Objectives The aim of sclerotherapy is to induce fibrosclerosis of superficial veins. We postulated that inadvertent entry of sclerosants into deep veins can result in sclerotic occlusion, deep vein sclerosis, a non-thrombotic process distinct from spontaneous deep vein thrombosis. The aim of this study was to assess the role of d-dimer in differentiating between deep vein sclerosis and deep vein thrombosis. Methods Proximal trunks of great and small saphenous veins were treated with endovenous laser ablation. Venous tributaries and perforators were treated with foam ultrasound guided sclerotherapy. Ultrasound studies of lower limb deep veins were performed before and one week after the procedures, to detect deep vein occlusions (DVOs). d-dimer levels were measured for DVOs and long-term ultrasound studies monitored the recanalisation rates. Results In a six-year period, 9143 procedures were performed in 1325 patients for bilateral varicose veins. This included 1124 endovenous laser ablation and 8019 foam ultrasound guided sclerotherapy procedures. A total of 259 DVOs (2.83%) were identified on ultrasound which included 251 deep vein sclerosis (2.74%), seven deep vein thrombosis (0.07%) and one endovenous heat-induced thrombosis (EHIT, 0.08%). d-dimer values <0.5 µg/mL excluded deep vein thrombosis s, 0.5–1.0 µg/mL were more likely to be associated with deep vein sclerosis and >1.0 µg/mL were a more likely to be associated with deep vein thrombosis. Lower sclerosant concentrations and higher foam volumes were associated with increased risk of DVO ( p <  .0001). No significant relationship was found between DVO and gender or thrombophilia. Deep vein thrombosis and EHIT cases but not deep vein sclerosis patients were anticoagulated. None had thromboembolic complications. Patients were followed up for a median of 299 days (37–1994 days). Recanalisation rates were 71.1% for deep vein sclerosis (92.3% competent) and 71.4% for deep vein thrombosis (60.0% competent). Conclusions Deep vein sclerosis is a relatively benign clinical entity distinct from deep vein thrombosis and does not require anticoagulation. Majority of affected veins on long-term follow-up regain patency and competence. d-dimer can be used to assist in differentiating deep vein sclerosis from deep vein thrombosis.

Background: Antimicrobial resistance (AMR) remains a major public health threat and the exploration of interventions which may reduce inappropriate antimicrobial use are of particular interest. An Antibiotic Timeout (ATO) was included within the electronic medicine (eMeds) system introduced to the Central Coast Local Health District (CCLHD) in 2018. The function allows prescribers to set a predetermined time at which antibiotic orders would cease. By default, the function set prescribed length to 5 days with a view to encourage prescribers to review existing antimicrobial orders and reduce inappropriate use.Methods: Records of adult inpatients prescribed broad spectrum antimicrobials with a registered indication of community acquired pneumonia (CAP) or an infective exacerbation of chronic obstructive pulmonary disease (IECOPD) between the 1st of March 2017 and 31st May 2017 for the pre eMeds cohort and 1st March 2019 and 31st May 2019 for the post eMeds cohort were randomly selected from our local health network’s Guidance MS® system. Baseline demographics, antimicrobial prescribing records and documented adverse events related to the antibiotic timeout function were collated/analysed. The days of therapy (DOT) and length of therapy (LOT) for each encounter were calculated manually and results analysed using a two-tailed t-test or Mann-Whitney U test.Results: Of patients eligible to have the ATO function activated during their admission, 34% (n=34) had the function deployed at least once. Following the introduction of eMeds mean DOT for the pooled indications cohort was reduced by 3.02 days (CI 95% 0.41 – 5.63, p<0.05) and mean LOT by 1.97 days (CI 95% 0.39 – 3.55, p<0.05). The timeout function resulted in 2 cases of delayed or unintentionally ceased therapies. Conclusions: Following the introduction of electronic prescribing and ATO, a significant reduction was observed in the DOT and LOT for antimicrobial use for inpatients with CAP and IECOPD without a significant increase in adverse events. Further research is required to determine the extent to which the antibiotic timeout functionality directly contributed to this effect and if the effect is present across a broader range of indications.

Objective: To evaluate the effectiveness of video conferences for the delivery of near-peer medical teaching adopted in response to the COVID-19 pandemic from the perspective of medical students and near-peer teachers.Methods: A mixed-methods online survey of medical students (years 3 -5 of a five-year medical program) and near-peer teachers (junior medical officers post-graduate years 1-3) participating in a video conference based near-peer medical teaching (NPMT) program was undertaken throughout the 2020 clinical year. A further comparative survey was conducted with those students and near-peer teachers who had previously participated in face-to-face near-peer teaching sessions. The results of these surveys were analysed using descriptive statistics and inductive thematic analysis.Results: Students and near-peer teachers found the video conference software to be user friendly (93.3%, n = 14 and 77.8%, n=7) and expressed interest in ongoing video conference delivered material (93.4%, n= 14 and 88.9% n = 8). Students were divided as to whether the video conference method of delivery limited (40%, n= 7) or did not limit (26.7%, n = 4) their interactions, while teachers noted that video conferencing did not enhance engagement (66.7%, n= 6). These findings were supported by the qualitative analysis. Key themes identified included positive reception of the teachers, content, and improved attendance/ease associated with video conferencing. Difficulties with the foreign nature of the teaching style and student engagement were also reflected in the qualitative data. Conclusion:The COVID-19 pandemic has impacted the manner in which medical student education is approached. The experience presented here from medical students and near-peer teachers demonstrates a general acceptance of video conferencing as a method of content delivery in the near-peer setting, necessitated by restrictions on face-to-face interactions secondary to the COVID-19 pandemic. Divisions remain as to whether the technology, as it is currently implemented, can maintain or surpass the interaction and engagement which accompanies face-to-face near-peer medical education.

Background Antimicrobial resistance (AMR) remains a major public health threat and the exploration of interventions which may reduce inappropriate antimicrobial use are of particular interest. An Antibiotic Hardstop (AH) was included within the eMeds system introduced to the Central Coast Local Health District (CCLHD) in 2018. The function allows prescribers to set a predetermined time at which antibiotic orders would cease. By default, the function set prescribed length to 5 days with a view to encourage prescribers to review existing antimicrobial orders and reduce inappropriate use. Methods Records of adult inpatients prescribed broad spectrum antimicrobials with a registered indication of community acquired pneumonia (CAP) or an infective exacerbation of chronic obstructive pulmonary disease (IECOPD) between the 1st of March 2017 and 31st May 2017 for the pre eMeds cohort and 1st March 2019 and 31st May 2019 for the post eMeds cohort were randomly selected from our local health network’s Guidance MS® system. Baseline demographics, antimicrobial prescribing records and documented adverse events related to the AH function were collated/analysed. The days of therapy (DOT) and length of therapy (LOT) for each encounter were calculated manually and results analysed using a two-tailed t-test or Mann–Whitney U test. Results Of patients eligible to have the AH function activated during their admission, 34% (n = 34) had the function deployed at least once. Following the introduction of eMeds mean DOT for the pooled indications cohort was reduced by 3.02 days (CI 95% 0.41–5.63, p < 0.05) and mean LOT by 1.97 days (CI 95% 0.39–3.55, p < 0.05). The hardstop function resulted in 2 cases of delayed or unintentionally ceased therapies. Conclusions Following the introduction of electronic prescribing and AH, a significant reduction was observed in the DOT and LOT for antimicrobial use for inpatients with CAP and IECOPD without a significant increase in adverse events. Further research is required to determine the extent to which the AH functionality directly contributed to this effect and if the effect is present across a broader range of indications.