Munad Khan

Simple clinical targets associated with a high level of patient satisfaction with their pain management

Introduction: We aimed to determine factors that are significantly associated with a high level of patient satisfaction with their pain management.

Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department

Objective To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). Methods We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint. The study sample was randomly selected from a list of all eligible patients. Data were extracted electronically from the ED records and by explicit extraction from the medical record. Logistic regression models were constructed to assess associations with the three binary study end points. Results 1289 patients were enrolled. Patients were less likely to receive any analgesia if they presented 08:00–15:59 hours (OR 0.67, 95% CI 0.46 to 0.98) or 16:00–24:00 hours (OR 0.55, 95% CI 0.37 to 0.80) were triage category 5 (OR 0.20, 95% CI 0.08 to 0.49) or required an interpreter (OR 0.34, 95% CI 0.14 to 0.86). Patients were less likely to receive NIA or early analgesia if they were aged 56 years or more (OR 0.70 and 0.63; OR 0.57 and 0.21, respectively) or if they had received ambulance analgesia (OR 0.59, 95% CI 0.36 to 0.95; OR 0.38, 95% CI 0.20 to 0.74, respectively). Conclusions Patients who present during the daytime, have a triage category of 5 or require an interpreter are less likely to receive analgesia. Older patients and those who received ambulance analgesia are less likely to receive NIA or early analgesia.

Complementary and Alternative Medicines Use in Patients on Warfarin and Matched Controls: A Retrospective Cohort Study

To investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting).

Primary bladder amyloidosis as a cause of haematuria

We report the case of a 46-year-old man who initially presented with macroscopic haematuria. Although initially concerning for a malignancy in the bladder, histology demonstrated a primary bladder amyloidosis that has remained stable for 6 years since the initial diagnosis. Primary bladder amyloidosis is an important clinical entity that can mimic bladder malignancy on clinical history, radiological investigation and cystoscopic evaluation. Although uncommon, it should not be neglected as a possible diagnosis in patients presenting with haematuria.

Response to Re: Interns’ perceptions of exposure to urology during medical school education in Victoria, Australia

1. Azer S, Khan M, Hoag N et al. Interns’ perceptions of exposure to urology during medical school education in Victoria, Australia. ANZ J. Surg. 2017; 87: 10–1. 2. Hill DA. Integration of the surgical specialties into an innovative undergraduate curriculum. Med. Educ. 1993; 27: 489–94. 3. Louie-Johnsun MW, Munzel B, Murphy DL. Hospital medical officers and basic urology: are they up to scratch? BJU Int. 2006; 98: 491–2. 4. Patel M, Pleass H. Teaching urology to medical students: “is this as good as it gets”? ANZ J. Surg. 2017; 87: 7–8.