Stroke care maintained during pandemic
Unlike some other countries there was no drop off in Australian hospital presentations for stroke during the COVID-19 lockdown in early 2020 compared to corresponding periods in previous years.
A Queensland study found no significant difference between a mean of 2.15 stroke admissions per day in March to May 2020 compared to 2.13 and 2.26 in 2018 and 2019 respectively (p=0.81). Similarly there were no differences in admissions for either ischaemic stroke or ICH.
In secondary outcomes, there was also no difference in rates of intravenous thrombolysis (p=0.82), endovascular thrombectomy (p=0.93) and time from last known well to presentation
(p=0.54).
Conversely, daily ED presentations (including non-stroke presentations) were significantly reduced in 2020 compared to the previous years (p<0.0001)
“The lack of change to stroke admissions in Brisbane during the early phase of the pandemic demonstrated in the present study may in part be due to effective communication by the public health authorities and these results provide reassurance that while internationally there were significant impacts to the timing and quality of stroke care, the same has not been seen in Brisbane,” the study authors said.
Read more in the Internal Medicine Journal
Regional specialist telehealth services hit by Tristar collapse
The collapse of the rural bulk-billing medical centre group Tristar Medical may result in clinic closures and reduced access to specialist telehealth services for people in regional Australia, doctors have been told.
The Mildura-based group went into administration on 24 May due to financial difficulties, with administrators McGrath Nicol saying there is a question mark over which of the 30 clinics would remain open in the long term unless a potential buyer can be found.
Tristar Medical was reported to be reliant on international medical graduates (IMGs) to staff its GP bulk billing clinics, and the AMA said it had concerns about unpaid wages and continuity of employment for doctors currently working at the clinics.
“It’s not an easy process for them to up sticks and go to another job because they also need to apply to the medical board to allow them to move to another employer,” a spokesman told the Ballarat Courier.
According to its website the Tristar Medical Group also promoted specialist telehealth services via its clinics across Victoria, NSW, SA and the NT. It offered GP-mediated telehealth consultations with cardiologists, dermatologists, endocrinologists, gastroenterologists, haematologists, neurologists, oncologists, rheumatologists and respiratory and sleep specialists, as well as surgeons and other physician specialities.
The demise of Tristar has been blamed on the freeze in Medicare rebates and reduced IMG recruitment during the pandemic.
Antiseizure medication link to neurodevelopmental disorders
Prenatal exposure to some antiseizure therapies could increase risks of neurodevelopmental disorders, Nordic researchers suggest.
Their study of 4,494,926 children of women with epilepsy who were or weren’t exposed to antiseizure medications during gestation found those exposed to topiramate, valproate and several dual therapies had a higher risk of autism spectrum disorder (ASD), intellectual disability (ID) or any neurodevelopmental disability diagnoses by age eight than those who weren’t.
Among 21,634 unexposed children, 1.5% had a diagnosis of ASD and 0.8%, ID by age eight.
In same-aged children of mothers with epilepsy exposed to topiramate and valproate monotherapy, 4.3% and 2.7% (adjusted hazard ratio [aHR]: 2.8 and 3.5), respectively, had ASD, and 3.1% and 2.4% (aHR, 2.4 and 2.5) had ID.
The aHRs increased with dosage, compared with children from the general population, the authors wrote in JAMA Neurology.
Regarding dual-therapies, carbamazepine and lamotrigine with topiramate were associated with increased risks of neurodevelopmental disorders in children of women with epilepsy, at eight-year cumulative incidence rates of 5.7% (levetiracetam plus carbamazepine, aHR: 3.5), 7.5% (lamotrigine with topiramate, aHR: 2.4).
No increased risk was associated with levetiracetam plus lamotrigine (eight-year cumulative incidence, 1.6%, aHR: 0.9), the authors wrote.
“No consistently increased risks were observed for neurodevelopmental disorders after prenatal exposure to monotherapy with lamotrigine, levetiracetam, carbamazepin, oxcarbazepine, gapapentin, pregabalin, clonazepam, or phenobarbital,” they added.
“Women of reproductive age who are prescribed [medications such as] topiramate should be informed of the potential risks, and these should be weighed against the benefits and available treatment options,” they wrote.