Biomedical subjects
Publications and source records attributed to Marie Pirotta.
Primary dysmenorrhoea is the occurrence of painful menstrual cramps in the absence of pelvic pathology. This review discusses alternative approaches to the management of this debilitating condition.
METHODS: Australian general practitioners' (GPs) attitudes toward and use of a range of complementary therapies (CTs) were determined through a self-administered postal survey sent to a random sample of 2000 Australian GPs. The survey canvassed GPs' opinions as to the harmfulness and effectiveness of CTs; current levels of training and interest in further training; personal use of, and use in practice of, CTs; referrals to CT; practitioners; appropriateness for GPs to practice and for government regulation; perceived patient demand and the need for undergraduate education. RESULTS: The response rate was 33.2%. Based on GPs' responses, complementary therapies could be classified into: nonmedicinal and nonmanipulative therapies, such as acupuncture, massage, meditation, yoga, and hypnosis, that were seen to be highly effective and safe; medicinal and manipulative therapies, including chiropractic, Chinese herbal medicine, osteopathy, herbal medicine, vitamin and mineral therapy, naturopathy, and homeopathy, which more GPs considered potentially harmful than potentially effective; and esoteric therapies, such as spiritual healing, aromatherapy, and reflexology, which were seen to be relatively safe yet also relatively ineffective. The risks of CTs were seen to mainly arise from incorrect, inadequate, or delayed diagnoses and interactions between complementary medications and pharmaceuticals, rather than the specific risks of the therapies themselves. CONCLUSIONS: Nonmedicinal therapies along with chiropractic are widely accepted in Australia and can be considered mainstream. GPs are open to training in complementary therapies, and better communication between patients and GPs about use of CTs is required to minimize the risk of adverse events. There is also a need to prioritize and provide funding for further research into the potential adverse events from these therapies and other therapies currently lacking an evidence base.
BACKGROUND: Shared maternity care is an important model of care in Australia and overseas, but Victorian studies have shown patient dissatisfaction and widespread communication problems. AIMS: This study aimed to implement and evaluate initiatives to improve communication between three maternity hospitals and general practitioners involved in shared maternity care in Melbourne. METHODS: A pre- and post-design with audit of 150 hospital records at each of three hospitals plus audit of 20 general practitioner files for evidence of key communications on shared care patients, before and after a multifaceted intervention. RESULTS: Significant improvements at individual hospitals were seen if one person was made responsible for a communication outcome. Other initiatives did not lead to improvements if they did not include individual accountability. CONCLUSION: The standard of integration of shared maternity care is unacceptable low. Improvements to communication are achievable but depend on the allocation of individual time and responsibility, plus a commitment by hospitals to ongoing audit of their performance.
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OBJECTIVE: To test whether oral or vaginal lactobacillus can prevent vulvovaginitis after antibiotic treatment. DESIGN: Randomised, placebo controlled, double blind, factorial 2x2 trial. SETTING: Fifty general practices and 16 pharmacies in Melbourne, Australia. PARTICIPANTS: Non-pregnant women aged 18-50 years who required a short course of oral antibiotics for a non-gynaecological infection: 278 were enrolled in the study, and results were available for 235. INTERVENTIONS: Lactobacillus preparations taken orally or vaginally, or both, from enrollment until four days after completion of their antibiotic course. MAIN OUTCOME MEASURES: Participants' reports of symptoms of post-antibiotic vulvovaginitis, with microbiological evidence of candidiasis provided by a self obtained vaginal swab. RESULTS: Overall, 55/235 (23% (95% confidence interval 18% to 29%)) women developed post-antibiotic vulvovaginitis. Compared with placebo, the odds ratio for developing post-antibiotic vulvovaginitis with oral lactobacillus was 1.06 (95% confidence interval 0.58 to 1.94) and with vaginal lactobacillus 1.38 (0.75 to 2.54). Compliance with antibiotics and interventions was high. The trial was terminated after the second interim analysis because of lack of effect of the interventions. Given the data at this time, the chances of detecting a significant reduction in vulvovaginitis with oral or vaginal lactobacillus treatment were less than 0.032 and 0.0006 respectively if the trial proceeded to full enrollment. CONCLUSIONS: The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results. Further research on this subject is unlikely to be fruitful, unless new understandings about the pathogenesis of post-antibiotic vulvovaginitis indicate a possible role for lactobacillus.
BACKGROUND: Complementary and alternative medicines are used by many consumers, and increasingly are being incorporated into the general practitioner's armamentarium. Despite widespread usage, the evidence base for most complementary therapies is weak or non-existent. Post-antibiotic vulvovaginitis is a common problem in general practice, for which complementary therapies are often used. A recent study in Melbourne, Australia, found that 40% of women with a past history of vulvovaginitis had used probiotic Lactobacillus species to prevent or treat post-antibiotic vulvovaginitis. There is no evidence that this therapy is effective. This study aims to test whether oral or vaginal lactobacillus is effective in the prevention of post-antibiotic vulvovaginitis. METHODS/DESIGN: A randomised placebo-controlled blinded 2 x 2 factorial design is being used. General practitioners or pharmacists approach non-pregnant women, aged 18-50 years, who present with a non-genital infection requiring a short course of oral antibiotics, to participate in the study. Participants are randomised in a four group factorial design either to oral lactobacillus powder or placebo and either vaginal lactobacillus pessaries or placebo. These interventions are taken while on antibiotics and for four days afterwards or until symptoms of vaginitis develop. Women self collect a vaginal swab for culture of Candida species and complete a survey at baseline and again four days after completing their study medications. The sample size (a total of 496--124 in each factorial group) is calculated to identify a reduction of half in post-antibiotic vulvovaginitis from 23%, while allowing for a 25% drop-out. An independent Data Monitoring Committee is supervising the trial. Analysis will be intention-to-treat, with two pre-specified main comparisons: (i) oral lactobacillus versus placebo and (ii) vaginal lactobacillus versus placebo.
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OBJECTIVES: This is a pilot study to test the validity of using one research assistant to train and support reception staff at five clinics to obtain waiting room data in general practice surveys. DESIGN: A research assistant trained reception staff at five randomly chosen general practices to administer a survey to all eligible women over a two-week period. Practices were audited daily by their appointment books and where possible by billing records to check total numbers of eligible women to determine the denominator of the sample. SETTING: Five metropolitan general practices in one divisional area. PARTICIPANTS: Twenty-five receptionists distributed surveys to 1,298 women. MAIN OUTCOME MEASURES: Number of eligible women missed at each clinic. RESULTS: The number of potential subjects missed by the reception staff ranged from nil to 18% with the appointment book audit. A second audit using billing records at three clinics revealed inaccuracies of up to 50%. The ability to accurately capture eligible patients for waiting room surveys depends on good administrative systems within the practice and motivated staff. CONCLUSIONS: It is important for general practice researchers to consider and account for eligible participants who are missed from the denominator with a waiting room survey method. Valid sampling using this method can be achieved in certain practices, however this may limit the generalisability of the findings.
BACKGROUND: To compare the characteristics of Victorian general practitioners who practise and do not practise complementary therapies. METHOD: A self administered postal survey sent to 800 Victorian GPs. RESULTS: The response rate was 64%. There were no statistically significant differences between complementary therapy practitioners and nonpractitioners in the number of patients seen per week, urban versus rural location, solo versus group practice or Fellowship of the Royal Australian College of General Practitioners. In some complementary therapies, practising GPs tended to be male, full time and older. DISCUSSION: Victorian GPs who practise complementary therapies are on the whole not from the fringes of the medical community. The reasons why GPs include complementary therapies in their practice cannot be answered by this study.