The Medical journal of Australia
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Sleep disorders are very common in childhood and are often amenable to simple advice and parental education. Questions about sleep should be an integral part of every paediatric consultation. Children with underlying syndromes or complex medical conditions often have multiple sleep issues. ⋯ Children with obesity and other comorbid conditions are at increased risk of persisting OSA despite adenotonsillectomy. Topical (nasal) steroids and/or anti-inflammatory agents have a role in the non-surgical treatment of mild OSA. Continuous positive airway pressure and orthodontic interventions are treatment options for treatment of persisting OSA in children.
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Comparative Study
Global trends in testosterone prescribing, 2000-2011: expanding the spectrum of prescription drug misuse.
To provide the first multinational survey of temporal trends in testosterone prescribing, given that anecdotal evidence indicates that it is increasing in some countries, including Australia. ⋯ In the absence of any new indications, off-label testosterone prescribing has increased in most countries in 2000-2011, especially over the last half of the period. The increased testosterone prescribing appears to be primarily for older men and driven by clinical guidelines that endorse testosterone prescribing for age-related functional androgen deficiency (andropause). By eliminating the fundamental distinction between pathological and functional androgen deficiency, these guidelines tacitly promote increased testosterone prescribing, bypassing the requirement for high-quality clinical evidence of safety and efficacy and creating dramatic increases in prescription of testosterone products.
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The Western Australian Audit of Surgical Mortality (WAASM) is an external, peer-reviewed audit of all deaths that occur in hospital of patients under the care of a surgeon. We conducted a retrospective analysis of prospective audit data collected from 1 January 2002 to 31 December 2011. The annual number of deaths peaked in 2006, then fell 22% by 2011. ⋯ A shift of high-risk patients to teaching hospitals, where there is a greater ability to "rescue" patients after complications, may have been an important factor in improved outcomes. This external, peer-reviewed mortality audit has changed surgical practice and reduced deaths. The same process should be applied to other sentinel events, and the lessons learned can also be extended to non-surgical specialties.
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To use an automated Classification of Hospital Acquired Diagnoses (CHADx) reporting system to report the incidence of hospital-acquired complications in inpatients and investigate the association between hospital-acquired complications and hospital length of stay (LOS) in multiday-stay patients. ⋯ An automated CHADx reporting system can be used to collect data on patients with hospital-acquired complications. Such data can be used to increase emphasis on patient safety and quality of care and identify potential opportunities to reduce LOS.