B Positive – all you wanted to know about - ASHM

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not possible to conceal the identity of the source patient who has refused to consent to disclosure � Provision of medical services in a particular instance of care where there is a need to know the patient’s infection status for treatment purposes of benefit to the patient (e.g. in an emergency or if the patient is unconscious). this should not, however, detract from the observance of standard infection control precautions. it is strongly recommended that practitioners familiarise themselves with the national Privacy Principles (which are legally binding) and contact the office of the Privacy commissioner if they wish to clarify the manner in which the national Privacy Principles might relate to specific situations. Legal advice should be sought from a legal practitioner. Contact tracing the practice of contact tracing raises the question of potential conflict between breaching a patient’s privacy and confidentiality, and alerting a third party to the fact that they may be at risk of HbV infection. although a case on this specific point is yet to be heard in australia, it seems likely that a health practitioner could be found negligent to a third party if they did not warn the third party that they were at risk. this potential conflict may be further complicated by a statutory obligation to counsel patients regarding sexually transmissible medical conditions. fortunately, public health services afford practitioners expert guidance to resolve the conflict between the duties to maintain confidentiality and privacy, and a possible duty of care owed to third parties. in instances where practitioners suspect a person may be putting others at risk, the practitioner should notify the health department using the methods prescribed by the relevant state or territory. Public health authorities then become responsible for making decisions around contact tracing, including the management of privacy issues. for a more detailed account of the contact tracing responsibilities of health care providers, please consult the Australasian Contact Tracing Manual Ed 3, available at: http:// www.ashm.org.au/contact-tracing/ . Criminal law there are two types of criminal offences associated with HbV and other blood-borne viruses. the first relates to the disclosure of information regarding a person who has an infection, or is suspected of having HbV or other blood-borne virus infections—as discussed above. there are also laws in every state and territory making it an offence to transmit an infection to another person. as with other areas of legislation, specifications around definition and scope differ across jurisdictions. the majority of these laws are not specific to bloodborne viruses, but instead refer to infectious diseases generally; more generic criminal offences, for example, causing grievous bodily harm, may also be applied. Anti-discrimination anti-discrimination provisions exist across all australian states and territories, making it illegal to discriminate against people on the basis of their (perceived) HbV infection. discrimination is prohibited on the basis of disability or impairment. it is important that health care practitioners consider behaviours they must avoid when testing and managing people with HbV. discrimination on the basis of disability or impairment includes treating a person less favourably as a result of their (perceived) disability or impairment. in a health care setting, this may include refusing to see a patient, offering different or inappropriate treatment, or placing a patient last on a consultation or operating list. as outlined in chapter 11: infection control and occupational health, standard precautions ensure a high level of protection against the transmission of infection in the health care setting and represent the level of infection control required in the treatment and care of all patients to prevent transmission of bloodborne infections. Health care workers with HBV infection Please refer to chapter 11: infection control and occupational health for obligations of health care practitioners who perform exposure prone procedures. b Positive – all you wanted to know about hepatitis b: a guide for primary care providers 95
THE ROLE OF COMPLEMENTARY MEDICINE IN HEPATITIS B Ses J Salmond Drug and Alcohol Clinical Services, Hunter New England Area Health Service, Arkana Therapy Centre and Leichhardt Women’s Community Health Centre, NSW. Robert Batey Drug and Alcohol Services, North Sydney Central Coast Area Health, Wyong Hospital, NSW. KEY POINTS � flavonoids isolated from the following plants have demonstrated anti-HbV activity in various in vitro and in vivo models: wogonin (scutellaria baicalensis) and apigenin (ocinum basilicum). � a multicentre study of chronic hepatitis b patients found that two different oxymatrine preparations administered for 24 weeks improved HbV dna clearance compared to placebo (p = 0.001). a randomised, double blind placebo controlled clinical trial of cpd 861 for 24 weeks in chronic hepatitis b patients with fibrosis and early cirrhosis found that the overall reversal rate in the grade of fibrosis was 52% in the cpd 861 group compared to 20% in the placebo (p < 0.05). this effect was more pronounced in those with more advanced fibrosis. Herbal medicines with well documented evidence of hepatotoxicity are: teucrium chamaedrys (wall germander) and teucrium polium, Mentha pulgeium (pennyroyal) atractylis gummifera (pine thistle) (current name carlina gummifera), certain pyrrolizidine alkaloids and Larrea tridenta (chapparal). � Patients with chronic hepatitis b virus infection interested in pursuing complementary medicine are advised to consult an accredited practitioner of traditional chinese medicine or western herbal medicine or naturopathy. Qualified practitioners can be found at: australian acupuncture and chinese Medicine association (aacMa) at www.acupuncture.org.au or phone 07 3324 2599 or the national Herbalists association of australia (nHaa) at www.nhaa.org.au or phone 02 8765 0071. complementary and alternative medicine (caM) is increasingly used by the public in parallel with, and instead of conventional medicine. 1 approximately half of the australian population use caM totalling an estimated a$2.3 billion in expenditure in 2000, almost four times the public contribution to all pharmaceuticals. 2 these local figures represent a 120% increase in the use of caM products and a 63% increase in expenditure on caM therapists respectively since 1993. 2 in 2004, the total expenditure fell to a$1.3 billion on caM products and to a$494 million on caM therapists despite the percentage of people using caM remaining constant at 50% in 1993, 52.1% in 2000 and 52.2% in 2004. 3 96 b Positive – all you wanted to know about hepatitis b: a guide for primary care providers 13 in the past decade, the interest in complementary medicine and its use in the treatment of chronic liver disease has also increased. 1 The role of complementary medicine in the treatment of chronic hepatitis B patients there is evidence to suggest that acupuncture, herbal medicines or the isolated active ingredients in certain herbal medicines can play a role in the management of people with chronic hepatitis b virus (HbV) infection. these complementary medicines appear to
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all you wanted to know about hepati
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B Positive - all you wanted to know
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4 b Positive - all you wanted to kn
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Foreword in nsW, just seven cancers
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Executive Summary this monograph ai
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Executive Summary variable course o
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Executive Summary of the exposed he
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5 Figures and 2 Tables 1 Prevalence
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1 Prevalence and epidemiology of he
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VIROLOGY: VIRAL REPLICATION AND DRU
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2 Virology: viral replication and d
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3 Hepatitis B virus testing and int
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References 1. Milich d, Liang tJ. e
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NATURAL HISTORY OF CHRONIC HEPATITI
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4 Natural history of chronic hepati
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Page 47 and 48: PRIMARY PREVENTION OF HEPATITIS B V
Page 49 and 50: 5 Primary prevention of hepatitis B
Page 51 and 52: 5 Primary prevention of hepatitis B
Page 53 and 54: 6 Clinical assessment of patients w
Page 59 and 60: 7 Treatment of chronic hepatitis B
Page 67 and 68: 8 Managing patients with advanced l
Page 69 and 70: 8 Managing patients with advanced l
Page 71 and 72: 9 Hepatitis B virus related hepatoc
Page 77 and 78: 10 Managing hepatitis B virus infec
Page 83 and 84: INFECTION CONTROL AND OCCUPATIONAL
Page 85 and 86: 11 Infection control and occupation
Page 91 and 92: PRIVACY, CONFIDENTIALITY AND OTHER
Page 93 and 94: 12 Privacy, confidentiality and oth
Page 95: 12 Privacy, confidentiality and oth
Page 99 and 100: 13 The role of complementary medici
Page 101 and 102: 13 The role of complementary medici
Page 103 and 104: Appendix 1 Hepatitis B Fact sheet -
Page 105 and 106: Appendix 1 - Continued support is a
Page 107 and 108: Appendix 2 List of useful organisat
Page 109 and 110: Appendix 2 - Continued » Hepatitis
Page 111 and 112: Appendix 2 - Continued The Hepatiti
Page 113 and 114: Appendix 2 - Continued otHer onLine
Page 115 and 116: GLOSSARY AND ABBREVIATIONS Viral he
Page 117 and 118: Glossary and abbreviations GP: Gene
Page 119 and 120: Glossary and abbreviations Standard
Page 121 and 122: Index • HBV DNA level............
Page 123 and 124: Index liver transplantation........
Page 125: Notes 1 4 b Positive - all you want
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