ; Eyelids ; Fatal Outcome ; Homicide ; Humans ; Hypersensitivity ; Methods ; New South Wales ; Permethrin ; Prospective Studies ; Scabies ; Seasons ; Surgical Instruments ; Tick Bites ; Tick Toxicoses ; Ticks