Tasman Medical Journal

Abstract

I describe my personal case of treatment for insulin-requiring mature onset type 1 diabetes that does not involve daily measurement of blood glucose. Using the described mode of treatment over 11 years has avoided finger stabbing while good diabetic control, defined by regular HbA1c and periodic fasting blood glucose measured in the laboratory, has been maintained, with absence of complications. Tasman Medical Journal 2024; 6: 1-3

Abstract

Background: Intensive care units are increasingly becoming involved in the management of critical care outreach services. At present, no guide exists to aid the design and implementation of a database to maintain an auditable record of these activities.

Objective: This study is a comparison of data completeness and auditor workload between electronic and paper record systems for documenting Intensive Care Outreach activity. We aim to describe the implementation and performance of an electronic critical care outreach database instrument (eTool) designed for this purpose. Details of database field design and practical details of the author’s experience with implementing this instrument are presented.

Method: The eTool was deployed using the PowerApps suite of applications included with a SharePoint and Microsoft Teams installation. Users were supplied with a mobile and desktop App for the creation and retrieval of records. The paper record and electronic database were audited to determine the difference in data completeness and the time taken to complete the audit.

Results: The paper record was less complete (total missing data = 11.82% vs.0.58%) and took longer to audit (average 5 hours 5 minutes vs. 41 minutes). There was excellent agreement between the auditors (ICC = 0.9977 and 0.9999 for the paper and electronic database respectively).

Conclusion: This example of an electronic solution for documenting critical care outreach work is an improvement over paper-based methods employed by most health services. Better integration with electronic patient records would yield even greater benefits.

Abstract

There is continuing support for hydroxychloroquine (HCQ) in the treatment of SARS-CoV-2 infection, one recent example in Australia being an article by Professor Robert Clancy in the centre-right monthly magazine Quadrant. Clancy argued that HCQ is effective and that its non-use reflects a conspiracy by the World Health Organisation and the global pharmaceutical industry to control patient care. In this article I review the trial evidence for HCQ efficacy and confirm that it does not support use of HCQ in any phase of COVID infection.

Abstract

I respond to a recently-published TMJ Editorial Review,¹ which commented on an article of mine entitled “The Curious Case of Hydroxychloroquine” published in Quadrant magazine (March 2024).²  I disagree with the reviewer’s points of view for the reasons presented here.

Abstract

Scabies and discoid lupus erythematosus are frequent dermopathies diagnosed in Australian Aboriginal and Torres Strait Islanders. Concomitant pathologies can complicate clinical symptoms and histological interpretation. Furthermore, chronic untreated dermopathies may lead to dermatopathic lymphadenitis, a benign lymphadenopathy that can mimic lymphoproliferative disorders.

Presented here is a rare and diagnostically complex case involving a 66-year-old Aboriginal female patient from a rural community. She had a two-year history of depigmented plaques, generalised pruritus, unexplained chronically elevated inflammatory markers, and new constitutional symptoms. Initial skin biopsies showed mixed histological findings favouring discoid lupus erythematosus and occult scabies. The patient was treated with topical steroids and ivermectin, which resolved the pruritus and raised inflammatory markers. Further investigation culminated in a final diagnosis of co-existing scabies, discoid lupus erythematosus and dermatopathic lymphadenitis.

This case demonstrates the importance of considering and empirically treating scabies in Aboriginal and Torres Strait Islander peoples with unexplained pruritus and eosinophilia, even when classic scabetic signs such as burrows and nodules are absent.

Abstract

We review the available evidence supporting the use of hydroxychloroquine-based multidrug protocols in the treatment of COVID-19, in response to a recently published editorial in the Tasman Medical Journal.

Abstract

Millar¹ promotes the primary use of controlled trials and denigrates other types of studies as sources of medical pharmacological knowledge. In this article we critique the overreliance on, and some shortcomings of, randomized control trials (RCTs). Here we suggest a comprehensive approach to obtaining medical evidence for clinical decision-making based on our Totality of Evidence-Based Medicine Wheel.