Australian healthcare professionals' beliefs and practice behaviours in management of chronic pelvic pain: a cross-sectional survey.

Background Chronic pelvic pain (CPP) is a common and debilitating condition, and sufferers present to healthcare professionals with variable complex symptoms and co-morbidities. This study aimed to investigate the current beliefs and practice behaviours of healthcare professionals towards the management of CPP in Australian females. Methods We distributed an online survey to Australian healthcare professionals. Participants were questioned regarding their beliefs, the importance of various contributing factors and assessment variables, and their management preferences for two CPP vignettes. Demographic information and responses were analysed with descriptive statistics. Results Complete data were obtained and analysed from 446 respondents including gynaecologists (n =75), general practitioners (GPs) (n =184) and physiotherapists (n =187). Most of the respondents were female (88.1%), with male (11.7%) and other (0.2%) making up a smaller representation. Physiotherapists rated themselves higher in understanding mechanisms of CPP (64.7% very good to excellent) compared to gynaecologists (41.3%) and GPs (22.8%). Physiotherapists also reported higher levels of confidence in managing patients with CPP (57.8% quite or extremely confident) compared to 41.3% of gynaecologists and 22.3% of GPs who reported being quite or extremely confident. All three professions rated patient's beliefs (89.8%), nervous system sensitisation (85.7%), stress/anxiety/depression (91.9%), fear avoidance (83.3%), history of sexual/emotional/physical abuse (94.1%) and pelvic floor muscle function (85.0%) as very/extremely important factors in the development of chronic pelvic pain. Most gynaecologists (71.0%) and GPs (70.2%) always referred for pelvic ultrasound during assessment. Physiotherapists assessed goal setting (88.8%) and screened for patients' beliefs (80.9%) more often than gynaecologists (30.4% and 39.1% respectively) and GPs (46.5% and 29.0% respectively). Conclusions All three groups of healthcare professionals demonstrated a good understanding of pain mechanisms and incorporated a biopsychosocial and multidisciplinary approach to management of females with chronic pelvic pain. However, both gynaecologists and GPs were less confident in their understanding of and management of CPP, and less likely to consider patient beliefs and goals. The findings of this online survey may assist in the provision of more targeted education to further improve management of this condition.

Outbreak of acute gastroenteritis among emergency department staff.

OBJECTIVES: We attempted to examine an outbreak of acute gastroenteritis among the staff of the emergency department of Glasgow Royal Infirmary. We specifically looked at the pattern of spread among staff, the estimated hours of sick time and the practicalities of applying standard hospital guidelines for infection control within the emergency department. METHODS: Anonymous questionnaires were filled in by all medical and nursing staff within the department. RESULTS: The outbreak, considered to be caused by norovirus infection, affected 45% of staff over a 51-day period. The most commonly affected grades were staff/enrolled nurses (56%) and SHOs (58%), arguably the groups with greatest patient contact. The outbreak appeared to occur in three waves with affected staff at the start of each wave being more likely to recall contact with an infected patient than those towards the end. A total of 449.5 working hours were lost to the department through staff illness with further hours lost as staff took time to care for ill family members. CONCLUSION: We hypothesise that the infection was introduced from the community on several occasions and was subsequently passed among staff within the department. Infection control measures designed for the inpatient setting can be partially applied to the emergency department. We felt the most useful measures would be early identification and isolation of infectious patients, barrier nursing, escalation of cleaning of the department and early investment in replacement staff to allow ill staff members to remain isolated at home and to prevent understaffing.

Acute mountain sickness and ascent rates in trekkers above 2500 m in the Nepali Himalaya.

INTRODUCTION: The aim of this study was to ascertain the incidence of acute mountain sickness (AMS) at different altitudes in the Solu-Khumbu. This was a pilot to examine the feasibility of investigating demographic, behavioral, and physiological factors related to the etiology of AMS and to assess the region's suitability for a future study. METHODS: A convenience sample of 150 recreational trekkers staying in teahouses was interviewed at altitudes above 2500 m. Two interviews were performed, firstly in the evening and then the subsequent morning. Trekker's age, gender, ascent profile, and use of acetazolamide were noted. A Lake Louise score was calculated to determine the presence of AMS. RESULTS: The incidence of AMS was 0% at 2500-3000 m, 10% between 3000-4000 m, 15% between 4000-4500 m, 51% between 4500-5000 m, and 34% over 5000 m. There was no significant association between age or gender and the altitude studied or incidence of AMS. Subjects with AMS ascended significantly further in the preceding 72 h than subjects without AMS, with a mean altitude gained of 846 m vs. 722 m. DISCUSSION: We concur with the literature that incidence of AMS increases with altitude. We found an abrupt increase in incidence over 4500 m. This appears to be a new finding. A future study examining factors predisposing to AMS would be most effectively performed above 4500 m. No association was found between age or gender and AMS. Mean vertical ascent gained in the previous 72 h was significantly higher among the trekkers with AMS but remained within recommended guidelines.

Can knowledge protect against acute mountain sickness?

BACKGROUND: Studies show that the well-prepared traveller is less likely to suffer travel related illness. This study is designed to examine trekkers' knowledge of altitude sickness in an attempt to see whether knowledge can protect against acute mountain sickness (AMS) and high altitude pulmonary or cerebral oedema (HAPE/HACE). METHODS: A convenience sample of 130 trekkers were interviewed in the Solu Khumbu region of Nepal. They were asked what action they would take firstly if they developed symptoms of AMS, and secondly, symptoms of HAPE/HACE whilst ascending. Options were to continue up, stay at the same altitude, descend or ask their guide. RESULTS: With symptoms of moderate to severe AMS, 37 trekkers (28 per cent) indicated they would continue their ascent while 113 (72 per cent) would not. Those individuals who proposed continued ascent were significantly more likely to be suffering from symptoms of AMS (p = 0.025) and had ascended significantly more rapidly over the preceding 72 h (p = 0.004) then those who proposed to halt their ascent. With regard to symptoms of HAPE/HACE, 12 (9 per cent) indicated they would not descend, demonstrating no association with AMS (p = 0.07) or ascent in preceding 72 h (p = 0.7). CONCLUSION: Trekkers who indicated that they would act safely in the event of developing moderate to severe AMS were significantly less likely to be suffering from AMS when interviewed and had ascended significantly less altitude in the preceding 72 h being more likely to adhere to recommended ascent guidelines.