Australia's processing of some asylum seekers on offshore detention centres has recently been brought to light by human rights organisation. While the internal politics of resettling refugees may be complex, Australia remains in the top five countries for resettlement per capita. However, these refugees remain a vulnerable patient population after immigrating. Refugee women, an understudied group, in particular experience higher adverse health outcomes.In this case report, we follow the medical journey of KB, a 38-year-old Rohingya refugee diagnosed with type 2 diabetes mellitus-the crux of all her health issues. We explore language differences as a barrier to healthcare and its near-fatal consequences, as well as communication breakdown in the context of the misalignment of health goals between the patient and the profession. As such, improving patient health literacy and cultural competency among doctors are core interventions in improving the delivery of refugee healthcare.We have a global responsibility to improve health literacy among refugee patients and by providing the basic standard of healthcare to every individual as a human right, which empower refugees in this regard to have a role in their health outcomes.
Kenneth G Jamieson described the emergent craniotomy for traumatic brain injuries (TBI) in the rural and regional setting back in 1965 in his book 'A First Notebook Of Head Injury'. Since then, there has been successful use of the technique in peripheral hospitals prior to the safe transfer of patients to metropolitan trauma centres. Although the procedure can be daunting in inexperienced hands, our institution supports ongoing education to continue implementation of trauma craniotomies by non-neurosurgeons if it means another life is potentially saved. Here we describe the surgical technique for an emergent craniotomy and craniectomy. Although the surgical technique has been described elsewhere, we have done so in a simplified 10-step approach with consideration of available resources in the peripheral hospital setting and the added pearls from the experience of a metropolitan neurosurgical unit. We also discuss future prospects for undertaking neurosurgical operations in peripheral hospitals but with intra-operative tele-surgery monitoring and supervision.
Largely attributed to the tyranny of distance, timely transfer of patients with major traumatic brain injuries (TBI) from rural or regional hospitals to metropolitan trauma centres is not always feasible. This has warranted emergent craniotomies to be undertaken by non‐neurosurgeons at their local hospitals with previous acceptable results reported in regional Australia. Our institution endorses this ongoing potentially life‐saving practice when necessary and emphasize the need for neurosurgical units to provide ongoing TBI education to peripheral hospitals. In this first of a two‐part narrative review, the authors describe the recommended diagnostic pathway for patients with a suspected TBI presenting to rural or regional hospitals and discuss local surgical management options in the presence or absence of a CT scanner.
Benign prostatic hyperplasia is a common condition. It can cause problems with urine storage and voiding, and the severity of symptoms may be unrelated to the size of the prostate. When drug treatment is required, benign prostatic hyperplasia can be managed with monotherapy or combination therapy. Most patients are managed with selective alpha blockers. Patients with larger prostate volumes may benefit from a 5-alpha-reductase inhibitor, usually in combination with an alpha blocker. Medical therapy for benign prostatic hypertrophy largely works by reducing dynamic and static components. In the last decade, clinical trials have shown that drug therapy is beneficial, however the currently available drugs vary in their efficacy depending on the patient's profile. Alpha blockers Alpha 1a adrenergic receptor inhibition with selective (tamsulosin, silodosin, terazosin, alfuzosin) or non-selective (prazosin) drugs treat the dynamic component of benign prostatic hyperplasia by relaxing smooth muscle in the prostate and bladder neck. This causes the urethral lumen to widen so improving urinary flow. 3 Alpha blockers can improve symptoms and increase the maximal urinary flow rate. 3,5,9-12 Adverse effects Although systemic adverse effects are less frequent with the more selective alpha blockers, they increase the risk of ejaculatory dysfunction. 3 Other adverse effects of alpha blockers include retrograde Manasi Jiwrajka Resident medical officer 1
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