The Royal College of Anaesthetists have set the standard that 85% of emergency caesarean sections should be carried out under regional anaesthesia. Reducing the frequency of caesarean sections carried out under general anaesthesia may serve to reduce maternal morbidity and mortality, which has been shown over recent years. A retrospective audit was carried out at a tertiary referral centre investigating the mode of anaesthesia and fetal outcome after emergency caesarean section. The proportion carried out under regional anaesthesia was less than recommended. Despite a longer time taken to induce anaesthesia there was no increase in adverse fetal outcome, supporting the use of regional anaesthesia wherever possible to keep maternal complications to a minimum.
Hendra virus (HeV) continues to pose a serious public health concern as spillover events occur sporadically. Terminally ill horses can exhibit a range of clinical signs including frothy nasal discharge, ataxia or forebrain signs. Early signs, if detected, can include depression, inappetence, colic or mild respiratory signs. All unvaccinated ill horses in areas where flying foxes exist, may potentially be infected with HeV, posing a significant risk to the veterinary community. Equivac® HeV vaccine has been fully registered in Australia since 2015 (and under an Australian Pesticides and Veterinary Medicines Authority special permit since 2012) for immunization of horses against HeV and is the most effective and direct solution to prevent disease transmission to horses and protect humans. No HeV vaccinated horse has tested positive for HeV infection. There is no registered vaccine to prevent, or therapeutics to treat, HeV infection in humans. Previous equine HeV outbreaks tended to cluster in winter overlapping with the foaling season (August to December), when veterinarians and horse owners have frequent close contact with horses and their bodily fluids, increasing the chance of zoonotic disease transmission. The most southerly case was detected in 2019 in the Upper Hunter region in New South Wales, which is Australia's thoroughbred horse breeding capital. Future spillover events are predicted to move further south and inland in Queensland and New South Wales, aligning with the moving distribution of the main reservoir hosts. Here we (1) review HeV epidemiology and climate change predicted infection dynamics, (2) present a biosecurity protocol for veterinary clinics and hospitals to adopt, and (3) describe diagnostic tests currently available and those under development. Major knowledge and research gaps have been identified, including evaluation of vaccine efficacy in foals to assess current vaccination protocol recommendations.
This article describes the expansion of a transcultural secondary consultation model run by a state-wide transcultural unit. The model aims to enhance cultural responsiveness in partnership with mental health services. We discuss a series of 12 consultations that occurred between 2011 and 2012. We outline the processes of setting up the structure of secondary consultation, the actual consultation-facilitation format, and methods of evaluation. Evaluations were done in two phases: the first immediately after the consult and the second after a period of 3-6 months. The discussion highlights the usefulness of a transcultural model of consultation and, based on the evaluations, identifies the benefits the model brings to understanding and intervening with clients, culture, and systems. The results emphasise the need for multidisciplinary collaboration and a facilitated space for clinical teams to explore culturally responsive therapeutic practices.
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