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Emergency medicine conference, Canberra - Wednesday


Emergency medicine conference, Canberra Convention Centre

Highlights for WEDNESDAY November 24

11.00-12.30 session

Amphetamines cause brain damage

Amphetamine use has serious effects on the brain, a new study has found.

Professor Daniel Fatovich, from the Department of Emergency Medicine at Royal Perth Hospital, and his colleagues studied 38 patients attending a tertiary hospital emergency department with an amphetamine-related illness.

Of those patients, 30 had MRI brain scans. Nineteen (63%) were male. They ranged in age from 19 to 41.

Their average age of first amphetamine use was 18 years.

Sixteen used crystal methamphetamine, 9 used “speed”, and 23 used ecstasy.

Twenty-six smoked marijuana and 28 drank alcohol.

Abnormalities on brain MRI scans were identified in six patients, most commonly unidentified bright objects. These probably represent scarring from brain injury.

The researchers concluded that in this small screening MRI brain study of young people attending the emergency department with an amphetamine-related presentation, one in five had an occult brain lesion, consistent with amphetamines causing brain injury.

This could have public health implications.

“Drug use has a huge impact on the community so the hope is that this type of research can be used to help educate the community in public health and the serious long-term effects of amphetamine use,” Professor Fatovich said.

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Complementary medicine use common in people taking warfarin but little awareness of adverse effects

People taking warfarin have very poor knowledge or understanding of complementary medicines, which they are frequently taking at the same time.

Yet, complementary and alternative medicines (CAM) may interact with warfarin and are associated with increased rates of important clinical adverse events.

This is the finding of an emergency department study comparing knowledge and use of CAM in people taking warfarin and those not taking it.

Associate Professor David Taylor, Director of Emergency and General Medicine Research at Austin Health, will tell the conference that, of the 500 people in the study, half of each of the warfarin user and control groups knew the potential for CAM and prescription drug interaction.

Only 60 (24.4%) cases reported having been warned about CAM use while on warfarin.

Fewer warfarin users than controls reported CAM use (28.9% versus 37.0%) and significantly fewer warfarin users used a CAM known to interact with warfarin (11.4% versus 18.7%).

Warfarin users reported significantly more bleeding and clotting events.

Professor Taylor urged warfarin users to avoid, where possible, the use of CAM. “They should advise their doctors of any CAM they presently take and seek their advice before beginning any CAM.”

1.30-3.00 session

Accuracy of methods of recording immunisation questioned

The accuracy of national and local methods of recording immunisation were questioned in a recent three-month study, according to Dr Ingrid Berling, from Hunter New England Area Health.

The study focused on children under seven years attending a tertiary hospital emergency department.

Of the possible 168 children in the study, 95 parents (57%) participated.

Thirty-eight children who were incompletely vaccinated had no contra-indications and would have consented to vaccination during their ED presentation.

The vaccination status of 78/95 (82%) children was recorded in ED records but was incorrect in 35 cases.

Forty parents indicated that the national Australian Childhood Immunisation Register (ACIR) record was incorrect and this was confirmed in 28 (70%).

The researchers concluded that there were missed opportunities to vaccinate a small proportion of children in ED.

Parents provided a more accurate timely history of immunisation status than ACIR and thus ED staff should ensure that parents are always asked whether their child is fully vaccinated, the researchers recommended.

Every health service presentation should be considered an opportunity to ensure children are fully immunised.

Australia should stop pretending to have one of the world’s best healthcare systems

We, as a nation, have to stop pretending that we have the best healthcare system in the world, according to Dr Alan Tankel, director of emergency medicine at Coffs Harbour Base Hospital.

The World Health Organisation ranked Australia at 32nd (out of 191) in 2000 based on a complex combination of factors including level of health, equity, responsiveness, health expenditure and overall health system performance.

Australia was ranked 20th out of 30 OECD countries.

“We are not even the best of the English-speaking world, and rank 4th amongst the 6 main English-speaking Western democracies (UK, Ireland, Canada, Australia, USA, and New Zealand respectively).”

Japan leads the world in life expectancy although Australia comes in at a respectable third. Japan also leads the world in total hospital beds per 1,000, with Australia a less than respectable 51st.

The USA spends more per capita on healthcare (Australia is 16th) and more as a percentage of its GDP than any other country in the world.

Cuba has the most physicians per capita (Australia lies 46th), while Ireland has the most nurses per capita (Australia is 14th).

Singapore has the lowest infant mortality rate (Australia is 25th).

Dr Tankel says Australia trails many European and Asian countries in various aspects of quality healthcare as measured by the WHO and OECD.

“It remains to be seen whether the proposed healthcare reforms will have any impact on our ability to deliver higher quality, and more efficient, healthcare to our patients.”


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