Narrow-band ultraviolet B (NBUVB) phototherapy is an important treatment modality in dermatology. The most common dermatological indications for NBUVB include psoriasis, atopic dermatitis and vitiligo; however, it has been found to be an... more
Narrow-band ultraviolet B (NBUVB) phototherapy is an important treatment modality in dermatology. The most common dermatological indications for NBUVB include psoriasis, atopic dermatitis and vitiligo; however, it has been found to be an effective and well-tolerated treatment option in various other dermatoses. The efficacy of NBUVB phototherapy compares favorably with other available photo(chemo)therapy options and its efficacy is further augmented by a number of topical and systemic adjuncts. The long-term safety of NBUVB phototherapy remains to be fully elucidated; however, available data now suggest that it is safe and well-tolerated. The objective of this review was to summarize the current understanding of the safety and efficacy of NBUVB phototherapy in dermatology.
Research Interests:
Topical corticosteroids (TCS) are the standard of care in paediatric atopic dermatitis (pAD). Parents commonly cite TCS phobia as a major impediment to treatment adherence. Misinformation on TCS side-effects can impact on perceptions of... more
Topical corticosteroids (TCS) are the standard of care in paediatric atopic dermatitis (pAD). Parents commonly cite TCS phobia as a major impediment to treatment adherence. Misinformation on TCS side-effects can impact on perceptions of TCS safety. We aimed to assess pharmacists' beliefs and information on the safety of TCS in pAD treatment and determine whether their beliefs could be modified. Australian pharmacists attending a continuing professional development conference were assessed before and after an evidence-based lecture on the use of TCS in pAD. Responses were recorded in real time on electronic keypads. The mean response rate was 86% of the 292 surveyed. Of responders, 64% recognised that treatment non-adherence was a major reason for treatment failure in pAD. The post-education session assessment demonstrated a major attitude shift compared to the pre-education assessment. After education, pharmacists would instruct parents/patients to apply TCS until the eczema is ...
Research Interests:
Atopic dermatitis (AD) is a chronic relapsing inflammatory disease of the skin and is the most common paediatric dermatological condition. While no cure is available, it can be treated effectively if adherence to a therapeutic plan is... more
Atopic dermatitis (AD) is a chronic relapsing inflammatory disease of the skin and is the most common paediatric dermatological condition. While no cure is available, it can be treated effectively if adherence to a therapeutic plan is maintained. Poor adherence to treatment is common in AD and can lead to treatment failure, which has significant impacts on the patient, family and society. A comprehensive literature search was conducted to identify factors that contribute to poor treatment adherence in childhood AD and to identify possible strategies to remedy these. Identified factors leading to poor treatment adherence include: complexity of treatment regimen, lack of knowledge, impaired quality of life, dissatisfaction with treatment strategies, infrequent follow up, corticosteroid phobia and the use of complementary and alternative medicine. Effective strategies to increase treatment adherence include: caregiver education and utilisation of education adjuncts, optimisation of the...
Research Interests:
The legalisation of voluntary physician-based euthanasia is currently the subject of much political, social and ethical debate and there is evidence in Australia of growing support for its implementation. In addressing many of the issues... more
The legalisation of voluntary physician-based euthanasia is currently the subject of much political, social and ethical debate and there is evidence in Australia of growing support for its implementation. In addressing many of the issues that surround legalisation, the article looks at some overseas jurisdictions that have legalised euthanasia to determine whether the social, political and ethical concerns prominent in the Australian debate have proved problematic in other jurisdictions. In addition, the article examines the report on the Dying with Dignity Bill 2009 (Tas) which commented extensively on the issues relating to voluntary physician-based euthanasia.
Research Interests:
This article focuses on the ethical, social and liability implications of patients obtaining unsolicited medical advice over the phone. The ethical discussion centres on the demise of paternalism and the increase in patient autonomy and... more
This article focuses on the ethical, social and liability implications of patients obtaining unsolicited medical advice over the phone. The ethical discussion centres on the demise of paternalism and the increase in patient autonomy and individualism and the growing public expectations of health professionals. The article then discusses the advantages and disadvantages of telephone consultations from a social and policy perspective. In light of these considerations it considers what the liability implications are for phone consultations. It argues that the ethic of individualism, coupled with recent Australian tort reforms, suggests that only in limited circumstances would a doctor be found liable for negligence in relation to telephone consultations. However, the increasing expectations being placed on medical personnel, as evidenced by the increase in unsolicited telephone consultations, if left untempered, may lead to a situation with which the health care system is ill equipped ...
Research Interests:
Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for... more
Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.
Research Interests:
The aim of this study was to evaluate the differences in knowledge, attitudes, and behaviors regarding sun protection in different age groups and between men and women. A multicenter cross-sectional study using a population-based survey... more
The aim of this study was to evaluate the differences in knowledge, attitudes, and behaviors regarding sun protection in different age groups and between men and women. A multicenter cross-sectional study using a population-based survey of 416 individuals over the age of 18 years was undertaken during 2014. Of individuals aged 18-30 years, 94 % had experienced at least one episode of sunburn in the previous year. The likelihood of self-examining increased as age increased (p < 0.001). Only 15 % of participants used the recommended amount (40 ml) of sunscreen. Women were twice as likely to put on sunscreen as men. Women had better knowledge about sun protection and sunscreen use, and were twice as likely to know that sunscreen was denatured by heat and had an expiry date (p = 0.01). Women were more than twice as likely to put on sunscreen every day compared with men (p = 0.002). Reported barriers to sunscreen use included greasiness and forgetfulness and this was more commonly rep...