http://en.wikipedia.org/wiki/Wernicke-Korsakoff_syndrome
Price J, Theodorus MT. The supplementation of alcoholic beverages with thiamin: a necessary preventative measure in Queensland. Aust N Z J Psychiatry 1979; 13: 315-320.
Wernicke's encephalopathy and thiamine fortification of food: time for a new direction?
We should be fortifying beer to target the people who develop this disorder
MJA 1998; 9168: 534-535
Although the occurrence of Wernicke-Korsakoff syndrome in Australia appears to have been reduced by thiamine fortification of bread, it has not been eliminated. As nearly all cases occur in heavy alcohol drinkers, beer is probably a more appropriate vehicle for thiamine nutrification than bread. Prominent psychiatrist Eric Dax first suggested this 30 years ago. Beer is the preferred beverage of patients presenting with Wernicke's encephalopathy; the taste of thiamine hydrochloride can merge with the flavour of beer (but not with that of table wine); and it has been estimated that addition of thiamine to beer would be much more cost-effective than adding it to bread. It is clearly time for Commonwealth and State health authorities, the brewers and the NHMRC to seriously reconsider trialling the addition of thiamine to Australian beers -- to make them nutritionally the best in the world.
Prevalence of Wernicke-Korsakoff syndrome in Australia: has thiamine fortification made a difference?
Clive G Harper, Donna L Sheedy, Ana I Lara, Therese M Garrick, John M Hilton and Jack Raisanen
MJA 1998; 168: 542-545
Although there has been a significant decrease in the prevalence of WKS in Australia since the introduction of thiamine enrichment of bread flour in 1991, the rate is still higher than in most other Western countries and there is a need to maintain vigilance in the management of patients, particularly those with known or suspected alcohol problems.
Aust N Z J Public Health. 1996 Apr;20(2):181-7.
Preventing the Wernicke-Korsakoff syndrome in Australia: cost-effectiveness of thiamin-supplementation alternatives.
Connelly L, Price J.
"Alcoholic Wernicke's encephalopathy has been commonplace in Australia for many years and, as this syndrome is attributed to a deficiency in the diet, it should be preventable. This study employs conventional cost-effectiveness methodology to compare the economic efficiency of several thiamin-supplementation alternatives that have been proposed for the prevention of Wernicke's encephalopathy. A series of rankings of these measures is derived from an estimated cost per case averted for each of the alternatives studied. These rankings identify the least cost-effective thiamin-supplementation alternative as that of enriching bread-making flour with thiamin."
Can someone tell me why thiamine is not added to alcoholic beverages ?
Monday, April 11, 2011
Monday, March 14, 2011
Nights on-call ...
Got complacent with a few nights on-call not busy ... Saturday night, two hours sleep, so my Sunday day off was mostly catchup sleep ... Sunday night three hours sleep and have to work Monday. I will be leaving early as I should be.
Saturday night keeping alive someone with a major head injury ... Sunday night two patients with cardiac chest pain. I have decided (perhaps in my ageing body) that money does not compensate for lack of sleep.
Saturday night keeping alive someone with a major head injury ... Sunday night two patients with cardiac chest pain. I have decided (perhaps in my ageing body) that money does not compensate for lack of sleep.
Wednesday, February 16, 2011
Far NW Queensland
After spending 5 weeks in the Mt Isa region and pondering what to write I find myself about to leave for Mossman and still haven't written a blog entry.
My Mt Isa experience was broken into two parts with a brief sojourn at Doomadgee, a remote indigenous community about 600km north of Mt Isa, about an hour's flight from Mt Isa. Twelve days of Christmas ... well almost, it was 11 days in total including being in the community over Christmas.
Once again the medical details have to be kept blurred as in small communities things I say here can be easily linked to the people concerned ... confidentiality must be maintained where at all possible.
However given this document is in the public domain I will take the liberty to comment on it in my blog, with particular reference to one specific component of the "health" section.
COAG target : Need to improve our dental hygiene and care as it can lead to chronic disease.
"12 Develop an improved Oral Health Care Plan for the community."
"12.1 Identify and implement strategies to increase frequency of dental service visits to community."
"12.2 Build on current teeth brushing health promotion campaign in the school."
"Health Outputs"
"Increase of visiting dental services to monthly by January 2011."
"Enhancements to teeth brushing health promotion campaign identified by December 2010."
You can be fairly confident (if you can actually understand the bureaucratic drivel) that neither of these two targets have been met.
The dental condition of the locals at Doomadgee is appalling and once a month visit is going to be chaos management at best. Currently it is a visit once every three months and in late December 2010 while I was at Doomadgee I admitted a local to hospital with a very severe dental infection. He had tried to get to see the dentist in November 2010 when they were last in the community could not be fitted in. Next visit expected was February 2011.
The community needs a dental hygienist on an ongoing basis not a dentist who visits rarely and all they will be doing is extracting irretrievable teeth in advanced dental disease.
This is third world medicine in your own back yard ... it is shameful.
Would I go back to Mt Isa ?
Possibly yes, but the work place dynamics of the ED were not to my liking - a systemic problem that seems to be part of the development of the public emergency department. I prefer to be "on the floor" working with my peers and with those I am mentoring, not hovering at a safe distance so I can have an "overview" supervisor role.
I would like to return to Doomadgee or even Mornington Island in a dry season ... being at Doomadgee was a challenging experience and provides opportunity for personal growth in addition to attempting to provide good medicine.
Finally I can only re-iterate my disgust with the government's requirement to have overseas trained doctors ( or rather "international medical graduates" IMGs) bonded to the rural community for up to ten years. They are supposed to be in a supervised position and many are token supervised only ... they are alone and supported only by telephone consultation for the majority of the time. These IMGs bring in not only a very different medical mind to that of the Australian training, but a different culture, and a different purpose for being in their bonded position.
If we must have IMGs to top up our medical resources ( not going anywhere near the immoral nature of taking away trained medico's from their own needy community where they were trained !! ) put them in genuine supervised positions in URBAN practice ( and no not the private hospital ED night shifts where also they are token supervised ). Then the Australian trained doctors who cannot practice without a provider number should, as a condition of holding onto their suburban provider number, be required to provide "national service" to the community ... 12 months of rural practice that can be given in one block or over time, say 3 month every 4 years. This will potentially provide better medical care to the rural community and may even increase the numbers of doctors staying in the rural community, when those working in suburbia discover the joys, challenges and rewards of rural medicine.
All it takes is the political will to make it happen ... restrict provider number access and make holding provider numbers conditional. Not popular but its not like the current political agenda has been popular with the profession either !
My Mt Isa experience was broken into two parts with a brief sojourn at Doomadgee, a remote indigenous community about 600km north of Mt Isa, about an hour's flight from Mt Isa. Twelve days of Christmas ... well almost, it was 11 days in total including being in the community over Christmas.
Once again the medical details have to be kept blurred as in small communities things I say here can be easily linked to the people concerned ... confidentiality must be maintained where at all possible.
However given this document is in the public domain I will take the liberty to comment on it in my blog, with particular reference to one specific component of the "health" section.
COAG target : Need to improve our dental hygiene and care as it can lead to chronic disease.
"12 Develop an improved Oral Health Care Plan for the community."
"12.1 Identify and implement strategies to increase frequency of dental service visits to community."
"12.2 Build on current teeth brushing health promotion campaign in the school."
"Health Outputs"
"Increase of visiting dental services to monthly by January 2011."
"Enhancements to teeth brushing health promotion campaign identified by December 2010."
You can be fairly confident (if you can actually understand the bureaucratic drivel) that neither of these two targets have been met.
The dental condition of the locals at Doomadgee is appalling and once a month visit is going to be chaos management at best. Currently it is a visit once every three months and in late December 2010 while I was at Doomadgee I admitted a local to hospital with a very severe dental infection. He had tried to get to see the dentist in November 2010 when they were last in the community could not be fitted in. Next visit expected was February 2011.
The community needs a dental hygienist on an ongoing basis not a dentist who visits rarely and all they will be doing is extracting irretrievable teeth in advanced dental disease.
This is third world medicine in your own back yard ... it is shameful.
Would I go back to Mt Isa ?
Possibly yes, but the work place dynamics of the ED were not to my liking - a systemic problem that seems to be part of the development of the public emergency department. I prefer to be "on the floor" working with my peers and with those I am mentoring, not hovering at a safe distance so I can have an "overview" supervisor role.
I would like to return to Doomadgee or even Mornington Island in a dry season ... being at Doomadgee was a challenging experience and provides opportunity for personal growth in addition to attempting to provide good medicine.
Finally I can only re-iterate my disgust with the government's requirement to have overseas trained doctors ( or rather "international medical graduates" IMGs) bonded to the rural community for up to ten years. They are supposed to be in a supervised position and many are token supervised only ... they are alone and supported only by telephone consultation for the majority of the time. These IMGs bring in not only a very different medical mind to that of the Australian training, but a different culture, and a different purpose for being in their bonded position.
If we must have IMGs to top up our medical resources ( not going anywhere near the immoral nature of taking away trained medico's from their own needy community where they were trained !! ) put them in genuine supervised positions in URBAN practice ( and no not the private hospital ED night shifts where also they are token supervised ). Then the Australian trained doctors who cannot practice without a provider number should, as a condition of holding onto their suburban provider number, be required to provide "national service" to the community ... 12 months of rural practice that can be given in one block or over time, say 3 month every 4 years. This will potentially provide better medical care to the rural community and may even increase the numbers of doctors staying in the rural community, when those working in suburbia discover the joys, challenges and rewards of rural medicine.
All it takes is the political will to make it happen ... restrict provider number access and make holding provider numbers conditional. Not popular but its not like the current political agenda has been popular with the profession either !
Tuesday, January 18, 2011
Sunday, January 2, 2011
Off topic - and happy new year !
The long white cloud ... representative of a place of origin, and acknowledgement of the importance of the elements we rely upon for life, air and water.
The fern ... representative of both a place of origin and transition. The fern, an ancient species of plant life, is stated to be a "specialist" in marginal habitats. It is also an acknowledgement of the importance of the earth and it's forests.
The butterfly ... a metaphor in many ways. Ulysses species to represent attraction to the tropics of Queensland, three chosen for three individuals of great importance.
The lioness ... also a metaphor in many ways. The lion represents consistency, strength and wisdom - the lioness in particular for nurturance and the power of feminine energy.
A work in progress ... thank you Eddie.
The fern ... representative of both a place of origin and transition. The fern, an ancient species of plant life, is stated to be a "specialist" in marginal habitats. It is also an acknowledgement of the importance of the earth and it's forests.
The butterfly ... a metaphor in many ways. Ulysses species to represent attraction to the tropics of Queensland, three chosen for three individuals of great importance.
The lioness ... also a metaphor in many ways. The lion represents consistency, strength and wisdom - the lioness in particular for nurturance and the power of feminine energy.
A work in progress ... thank you Eddie.
Thursday, December 30, 2010
Friday, December 3, 2010
Closing the Gap ... it's not just a gap y'know
Closing the Gap—PBS Co-payment Measure - this system is in place to subsidise prescriptions for those of an indigenous background
"who present with an existing chronic disease or are at risk of chronic disease and in the opinion of the prescriber:
would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine and
are unlikely to adhere to their medicines regimen without assistance through the measure."
A practice needs to be registered for PIP or an Indigenous Health Service (IHS).
I have been instructed that I cannot write Closing the Gap(CTG) scripts because I am neither employed by the IHS nor is there any formal agreement between myself and the IHS.
I am contracted by Queensland Health Service (QHS) via the locum service to provide medical services to the local community and as such not directly employed by the local IHS.
It therefore comes down to whether a formal agreement is in place between myself and the IHS ... and it appears there is none. There is currently an outstanding lack of agreement between the local IHS and QHS. I have, after some considered thought and attempting to seek independent verification, decided that a formal agreement is not required between QHS and the local IHS for a formal agreement to be in place between myself as an individual and the IHS.
I will pursue this avenue. Unless this issue is resolved the local community is disadvantaged. The community come in through a single door into a single facility (recently built at the cost of 16.3 million dollars) and if they cannot see the IHS employed doctor who can give them "free" prescriptions, they must see a QHS doctor who according the IHS management, cannot write a "free" prescription.
I hope while the major formal agreement is pending, a local arrangement can be entered into to support the community where it is needed.
"who present with an existing chronic disease or are at risk of chronic disease and in the opinion of the prescriber:
would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine and
are unlikely to adhere to their medicines regimen without assistance through the measure."
A practice needs to be registered for PIP or an Indigenous Health Service (IHS).
I have been instructed that I cannot write Closing the Gap(CTG) scripts because I am neither employed by the IHS nor is there any formal agreement between myself and the IHS.
I am contracted by Queensland Health Service (QHS) via the locum service to provide medical services to the local community and as such not directly employed by the local IHS.
It therefore comes down to whether a formal agreement is in place between myself and the IHS ... and it appears there is none. There is currently an outstanding lack of agreement between the local IHS and QHS. I have, after some considered thought and attempting to seek independent verification, decided that a formal agreement is not required between QHS and the local IHS for a formal agreement to be in place between myself as an individual and the IHS.
I will pursue this avenue. Unless this issue is resolved the local community is disadvantaged. The community come in through a single door into a single facility (recently built at the cost of 16.3 million dollars) and if they cannot see the IHS employed doctor who can give them "free" prescriptions, they must see a QHS doctor who according the IHS management, cannot write a "free" prescription.
I hope while the major formal agreement is pending, a local arrangement can be entered into to support the community where it is needed.
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