Combination treatment of interferon ß-1b and warfarin for a patient with Baló's concentric sclerosis and antiphospholipid syndrome.

BACKGROUND: Baló's concentric sclerosis (BCS), a rare variant of multiple sclerosis (MS), as the initial presentation of antiphospholipid syndrome (APS) is unusual. The pathogenic role of antiphospholipid antibodies in the development of MS remains unknown. Anticoagulant therapy might be used in patients with MS and APS for prevention against the relapse of MS. CASE REPORT: We present a 27-year-old man diagnosed as BCS with APS. Initially, after corticosteroid therapy, he exhibited a complete recovery. During follow-up, his Baló-like lesion dissolved over time but transformed into other asymptomatic MS-like lesions. He also had persistently elevated anticardiolipin IgG levels. The patient was, therefore, on a combined therapy of interferon ß-1b and an anticoagulant agent. No new brain lesions were found on 2 occasional head magnetic resonance imaging studies at 1 year follow-up. CONCLUSIONS: To prevent further MS relapse and thrombotic complications of APS, a combined therapy of interferon ß-1b and an anticoagulant agent can be an important strategy in treating patients with both BCS and APS.

Utility of a primary care based transient ischaemic attack electronic decision support tool: a prospective sequential comparison.

BACKGROUND: Stroke is a major cause of death and disability worldwide. Reducing the incidence of stroke has the potential to not only improve health outcomes, but also lead to significant cost savings for health services. Transient ischaemic attacks (TIA) can herald an imminent stroke and following a TIA early initiation of best medical therapy significantly reduces the risk of subsequent stroke. To achieve time targets rapid access stroke specialist services have been promoted; however, a number of resource related barriers can impede specialist access and cause unnecessary time delays. Cross sector collaboration led to the development of a primary care based TIA/Stroke electronic decision support (EDS) tool. This study aimed to assess the impact of this tool on improving access and reducing management delays. METHODS: This is a prospective before (2009) versus after (2011) study of the effect on process of care following the implementation of EDS assisted TIA management in primary care. All patients presenting with TIA to secondary services were included. Outcomes assessed were TIA Guideline adherence and patient safety. RESULTS: Over the study period 266 patients presented for TIA assessment (130 in 2009 and 136 in 2011). Following EDS implementation the median delay to specialist assessment fell from 10 days in 2009 to three days in 2011 (HR 1.45; 95% CI 1.13-1.86; p=0.001), the number of patients achieving optimal medical therapy within 24 hours rose from 43% to 57% (RR 1.33; 95% CI 1.02-1.71; p=0.04), carotid and CT imaging were achieved significantly faster (HR 1.52 (1.02-2.26) p=0.003 and HR 1.34 (1.16-1.78 p=0.002) respectively), and there were no adverse events associated with EDS use. CONCLUSION: The availability of TIA/Stroke electronic decision support in the primary care setting was associated with reductions in management delays without compromising patient safety.

Bilingual medical students as interpreters--what are the benefits and risks?

AIMS: To identify the frequency of medical students interpreting in healthcare settings and to explore the issues related to the use of non-professional interpreters. METHODS: All 4th and 5th year University of Otago medical students were surveyed to identify bilingual medical students who have interpreted for patients. Students and key informants were interviewed and audiotaped. RESULTS: Of the 102 bilingual students identified, 59 interpreted for patients. We analysed 39 student interviews. Most reported a 'good' interpreting experience and thought student interpreting was 'a good idea', but some encountered 'bad' experiences. Stakeholders (professional interpreters, DHB policy staff, and clinicians who use interpreters) thought students should not interpret. Issues explored were: student comfort, clinician's choice, the interpreter's role, cultural competency, awareness, and provision of interpreting services. CONCLUSIONS: A considerable proportion of bilingual clinical medical students have interpreted for patients contrary to Capital and Coast District Health Board policy and professional interpreter recommendations. In conjunction with published literature and after consulting with interpreter trainers, we have developed a document which canvasses the issues involved and proposed practical guidelines, to better prepare healthcare professionals and non-professional interpreters for interpreting situations. More research is required to find out why clinicians are asking medical students and others to interpret rather than engaging professional interpreters.