ORCID Profile
0000-0001-7324-9171
Current Organisation
University of South Australia
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Migration | Mental Health | Demography | Multicultural, Intercultural and Cross-cultural Studies | Psychology | Social and Community Psychology
Ethnicity, Multiculturalism and Migrant Development and Welfare | Cultural Understanding not elsewhere classified | Health and Support Services not elsewhere classified | Mental Health | Employment Patterns and Change |
Publisher: SLACK, Inc.
Date: 08-2018
DOI: 10.3928/1081597X-20180706-01
Abstract: To compare “total keratometry” measurements with Goggin nomogram adjusted anterior keratometry (GNAK) for toric intraocular lens calculation. Routine biometry provided measured total keratometry values from which astigmatism was derived. The Goggin nomogram was applied to anterior keratometry values on the same eyes to provide nomogram-adjusted anterior keratometry values (GNAK) that estimate total corneal astigmatism. The agreement between total keratometry and GNAK was analyzed. Overall, in 46 eyes there was no statistically significant difference between median GNAK and total keratometry power values ( P = .746). No statistically significant difference remained in against-the-rule and oblique subgroup analyses. Absolute and signed steep axis of astigmatism was statistically significantly different for GNAK and total keratometry in the overall analysis ( P .001 and = .029, respectively) and for against-the-rule and oblique subgroup analyses. The with-the-rule subgroup showed a statistically significant difference in astigmatic power and no significant signed steep axis difference between GNAK and total keratometry. Total keratometry appears able to measure total corneal astigmatism to match closely (clinically and statistically) GNAK estimation of that parameter. This indicates that it would be safe and reasonable to use total keratometry data for planning of cataract surgery with toric IOLs. [ J Refract Surg. 2018 (8):521–526.]
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.PEDN.2015.10.022
Abstract: There are few studies that exist which focus specifically on parents with a child with a rare disease. The purpose of this study was to better understand the lived experiences and supportive care needs (SCN) of parents caring for a child across a spectrum of rare diseases. A qualitative descriptive approach was used to guide the research, and four semi-structured focus group interviews were conducted with 23 parents (17 mothers and 6 fathers). Participants described 'feeling boxed-in outside the box' due to a number of limitations unique to their child's disease, daily practical challenges in providing care and the various relational impacts of caring for a child with a rare disease were discussed. The results from this study help to give clearer direction for health professionals on where to focus future efforts in better meeting the supportive care needs of parents and their child with a rare disease.
Publisher: Informa UK Limited
Date: 06-2008
DOI: 10.1080/17549500701849789
Abstract: Children with and without speech, language and/or literacy impairment, delete consonants when they name pictures to elicit single words. Consonant deletion seems to be more frequent in long words (words of three or more syllables) than in short words (words of one or two syllables). However, it may be missed in long words because they are not routinely assessed and, even if they are, there is little normative data about them. The study aims were (1) to determine if a relationship exists between consonant deletion and the number of syllables in words, (2) delimit variation in the numbers of children using it, its frequency of occurrence and the words it affects and (3) to discuss the application of these data to clinical practice. The participants were 283 typically developing children, aged 3 to 7 years, speaking Australian English with proven normal language, cognition and hearing. They named pictures, yielding 166 selected words that were varied for syllable number, stress and shape and repeatedly s led all consonants and vowels of Australian English. Almost all participants (95%) used consonant deletion. Whilst a relationship existed between consonant deletion frequency and the number of syllables in words, the syllable effect was interpreted as a proxy of an interaction of segmental and prosodic features that included two or more syllables, sonorant sounds, non-final weak syllables, within-word consonant sequences and/or anterior-posterior articulatory movements. Clinically, two or three deletions of consonants across the affected words may indicate typical behaviour for children up to the age of 7 years but variations outside these tolerances may mark impairment. These results are further evidence to include long words in routine speech assessment.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.APNR.2018.06.013
Abstract: Accessing the peripheral veins for blood s ling and short-term peripheral intravenous catheter insertion is common in contemporary healthcare. Clinicians may apply heat or promote oral hydration to increase vein diameter and reveal veins to improve success rates. However, there is limited research that has examined the effect of these interventions on vein diameter and depth. To determine the effect of localised heat and oral hydration on vein diameter and depth. A three arm parallel randomised controlled trial was undertaken with 39 healthy participants from a University. All participants fasted from food and fluid from midnight. At 10 am the next day, a mark was made at the cephalic (120 mm proximal from the radial styloid) and median cubital veins (at cubital fossa) with non-permanent ink and participants underwent baseline vein diameter and depth measurement using ultrasound. Participants were randomised to either a control, heat or hydration group. Participants in the hydration arm consumed 1 L of room temperature tap water, those in the heat group had a wheat bag applied to the area for 10 min and those in the control group had no intervention and were asked to sit quietly. A second measurement was undertaken immediately after the heat intervention and 1 h after the baseline measurement for those in the hydration and control groups. The application of localised heat and oral hydration did not affect the depth of the cephalic vein. Whilst hydration had no effect on median cubital vein depth, the application of heat did make this vein more superficial compared to the control group (p = 0.033). The application of heat resulted in a statistically significant (p = 0.006) increase in cephalic vein diameter compared to the control group, this effect did not occur with the median cubital vein (p = 0.087). Oral hydration resulted in a reduction in the mean diameter of both veins. Compared to the control group, the average median cubital vein diameter decreased by 0.57 mm (p = 0.003 95% CI -0.940 to -0.193) and the cephalic vein reduced by 0.33 mm (p = 0.015 95% CI -0.593 to -0.064) after oral hydration. The use of localised heat was inconsistent in its effect on vein diameter and depth. Oral hydration caused a reduction in vascular calibre in both the cephalic and median cubital veins. The promotion of water consumption to improve venepuncture success is not supported.
Publisher: FapUNIFESP (SciELO)
Date: 2014
DOI: 10.1590/1516-3180.20141323T1
Abstract: People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered. To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies. Twenty-one studies (772 participants) were included in this review with two additional 2012 studies identified as 'awaiting classification'. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD) 4.92 mL/kg/min 95% confidence interval (CI) 3.98 to 5.87 P < 0.00001 8 studies on 267 participants) however, no statistically significant effects were observed for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), minute ventilation at maximal exercise (VEmax) or peak expiratory flow rate (PEFR). Meta-analysis of four studies detected a statistically significant increase in maximum heart rate, and following a sensitivity analysis and removal of two studies significance was maintained (MD 3.67 bpm 95% CI 0.90 to 3.44 P = 0.01). Although there were insufficient data to pool results due to erse reporting tools, there was some evidence to suggest that physical training may have positive effects on health-related quality of life, with four of five studies producing a statistically and clinically significant benefit. This review demonstrated that physical training showed significant improvement in maximum oxygen uptake, though no effects were observed in other measures of pulmonary function. Physical training was well tolerated among people with asthma in the included studies and, as such, people with stable asthma should be encouraged to participate in regular exercise training, without fear of symptom exacerbation. More research is needed to understand the mechanisms by which physical activity impacts asthma management.
Publisher: Informa UK Limited
Date: 06-2018
DOI: 10.2147/JMDH.S166022
Publisher: Wiley
Date: 04-11-2014
DOI: 10.1002/AUR.1428
Abstract: Autism spectrum disorders are a set of neurodevelopmental disorders that are highly hereditable. Increased genomic instability has been observed in other heritable paediatric neurobiological disorders therefore, the aim of our study was to test the hypothesis that DNA damage is increased in children with autism and that B vitamin status may explain variations in genome integrity between autistic and normal children. We compared 35 children with autism, 27 of their siblings without autism and 25 age- and gender-matched community controls for genomic stability using the cytokinesis-block micronucleus cytome (CBMN-cyt) assay, B vitamins and homocysteine, as well as autism-related behaviours. It was found that there were no differences in CBMN-cyt biomarkers between the three groups. Vitamin B2 was significantly raised in children with autism and their siblings compared with controls (P = 0.027 and P = 0.016 respectively) but there was no difference in other B vitamins or homocysteine. In conclusion, although replication using a larger cohort is needed, it appears unlikely that genomic instability is a feature of the aetiology of autism. We cannot rule out in utero effects or other types of DNA damage not measured by the CBMN-cyt assay.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: SLACK, Inc.
Date: 07-2010
DOI: 10.3928/1081597X-20090814-01
Abstract: To determine whether preoperative marking of the limbal cornea improves treatment of myopic astigmatism with the excimer laser. Retrospective study on 108 eyes with myopic astigmatism that underwent LASIK or laser epithelial keratomileusis (LASEK) with the Technolas 217 (Bausch & Lomb) excimer laser. Preoperative limbal marking was performed in 47 eyes (marked group). The 12-month results were used for refractive and visual analysis. The achieved cylinder reduction, spherical reduction, and refractive predictability were similar for the marked and unmarked groups in the overall study collective, in the LASIK and LASEK subgroup analysis, and in a higher astigmatism ( .25 diopters) subgroup analysis. Limbal marking showed no influence on the refractive results, and vector analysis showed no significant difference in angle of error among groups. Corneal limbal marking failed to improve the refractive outcome in LASIK and LASEK for myopic astigmatism.
Publisher: SAGE Publications
Date: 06-2007
DOI: 10.1258/096914107781261927
Abstract: Objectives: To determine the impact of novel invitation strategies on population participation in faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening. Setting A community screening programme in Adelaide, South Australia. Methods: In total, 2400 people aged 50–74 years were randomly allocated to one of four CRC screening invitation strategies: (a) Control: standard invitation-to-screen letter explaining risk of CRC and the concept, value and method of screening (b) Risk: invitation with additional messages related to CRC risk (c) Advocacy: invitation with additional messages related to advocacy for screening from previous screening programme participants and (d) Advance Notification: first, a letter introducing Control letter messages followed by the standard invitation-to-screen. Invitations included an FIT kit. Programme participation rates were determined for each strategy relative to control. Associations between participation and sociodemographic variables were explored. Results: At 12 weeks after invitation, participation was: Control: 237/600 (39.5%) Risk: 242/600 (40.3%) Advocacy: 216/600 (36.0%) and Advance Notification: 290/600 (48.3%). Participation was significantly greater than Control only in the Advance Notification group (Relative risk [RR] 1.23, 95% confidence interval [CI] 1.06–1.43). This effect was apparent as early as two weeks from date of offer Advance Notification: 151/600 (25.2%) versus Control: 109/600 (18.2%, RR 1.38, 95% CI 1.11–1.73). Conclusions: Advance notification significantly increased screening participation. The effect may be due to a population shift in readiness to undertake screening, and is consistent with the Transtheoretical Model of behaviour change. Risk or lay advocacy strategies did not improve screening participation. Organized screening programmes should consider using advance notification letters to improve programme participation.
Publisher: Wiley
Date: 08-2009
DOI: 10.1016/J.OTOHNS.2009.03.022
Abstract: To measure long‐term quality‐of‐life (QOL) improvement following contemporary multilevel upper airway reconstruction surgery, compared with continuous positive airway pressure (CPAP) therapy. Secondary aims were to investigate factors determining clinical effectiveness and QOL impact of reported side effects. Cohort study. Consecutive, simultaneously treated adult patients with moderate‐severe obstructive sleep apnea (OSA) having upper airway surgery (N = 77) or CPAP (N = 89) therapy were studied by questionnaire. Glasgow Benefit Inventory (GBI), change in snoring status and Epworth Sleepiness Scale (ESS), subjective CPAP compliance, and side effects in both groups were measured at mean ± SEM 44.12 ± 5.78 months (3.68 ± 0.48 years) after commencement of therapy. No significant difference was seen between surgical outcomes for GBI, snoring, or ESS and CPAP controls. Multivariate analysis showed reduction in Respiratory Disturbance Index (RDI) predicted postoperative snoring and ESS, but not GBI outcomes. Snoring control and GBI were related to CPAP compliance ( P 0.001). CPAP side effects (reported in 26%) significantly reduced the QOL benefit of treatment, independent of compliance. Surgical complications (occurring in 44%) did not affect QOL treatment benefit. Patients with poor CPAP compliance and/or significant side effects of CPAP therapy (45% of cases in this series) should be evaluated for contemporary upper airway reconstructive surgery.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.JACC.2015.04.029
Abstract: Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up. Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83 p = 0.285), cardiovascular mortality (OR: 0.66 p = 0.103), and hospitalization (OR: 0.83 p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65 p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05 p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55 p = 0.002). Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Informa UK Limited
Date: 24-07-2023
Publisher: Informa UK Limited
Date: 03-06-2011
DOI: 10.1080/13803395.2011.575769
Abstract: The assessment of cognitive function is often neglected following stroke, with no consensus on the optimal method to assess poststroke cognition. We evaluated the ability of a brief protocol to detect cognitive impairment in community-dwelling people with chronic stroke compared to healthy controls and its ability to detect changes in cognition in stroke participants undergoing an exercise intervention. Four tests of cognition were able to detect differences between the groups in the domains of executive function, memory, and information-processing speed. Stroke survivors undergoing exercise over a 5-month period showed significantly improved memory and speed of information processing. Results suggest that exercise may have the potential to improve cognition in long-term stroke survivors and that these tests are sensitive measures of poststroke cognition.
Publisher: Asian Pacific Organization for Cancer Prevention
Date: 31-12-2012
DOI: 10.7314/APJCP.2012.13.12.5989
Abstract: There is little information on longitudinal patterns of participation in faecal occult blood test (FOBT) based colorectal cancer (CRC) screening or on demographic or behavioural factors associated with participation in re-screening. The lack of an agreed system for describing participatory behaviour over multiple rounds also h ers our ability to report, understand and make use of observed associations. Our aims were to develop a system for describing patterns of participatory behaviour in FOBT-based CRC screening programs and to identify factors associated with particular behavioural patterns. A descriptive framework was developed and applied to a data extract of screening invitation outcomes over two rounds of the NBCSP. The proportion of invitees in each behaviour category was determined and associations between behaviour patterns and demographic and program factors were identified using multivariate analyses. We considered Re- Participants, Dropouts, Late Entrants and Never Participants to be the most appropriate labels for the four possible observed participatory categories after two invitation rounds. The screening participation rate of the South Australian cohort of the NBCSP remained stable over two rounds at 51%, with second round Dropouts (10.3%) being balanced by Late Entrants (10.5%). Non-Participants comprised 38.7% of invitees. Relative to Re-Participants, Dropouts were older, more likely to be female, of lower SES, had changed their place of residence between offers had a positive test result in the first round. Late Entrants tended to be in the youngest age band. Specific demographic characteristics are associated with behavioural sub-groups defined by responses to 2 offers of CRC screening. Targeted group-specific strategies could reduce dropout behaviour or encourage those who declined the first invitation to participate in the second round. It will be important to keep first round participants engaged in order to maximise the benefit of a CRC screening program.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.DIABRES.2017.09.012
Abstract: To determine the effect of treatment for Strongyloides stercoralis infection on type 2 diabetes mellitus in an Australian Aboriginal population. A three-year cohort study of 259 Aboriginal adults living in northern Australia. Subjects were tested for S. stercoralis infection, diabetic status and HbA1c at recruitment. 92 subjects were ELISA positive for S. stercoralis and 91 were treated with two doses of ivermectin 0.2mg/kg. Serological cure was assessed after 6months and those who remained positive were retreated. All subjects then underwent the same testing at 3years follow up. Follow up was successful in 80% of subjects. Eight new cases of T2DM were recorded, 7 in the treatment group and 1 in the non-treatment group (Unadjusted RR 7.71, CI 0.98-60.48, p=0.052. Adjusted RR 5.45, CI 075-35.92, p=0.093). In addition, worsening glycemic control (T2DM or newly diagnosed glucose intolerance) was recorded in 13 cases (10 treatment group, 3 non treatment. Adjusted RR 3.74, CI 1.06-13.20, p=0.04). There was a significant improvement in glycemic control in the patients with pre-existing T2DM when treated for S. stercoralis compared to the non-treatment group (Diff. -1.03, p=0.009). This study demonstrated a differential effect of treatment for S. stercoralis on glucose metabolism in patients with and without T2DM. It showed a significant effect on the development of T2DM and glucose intolerance in those without T2DM, while improving glycemic control in subjects with pre-existing T2DM. Although numbers in this study are small, it suggests that larger studies may be of interest.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1111/J.1753-6405.2010.00661.X
Abstract: To assess the effect of South Australian Kindergarten Union participation on adult cardiovascular behavioural risk factors. Using a retrospective cohort design, this study examined the effect of attendance at a Kindergarten Union preschool from 1940 to 1972 on behavioural risk factors for cardiovascular disease in adults 34-67 years. Dichotomous outcomes were analysed using a generalised linear model (Poisson distribution) with robust variance estimates. Outcomes with more than two categories were analysed with a multinomial logistic model. There was a beneficial effect of preschool on high physical activity relative to sedentary and on ever smoking, but a negative effect on fruit consumption. Preschool attendance was not associated with alcohol risk or vegetable consumption under traditional criteria, however the point estimate for vegetable consumption was in the beneficial direction. The point estimates from the multinomial model suggested a step-wise decreasing risk for preschool attendees to have less risk of experiencing multiple behavioural risk factors (e.g. risk of five risk factors for preschool participants compared with non-participants). Attendance at a Kindergarten Union preschool was associated with a reduced risk of two and an indication of benefit in a third behavioural risk factor in adulthood. This study provides some evidence for the potential health benefit of interventions outside of the health sector to prevent cardiovascular diseases, which are strongly associated with lifelong social disadvantage.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2011
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.ARCHGER.2009.04.004
Abstract: The aim of this study was to examine the effect of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives) on the risk of falls and fractures in a cohort of elderly people in South Australia. A retrospective cohort study was undertaken using the wave 1 (1992) and wave 3 (1994) data of the Australian Longitudinal Study of Ageing (ALSA). Persistent use of psychotropic medicines was defined as use of one or more psychotropic medications at both wave 1 and wave 3. A comprehensive list of potential confounding variables was in idually entered into regression models to examine effects on risk ratios. The results showed that the use of psychotropic medications was associated with an increased risk of falls in females (IRR=1.47, 95% CI=1.31-1.64) but not in males (IRR=1.03, 95% CI=0.85-1.26). The use of psychotropic medications was also associated with an increased risk of a fracture in females (RR 2.54 CI 1.57-4.11 p<0.0001) but not in males (RR=0.66 p=0.584 CI 0.15-2.86). In both analyses, the body mass index (BMI) was determined to be the only confounding variable. After adjusting for BMI, the IRR in females decreased to 1.22 (95% CI 1.02-1.45 p<0.015) for falls and the RR decreased to 1.92 (p<0.015, CI 1.13-3.24) for fractures.
Publisher: American Psychological Association (APA)
Date: 1992
Publisher: JMIR Publications Inc.
Date: 17-09-2021
Abstract: ementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). his paper reports the protocol of a pilot RCT evaluating the iSupport VA. even versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. his study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). his protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. ustralian New Zealand Clinical Trials Registry ACTRN12621001452886 fum5tjz RR1-10.2196/33572
Publisher: Oxford University Press (OUP)
Date: 16-07-2014
DOI: 10.1093/NTR/NTU112
Abstract: Inpatient medical settings offer an opportunistic environment for initiating smoking cessation interventions to patients reflecting on their health. Current evidence has shown the superior efficacy of varenicline tartrate (VT) for smoking cessation compared with other tobacco cessation therapies however, recent evidence also has highlighted concerns about the safety and tolerability of VT. Given these apprehensions, we aimed to evaluate the safety and effectiveness of VT plus quitline-counseling compared to quitline-counseling alone in the inpatient medical setting. Adult patients (n = 392, 20-75 years) admitted with a smoking-related illnesses to 3 hospitals were randomized to receive either 12 weeks of varenicline tartrate (titrated from 0.5mg daily to 1mg twice daily) plus quitline-counseling (VT+C), (n = 196) or quitline-counseling alone (n = 196). VT was well tolerated in the inpatient setting among subjects admitted with acute smoking-related illnesses (mean age 52.8±2.89 and 53.7±2.77 years in the VT+C and counseling alone groups, respectively). The most common self-reported adverse event during the 12-week treatment phase was nausea (16.3% in the VT+C group compared with 1.5% in the counseling alone group). Thirteen deaths occurred during the study period (n = 6 were in the VT+C arm compared with n = 7 in the counseling alone arm). All of these subjects had known comorbidities or developed underlying comorbidities. VT appears to be a safe and well-tolerated opportunistic treatment for inpatient smokers who have related chronic disease. Based on the proven efficacy of varenicline from outpatient studies and our recent inpatient evidence, we suggest it be considered as part of standard care in the hospital setting.
Publisher: SAGE Publications
Date: 15-08-2018
Abstract: While perceived as safe, diagnostic ultrasound has the potential to cause biological effects on the body tissues. The aim of this study was to evaluate knowledge, attitudes, and practices of Australasian sonographers on bioeffects and safety of ultrasound scanning. Focus groups were used to develop a questionnaire to explore knowledge, attitudes, and practices of ultrasound safety, which was then distributed to Australasian sonographers. Thematic (focus groups) and descriptive (questionnaires) analyses were undertaken. A 37-item questionnaire addressed knowledge, attitudes, and practices of ultrasound safety. In 47 collected responses, sonographers demonstrated good familiarity of thermal index (TI) (79%), mechanical index (MI) (68%), and “as low as reasonably achievable” (ALARA) principle (85%). However, most sonographers could not accurately define TI (13%) and had poor knowledge of safety guidelines relating to TI (19%) and MI (14%). Over 30% were uncertain about their attitudes to ultrasound safety issues. While 52% always and 30% most of the time adhere to ALARA, 37% of sonographers reported never monitoring TI and MI. While familiar with safety terms, knowledge of safety guidelines was lacking. Many sonographers were uncertain about their attitudes to the safety of scans, and safety practices involving monitoring for bioeffects were not a high priority.
Publisher: BMJ
Date: 06-2007
Publisher: Human Kinetics
Date: 10-2015
Abstract: The purpose of this study was to test the reliability and validity of 2 standardized methods for calculating speed at the second lactate-threshold point (LT 2 ) based on the preexisting D max (LT D ) and modified D max (LT MOD ) procedures. 13 trained male road runners and triathletes completed 2 incremental laboratory running tests to determine LT 2 , followed by separate time trials (5, 10, 15 km) on an outdoor running track. Two new methods were proposed for calculating the speed at LT 2 : (1) the single standardized lactate threshold (LT SDs ) and (2) the paired standardized lactate threshold (LT SDp ) for quantifying changes over time. The LT SDs and LT SDp methods had high relative (ICC ≥ .98) and absolute (CV ≤ 1.9%) reliability in identifying the speed at LT 2 . The speed at LT2 according to the LT SDs and LT SDp methods had a strong correlation and was not different to the performance speed during the 10- and 15-km time trials (≤2.3% ρ c 0.8 P .05). The following natural logbased formula was created to estimate the percentage of LT 2 speed (using the LT SDs method) that could be sustained for events ~15–75 min: y = –7.256(ln x ) + 157.64, where y = %LT 2 speed, x = time-trial performance (s), and ln = natural log. The standardized methods are reliable for determining LT 2 . The LT SDs and LT SDp methods for calculating the speed at LT 2 from a near-maximal incremental test calculated speeds similar to those exhibited in 10- and 15-km running time trials. A prediction equation for estimating the percentage of LT 2 that can be sustained for events of ~15–75 min was generated.
Publisher: Springer Science and Business Media LLC
Date: 05-10-2015
Publisher: Springer Science and Business Media LLC
Date: 07-08-2019
Publisher: Oxford University Press (OUP)
Date: 12-2003
Abstract: Prostate-specific antigen (PSA) testing for prostate cancer is controversial. Demand for PSA testing is likely to rise in the UK, Australia and other western countries. Primary care needs to develop appropriate strategies to respond to this demand. Our aim was to compare the effectiveness of educational outreach visits (EOVs) and mailout strategies targeting PSA testing in Australian primary care. A randomized controlled trial was conducted in general practices in southern Adelaide. The main outcome measures at baseline, 6 months and 12 months post-intervention were PSA testing rates and GP knowledge in key areas relating to prostate cancer and PSA testing. The interventions were able to demonstrate a change in clinical practice. In the 6 months post-intervention, median PSA testing rate in the EOV group was significantly lower than in the postal group, which in turn was significantly lower than the control group (P < 0.001). Statistically significant differences were not, however, maintained in the 6-12 month post-intervention period. The EOV group, at 6 months follow-up, had a significantly greater proportion of "correct" responses than the control group to questions about prostate cancer treatment effectiveness (P = 0.004) and endorsement of PSA screening by professional bodies (P = 0.041). Primary care has a central role in PSA testing for prostate cancer. Clinical practice in this area is receptive to evidence-based interventions.
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/16094069211008333
Abstract: Australia has one of the highest asthma prevalence rates in the world, with this chronic and debilitating condition affecting one in nine people. The health and mental wellbeing of young people with asthma are worse than not only their peers without asthma but also worse than that of people with asthma at other ages. Psychological interventions could be beneficial in treating symptoms of elevated psychological distress in patients with asthma. However, evidence suggests that engagement with mental health services is low in this population. Technology-based solutions that engage youth may overcome barriers to service uptake for both mental health and asthma management. To fast-track the successful translation of evidence-based treatment into practice, interactive, mixed-reality technologies such as augmented reality (AR), virtual reality (VR) and holographic technology may provide a novel, low-cost solution, yet to date, methodological rigor in the evaluation of mixed reality for this purpose is lacking. To evaluate the perceived usability and acceptability of these technologies, mixed reality tools will be developed by the author team to deliver a component of a psychological intervention for treatment of elevated psychological distress among young people with asthma. Qualitative research will be conducted through one-on-one interviews with young people with asthma, parents/caregivers of young people with asthma, and with health professionals, during which participants will have time to interact with the resources. Moderator guides will be used to direct interviews, and will be supplemented with a questionnaire, including Likert-type measures of usability and acceptability to facilitate triangulation of data. Understanding and data obtained through this study will be used to develop version 2.0 mixed reality tools, which will be tested for feasibility in a RCT. Improving access to and uptake of evidence-based treatments for elevated psychological distress in young people with asthma may reduce the burden of this highly prevalent disease.
Publisher: Elsevier BV
Date: 05-2016
Publisher: Wiley
Date: 08-09-2016
Publisher: Wiley
Date: 02-06-2017
Publisher: JMIR Publications Inc.
Date: 26-07-2023
DOI: 10.2196/34629
Abstract: Interactive, mixed reality technologies such as augmented reality, virtual reality, and holographic technology may provide a novel solution to fast-track the translation of evidence into practice. They may also help overcome barriers to both mental health and asthma management service uptake, such as cost, availability of appointments, fear of judgment, and quality of care. This study aimed to investigate if mixed reality technology is an acceptable mechanism for the delivery of a component of cognitive and behavioral therapies for the management of elevated psychological distress among young people with asthma. To explore the perceived acceptability of these technologies, mixed reality tools were evaluated via qualitative, 1-on-1 interviews with young people with asthma and symptoms of psychological distress, parents/caregivers of young people with asthma and symptoms of psychological distress, and relevant health professionals. The Theoretical Framework of Acceptability was used for the deductive coding of the recorded interview transcripts. This study enrolled the following participants: (1) 3 adolescents with asthma and symptoms of psychological distress with a mean age of 14 (SD 1.7) years (2) 4 parents/caregivers of adolescents with asthma with a mean age of 55 (SD 14.6) years and (3) 6 health professionals with a mean age of 40.8 (SD 4.3) years. A total of 4 constructs—experienced affective attitude, experienced effectiveness, self-efficacy, and intervention coherence—were coded in all participant transcripts. The most frequently coded constructs were experienced affective attitude and intervention coherence, which were reported a total of 96 times. The least frequently coded construct was anticipated opportunity cost, which was reported a total of 5 times. Participants were mostly positive about the mixed reality resources. However, some concerns were raised regarding ethicality, particularly regarding privacy, accessibility, and messaging. Participants noted the need for technology to be used in conjunction with face-to-face engagement with health professionals and that some patients would respond to this type of delivery mechanism better than others. These results suggest that mixed reality technology to deliver psychological interventions may be an acceptable addition to current health care practices for young people with asthma and symptoms of psychological distress. Australia and New Zealand Clinical Trials Registry ACTRN12620001109998 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380427
Publisher: Informa UK Limited
Date: 04-05-2015
DOI: 10.1080/10376178.2015.1101352
Abstract: Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention. In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population. This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.
Publisher: Springer Science and Business Media LLC
Date: 19-02-2015
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.NEDT.2011.01.007
Abstract: In Australia, nurse education was transferred from hospital based nursing schools to the higher education sector. This transfer resulted in a change for students, from hospital employee to an unpaid, supernumerary role during professional placements. The majority of undergraduate nursing students now combine part time employment with their studies, working mainly within health settings or service sectors such as hospitality and retail. The aims of this study were to identify if newly qualified registered nurses engaged in paid employment during their final year of undergraduate studies, the types of employment they chose, reasons for that choice, skills acquired and their views on any link between employment choice and transition to practice. Focus group interviews involving sixty seven new graduates were conducted. From the data, four organising themes were identified financial independence and autonomy, confidence and experience, future opportunity and ease of transition. The global theme maximising opportunity describes nurse's views about their decisions on student employment. Participants had differing views on employment choice and transition to practice. Further research is needed in the area to identify whether there is any link between student employment choice and transition to practice.
Publisher: BMJ
Date: 19-09-2012
DOI: 10.1136/THORAXJNL-2012-202484
Abstract: Smoking cessation interventions in outpatient settings have been demonstrated to be cost effective. Given this evidence, we aimed to evaluate the effectiveness of varenicline tartrate plus Quitline-counselling compared with Quitline-counselling alone when initiated in the inpatient setting. Adult patients (18-75 years) admitted with a smoking-related illness to three hospitals, were randomised to receive either 12-weeks of varenicline tartrate plus Quitline-counselling, (n=196) or Quitline-counselling alone, (n=196), with 12-months follow-up. For the primary analysis population (intention-to-treat), the proportion of subjects who remained continuously abstinent were significantly greater in the varenicline plus counselling arm (31.1%, n=61) compared with counselling alone (21.4%, n=42 RR 1.45, 95% CI 1.03 to 2.03, p=0.03). The combined use of varenicline plus counselling when initiated in the inpatient setting has produced a sustained smoking cessation benefit at 12-months follow-up, indicating a successful opportunistic treatment for smokers admitted with smoking related illnesses. www.clinicaltrials.gov/ ClinicalTrials.gov identification number: NCT01141855.
Publisher: Springer Science and Business Media LLC
Date: 02-05-2015
Publisher: Oxford University Press (OUP)
Date: 2016
DOI: 10.1093/OFID/OFW029
Abstract: Background. This study examines the predictive value of eosinophilia for Strongyloides stercoralis infection, as measured by enzyme-linked immunosorbent assay (ELISA) testing, in an endemic community. In remote communities, eosinophilia is frequently used as a proxy test for the presence of helminth infections. Past studies of eosinophilia and Strongyloides infection have been conducted in specific groups such as immigrants and refugees, or in subpopulations of nonendemic communities, rather than in endemic communities. Methods. We conducted a cross-sectional study of the relationship between eosinophilia and Strongyloides ELISA serology, as part of a study into the relationship between S stercoralis infection and type 2 diabetes mellitus (T2DM) in an Indigenous community in northern Australia. Results. Two hundred thirty-nine adults had their eosinophil count and S stercoralis ELISA serology measured in 2012 and 2013, along with other biometric and metabolic data. Eosinophilia was found to have a relatively poor sensitivity (60.9%), specificity (71.1%), positive predictive value (54.6%), and negative predictive value (76.1%) for S stercoralis ELISA positivity in this group. However, there was a more constant relationship between eosinophilia and S Stercoralis ELISA positivity in patients with T2DM (negative predictive value 87.5%). Conclusion. This study suggests that the presence or absence of eosinophilia is not an adequate proxy test for S stercoralis infection in a community where the infection is prevalent, and that the association between eosinophilia and S stercoralis ELISA positivity is more constant in patients with T2DM.
Publisher: Elsevier BV
Date: 06-2012
Predictors of Depression, Anxiety and Stress Indicators in a Cohort of Women with Chronic Pelvic Pain
Publisher: Informa UK Limited
Date: 03-2020
DOI: 10.2147/JPR.S223177
Publisher: SLACK, Inc.
Date: 07-2012
Publisher: Wiley
Date: 26-09-2013
Abstract: To measure quality‐of‐life outcomes, polysomnographic outcomes, and adverse effects for a new technique of tongue reduction in obstructive sleep apnea. Case series. Tertiary hospital. Consecutively treated adult patients (N = 27) with obstructive sleep apnea having submucosal lingualplasty in 2007 were studied. All had concurrent or previous uvulopalatoplasty ± palatal advancement. Full polysomnography preoperatively and 3.7 ± 0.4 months postoperatively, scored using the American Academy of Sleep Medicine 2007 criteria, was recorded. Snoring severity score, Epworth Sleepiness Scale, and complication data were collected at a 2.61 ± 0.08‐year follow‐up via questionnaire. Mean snoring severity score fell from 7.1 ± 0.4 to 2.3 ± 0.6 ( P . 05). Epworth Sleepiness Scale score fell from 8.3 ± 1.1 to 5.8 ± 1.0 ( P . 05). The apnea‐hypopnea index (AHI) fell from 44.0 ± 4.3 to 12.5 ± 2.3 ( P . 05). Success, defined as achieving an AHI postoperatively, was observed in 74% (20/27), with each of these patients achieving a reduction in AHI %. Lowest oxygen saturation improved from 84 ± 1 to 88 ± 1 ( P . 05). Pain was mild to moderate. Short‐term postoperative complications included bleeding (3.7%) and infection (14.8%). Some minor long‐term (6 months) alteration in tongue function was reported with regard to speech (47%), swallow (33%), and taste (33%). Submucosal lingualplasty with concurrent palatal surgery is a promising treatment option in adult patients with obstructive sleep apnea with macroglossia.
Publisher: Springer Science and Business Media LLC
Date: 24-12-2011
DOI: 10.1245/S10434-010-1474-5
Abstract: Most studies analyzing risk factors for pulmonary morbidity date from the early 1990s. Changes in technology and treatment such as minimally invasive esophagectomy (MIE) and neoadjuvant treatment mandate analysis of more contemporary cohorts. Predictive factors for overall and specific pulmonary morbidity in 858 patients undergoing esophagectomy between 1998 and 2008 in five Australian university hospitals were analyzed by logistic regression models. A total of 394 patients underwent open esophagectomy, and 464 patients underwent MIE. A total of 259 patients received neoadjuvant chemoradiotherapy, 139 preoperative chemotherapy alone, and 2 preoperative radiotherapy alone. In-hospital mortality was 3.5%. Smoking and the number of comorbidities were risk factors for overall pulmonary morbidity (odds ratio [OR] 1.47, P = 0.016 OR 1.35, P = 0.001) and pneumonia (OR 2.29, P = 0.002 1.56, P = 0.005). The risk of respiratory failure was higher in patients with more comorbidities (OR 1.4, P = 0.035). Respiratory comorbidities (OR 3.81, P = 0.017) were strongly predictive of postoperative acute respiratory distress syndrome (ARDS). ARDS (4.51, P = 0.032) or respiratory failure (OR 8.7, P < 0.001), but not anastomotic leak (OR 2.22, P = 0.074), were independent risk factors for death. MIE (OR 0.11, P < 0.001) and thoracic epidural analgesia (OR 0.12, P = 0.003) decreased the risk of respiratory failure. Neoadjuvant treatment was not associated with an increased risk of pulmonary complications. Preoperative comorbidity and smoking were risk factors for respiratory complications, whereas neoadjuvant treatment was not. MIE and the use of thoracic epidural analgesia decreased the risk of respiratory failure. Respiratory failure and ARDS were the only independent factors associated with an increased risk of in-hospital death, whereas anastomotic leakage was not.
Publisher: Elsevier BV
Date: 11-1998
Abstract: Port Pirie is 230 km north of Adelaide, the capital of South Australia. The major industry in the city is a lead smelter owned by Pasminco. Fume, dust, and fugitive emissions from the smelter have been deposited in and around Port Pirie over the past 100 years. The results presented in this paper are from an air monitoring station situated at the southeast entrance of the smelter, approximately 600 m from the blast furnace. Measurements include total suspended particulate (TSP) and total suspended particulate lead (TSPL) reported as concentrations (microgram/m3). Data are available from 1986 to 1996 and consist of 548 measurements. Analysis of geometric mean concentration levels by wind direction showed that while for TSP there was little relationship with wind direction, TSPL increased substantially as the wind came from the direction of the smelter. An analysis of geometric mean concentration levels by wind speed showed that TSP was significantly correlated with wind speed for all wind sectors apart from winds coming from the smelter production area. The lack of correlation between TSP and wind speed when the wind blows from the direction of the smelter is probably due to the dilution effect of particulate from a point source as wind speed increases. TSPL was significantly correlated with wind speed for all wind sectors apart from winds coming from the city. As expected, both TSP and TSPL concentrations were significantly lower on days when rain fell. Both mean geometric TSP and TSPL concentrations were lower in the period 1993-1996 than in 1986-1992. Multiple linear regression analysis was used to demonstrate that this decline was statistically significant after adjusting for weather conditions. Wind directions were ided into four sectors: winds from the smelter production area winds from the smelter nonproduction area winds from the zinc wharf and east of the city and winds from the city. Structural equation models for each sector were used to demonstrate that the decline in geometric mean TSPL concentrations over the two periods were of a similar order of magnitude for all four sectors. The relevance of this to the lead abatement programs that have been undertaken both within the city of Port Pirie and inside the smelter itself is discussed.
Publisher: Wiley
Date: 05-2007
DOI: 10.1016/J.OTOHNS.2006.12.004
Abstract: To investigate and compare the prevalence of pharyngeal reflux (PR) events in normal controls and patients with clinically diagnosed reflux laryngitis. A systematic review of the literature was performed to identify all prospective studies on the results of 24‐hour double‐probe (pharyngeal and esophageal) pH monitoring in normal controls and in patients with symptoms and/or signs of reflux laryngitis. Eleven relevant studies on 192 normal controls and 13 studies on 512 patients with reflux laryngitis were identified. One or more PR events were detected in 51 normal controls (22.9% 95% CI, 13.9% to 33.3%) and in 154 of 422 patients (38.3% 95% CI, 25.4% to 52.1%). There is no significant difference in the prevalence of PR events between normal controls and patients with reflux laryngitis ( P = 0.079). In addition, the prevalence of PR events in patients with reflux laryngitis is much lower than reported in previous reviews on this subject. This systematic review calculated that (1) only a minority of patients with clinically diagnosed reflux laryngitis will show PR events, and (2) there is no significant difference between the prevalence of PR events in patients with reflux laryngitis and healthy controls. At the moment, there is no reliable means to confirm reflux of gastric juice in patients with suspected reflux laryngitis. This diagnostic vacuum is fundamental and may pose important questions at the current concept of reflux of gastric juice as a common cause of laryngopharyngeal inflammation.
Publisher: Informa UK Limited
Date: 1984
Publisher: Springer Science and Business Media LLC
Date: 04-2006
Publisher: Wiley
Date: 03-2015
DOI: 10.1111/IMJ.12680
Abstract: Few studies have specifically investigated treatment of prednisolone-induced hyperglycaemia. To determine if a basal bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease. In a cross-sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty-four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level. There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, P = 0.88), age (77 ± 11 vs 75 ± 14 years, P = 0.57), male sex (63 vs 60%, P = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m(2) , P = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, P < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, P < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, P < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67-0.70 vs 0.61-0.65 U/kg, P = 0.001) because of higher doses of ultra-rapid-acting insulin at 1200 h and 1700 h. Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone-induced hyperglycaemia are needed that recommend more insulin during this time period.
Publisher: Informa UK Limited
Date: 26-06-2019
DOI: 10.1080/01612840.2019.1609637
Abstract: A broad array of needs often arise for in iduals when significant physical or mental illness occurs. The aim of this study was to investigate the needs experienced by in iduals recovering from a first-episode of mental illness, to explore how these needs have been assessed and to gauge the acceptability of participating in formal, systematic needs assessments in the future. Fifteen in iduals who had presented to a tertiary mental health service within the previous 3 years, and who were considered to be recovering from a first-episode of mental illness discussed their current and previous needs in small focus groups. A qualitative descriptive methodology was adopted to analyse data. Three themes incorporating the broad range of inter-related and often complex needs were identified as being: the need for safety, stability and security the need to be understood and to understand and the need for support networks and services. Participants reported a lack of involvement in discussions with mental health clinicians regarding their needs, and were in favour of participating in formal, systematic needs assessments in the future.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.NEPR.2017.09.003
Abstract: This mixed-method study focused on new graduate nurses and their transition to practice. Transition to practice can be a time of heightened stress and anxiety, leaving many new graduates disillusioned and dissatisfied with their work. The study explored how satisfaction levels with transition may improve during their first year, using a unique approach of a continuous quality assurance feedback loop. This assurance framework is utilised in hospitality, automotive and supply chain logistics and in health, primarily to monitor patient outcomes. However, an association with graduate nurse satisfaction has not been previously reported. Graduate nurses from two health services completed a short survey questionnaire every four weeks for 12 months. De-identified aggregated data was sent to health service management, giving them an opportunity to integrate the findings with the objective of potentially increasing graduate satisfaction ratings. Quantitative findings showed no statistical significance of graduate nurse satisfaction scores between health services, however, one health service consistently outperformed the other. Qualitative findings drawn from a seminar and interviews confirmed that one health service took a more proactive stance with the monthly reports, communicating the results to ward managers. Outcomes reflected a greater commitment of support and an overall increase of satisfaction scores.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Cambridge University Press (CUP)
Date: 20-01-2009
DOI: 10.1017/S0022215109004514
Abstract: To investigate the differing opinions of patients and medical practitioners regarding the relative priorities of pain relief versus bleeding prevention following tonsillectomy. Questionnaires were mailed out to adult patients, paediatric patients' parents, general practitioners and ENT surgeons. A total of 72/112 (64.3 per cent) questionnaires were returned. Adult patients, paediatric patients' parents, general practitioners and ENT surgeons all ranked bleeding as the most important factor when assessing risks related to tonsillectomy. Most adult patients indicated that they would accept a bleeding risk of 2 per cent however, parents indicated that they would accept a higher bleeding risk (3 per cent) for their children in exchange for better pain control. Adult patients, paediatric patients' parents and doctors were slightly more inclined to ‘trade-off’ an increased post-tonsillectomy bleeding risk in exchange for better post-tonsillectomy pain control, although concerns about post-operative haemorrhage remained the main priority for all groups.
Publisher: Oxford University Press (OUP)
Date: 07-2007
DOI: 10.1111/J.1743-6109.2007.00536.X
Abstract: The South Australian Couples Sildenafil (SACS) study sought to look more closely at the role of sexual functioning in couples by exploring the impact of treatment for erectile dysfunction (ED) with sildenafil. The SACS study investigated the in idual and dyadic impact of the drug sildenafil (Viagra) on couples over a 6-month period. A range of outcome measures were utilized including the Dyadic Adjustment Scale (DAS), the International Index of Erectile Function (IIEF), and the Erectile Dysfunction Inventory of Treatment Satisfaction. Couples were recruited through the use of local media and general practitioners. Couples were randomly allocated to placebo or active drug with the option of using up to one study tablet per day for 6 months. Couples were reviewed at 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months. There were 108 couples who were eligible for the study with the eventual analysis including 49 couples in the active treatment group and 47 in the placebo group with similar demographic and background profiles found in both groups. A large number of psychosocial, quality-of-life, and sexual measures were recorded at the end of the trial for both male subjects and their female partners. Predictably, the erectile response in the active treatment group showed a significant improvement as measured by the IIEF although no change was found between the active and placebo groups in relationship functioning as measured by the DAS scores. The SACS study found no difference between treatment arms with regard to relationship functioning after the use of sildenafil for ED. Potential contributing factors to a "no change" result are discussed. The SACS study adds to the available literature on psychological and interpersonal factors in the treatment of ED which have not been sufficiently investigated until recently.
Publisher: Springer Science and Business Media LLC
Date: 13-10-2014
DOI: 10.1007/S00520-013-2004-3
Abstract: Prolonged neurotoxicity after systemic chemotherapy has the potential to impact on quality of life. We explored the frequency of persistent peripheral neuropathy in patients who received oxaliplatin for colorectal cancer at two local centres. Questionnaires were sent to patients who completed treatment with oxaliplatin for colorectal cancer at least 20 months prior to entering the study. Neuropathy questions were adapted from the FACT/GOG-Ntx (V.4) questionnaire. Of the 56 eligible patients, 27 returned the questionnaire. Twenty-five patients (93 %) experienced neuropathic symptoms during their treatment 11 had grade-2, and two had grade-3 symptoms. At the time of completing the questionnaire, 17 patients (63.0 % 95%CI 43.9-79.4 %) were still symptomatic with 12 patients (44.4 % 95%CI 26.8-63.3) having grade-2 or grade-3 symptoms and three patients (11.1 % 95%CI 2.9-27.3) having grade-3 neuropathic symptoms. Participants who received more than 900 mg/m2 oxaliplatin had a significantly higher risk of persistent grade-2 or grade-3 neuropathy (p = 0.031, RR = 8.3 95%CI = 1.2-57.4). There was a trend toward increased risk of persistent neuropathy of any grade among participants with a history of regular alcohol use (p = 0.051 RR = 1.7 95%CI 1.0-2.8). Persistent oxaliplatin-induced neuropathy is not as uncommon as previously suggested, and the rate of grade-2 and grade-3 symptoms could be considerably higher than previous reports.
Publisher: Wiley
Date: 15-02-2011
DOI: 10.1111/J.1365-2702.2010.03553.X
Abstract: Aims and objectives. The purpose of this study was to examine absconding behaviour (a patient leaving the hospital without permission) in acute and rehabilitation wards of one Australian psychiatric institution to describe the characteristics of the absconding patient and these events. Background. Absconding is a significant issue in psychiatric inpatient settings, with risks that include patient harm, aggression and violence. In spite of this, limited research has been conducted in Australia on patients who abscond while receiving psychiatric care. Design. The study was a retrospective descriptive analysis. Method. Absconding events from three acute and seven rehabilitation wards over a 12‐month period were studied. Results. The rate of absconding events by detained patients was 20·82%. Gender was not significantly associated with absconding, although 61·19% of those who absconded were men diagnosed with schizophrenic disorders. Over half of acute care patients who absconded left during their first 21‐day detention order. More than half of absconding events were by patients that absconded more than once. There was limited support for the efficacy of locking ward doors. Age and diagnosis emerged as particularly important factors to consider. Discussion. The study revealed that men are not more likely to abscond than women, that locking ward doors does not deter the determined absconders and that once a person has absconded, they are more likely to do so again. Younger patients and those with a schizophrenic disorder may be particularly likely to abscond. There also appears to be a link between continuing detention orders and an absconding event. Conclusions. Findings provide new data about the profile of absconding patients in Australia. Exploration of the reasons why patients abscond and why many do so repeatedly warrants further investigation. Relevance to clinical practice. Risk management approaches taking into account factors associated with absconding could be trialled to reduce the incidence of absconding in psychiatric inpatient settings.
Publisher: Oxford University Press (OUP)
Date: 13-06-2013
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-03-2016
DOI: 10.5664/JCSM.5568
Publisher: Wiley
Date: 06-07-2017
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.WOMBI.2015.04.003
Abstract: Alcohol consumption during pregnancy has the potential to cause significant harm to the foetus and the current Australian guidelines state that it is safest not to drink alcohol while pregnant. However, conflicting messages often appear in the media and it is unclear if the message to avoid alcohol is being effectively conveyed to pregnant women. This research aims to explore the advice that health professionals provide to pregnant women about alcohol consumption the knowledge of health professionals regarding the effects of alcohol consumption and their consistency with following the Australian guidelines. Ten semi-structured face to face interviews were conducted with health professionals who regularly provide antenatal care. These include midwives, obstetricians, and shared care general practitioners. A six-stage thematic analysis framework was used to analyse the interview data in a systematic way to ensure rigour and transparency. The analysis involved coding data extracts, followed by identifying the major themes. Health professionals displayed adequate knowledge that alcohol can cause physical and mental difficulties that are lifelong however, knowledge of the term FASD and the broad spectrum of difficulties associated with alcohol consumption during pregnancy was limited. Although health professionals were willing to discuss alcohol with pregnant women, many did not make this a routine part of practice, and several concerning judgements were noted. Communication between health professionals and pregnant women needs to be improved to ensure that accurate information about alcohol use in pregnancy is being provided. Further, it is important to ensure that the national guidelines are being supported by health professionals.
Publisher: Informa UK Limited
Date: 12-10-2022
DOI: 10.1080/02646838.2022.2134848
Abstract: This study examined the intra- and inter-rater reliability of the Recorded Interaction Task (RIT) a novel tool to assess mother-infant bonding via observational methods. Mother-infant bonding describes the reciprocal early emotional connection between mother and infant. Whilst various tools exist to assess mother-infant bonding, many incorrectly confuse this construct with mother-infant attachment. Further, available tools are limited to those that employ self-report methods, thus may reflect perceived behaviour, rather than actual behaviour. The RIT is a novel tool for observational assessment of mother-infant bonding. A standard interaction between mother and infant is recorded, and later assessed against specified bonding-related behaviours. Before its use in research, reliability testing must be undertaken to ensure the RIT may be used consistently. The RIT was administered to 15 mother-infant dyads. Participant recordings were assessed by three trained raters at two time points, using the RIT observation scoring sheet. Intra-rater reliability was determined by comparing scores at each time point for each rater. Inter-rater reliability was determined by assessing reliability of scores at the first time point. Strong intra-rater reliability (ICC >0.86) and fair inter-rater reliability (ICC = 0.55) were observed. The current findings support the RIT's potential to reliably assess mother-infant bonding.
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/6327180
Abstract: Background and Objective . We aimed to assess the validity of using the Global Lung Function Initiative’s (GLI) 2012 equations to interpret lung function data in a healthy workforce of South Australian Metropolitan Fire Service (SAMFS) personnel. Methods . Spirometry data from 212 healthy, nonsmoking SAMFS firefighters were collected and predicted normal values were calculated using both the GLI and local population derived (Gore) equations for forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), and FEV 1 /FVC. Two-tailed paired s le Student’s t -tests, Bland-Altman assessments of agreement, and z -scores were used to compare the two prediction methods. Results . The equations showed good agreement for mean predicted FEV 1 , FVC, and FEV 1 /FVC. Mean z -scores were similar for FEV 1 and FVC, although not FEV 1 /FVC, but greater than 0.5. Differences between the calculated lower limits of normal (LLN) were significant ( p 0.01 ), clinically meaningful, and resulted in an 8% difference in classification of abnormality using the FEV 1 /FVC ratio. Conclusions . The GLI equations predicted similar lung function as population-specific equations and resulted in a lower incidence of obstruction in this s le of healthy SAMFS firefighters. Further, interpretation of spirometry data as abnormal should be based on both an FEV 1 and FEV 1 /FVC ratio LLN.
Publisher: SAGE Publications
Date: 24-08-2023
DOI: 10.1177/14713012231181167
Abstract: This study was conducted to assess Vietnam’s dementia service delivery. Using WHO methodology, website searches of key organisations focused on three aspects of Vietnam’s healthcare system: (1) Health and social workforce (2) Services, supports and treatment programs and (3) Promotion of awareness and understanding. Data were analysed using content analysis. While key members of the healthcare workforce receive some education in dementia competencies during their training, the skill-mix of staff in the current workforce appears inadequate to address the complex needs of people with dementia. Although Vietnam’s general healthcare system comprises a good variety of service types, there is a lack of dementia-specific services. Available diagnosis and treatment services are concentrated in the hospital system and are mainly located in metropolitan areas, impacting their accessibility. While both community-based and institutional long-term care is available, institutional care is not universally accessible and home-based care is mainly provided by family carers who don’t have access to dementia care training. There is no active dementia prevention or public awareness c aign. To improve the ability of Vietnam’s service delivery to meet the needs of people with dementia and their carers, the skill-mix of the healthcare workforce should be strengthened by ensuring that dementia core competencies are embedded within undergraduate and graduate education programs and making post-qualification dementia care training available. The capacity of existing community-level health and social services should be expanded to ensure that integrated, specialised and comprehensive health and social services are accessible to all people with dementia. Expanding access to institutional long-term care and making dementia education available to family and other informal carers could increase choice and improve quality of care. Finally, Vietnam could look to other countries in the region with regards to the development of a dementia prevention and public awareness c aign.
Publisher: Wiley
Date: 2015
DOI: 10.1002/14651858
Publisher: SAGE Publications
Date: 04-09-2014
Abstract: Sonography is an effective, noninvasive, safe, and inexpensive technique for measurement of the liver. Measurements of the liver using 2D ultrasound aid in diagnosing and tracking liver disease and in surgical planning. Multiple studies have developed techniques to measure the adult liver using 2D ultrasound. The aim of this systematic literature review was to determine whether a correctly developed, reliable, and reproducible technique for measuring the liver using 2D ultrasound has been reported. Analysis of studies meeting the inclusion criteria showed that none of these studies has been rigorously undertaken in terms of s le size justification, validity, reliability, and/or statistical analysis.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.NEDT.2014.07.011
Abstract: Graduate nurse transition continues to remain a difficult time for many new graduate nurses, with significant numbers of graduates being dissatisfied, ultimately considering leaving or exiting the profession. Currently, many graduate nurse programs within Australia and internationally reflect a homogeneous nature pertaining to content and program delivery. A refinement of graduate nurse transition programs through an adaptation of a model of organisational socialisation supports a more in idualised approach to transition, improving graduate outcomes and addressing attrition rates. To propose a model which supports the accommodation of new graduates within a health service improving both new graduate and health service outcomes through greater levels of job satisfaction, increased commitment to an organisation and decreased turnover of new staff. Theoretical paper based on a program of research. An adaptation of a model of organisational socialisation was applied to the process of transition for newly qualified graduate nurses. This adaptation was informed by a larger 2012 Australian study (findings reported extensively elsewhere) with 459 newly qualified graduate nurses reporting their transition experiences of the first year of practice. Newly qualified graduate nurses reported effective socialisation with transition based on the following enduring and continuous orientation throughout the first year of practice, allocation of patient responsibilities reflecting a level of acuity commensurate with a beginning skill set to meet care needs, and feedback of a respectful nature to improve confidence and competence in practice. Negative transition experiences were noted by many new graduates if these factors were not considered. Graduate nurse turnover is costly and destabilising for health services. One means of addressing this is the creation of positive working environments which appropriately socialise new graduates into health services. Accommodating new employees through in idual recognition, modelling of behaviours and developing positive transition outcomes will improve graduate nurse satisfaction and importantly retention.
Publisher: SAGE Publications
Date: 09-2003
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.IJNURSTU.2014.12.002
Abstract: Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. Data were available for 136 patients (50% cancer 44% infection 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022 CI 1.445-122.788). It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research is needed to confirm these results as although adequately powered the number of cases of VTE was comparatively small, resulting in wide confidence intervals.
Publisher: Cambridge University Press (CUP)
Date: 12-1988
DOI: 10.1017/S0950268800029551
Abstract: Direct and indirect antigen capture enzyme immunoassays (Ag-EIA) have been developed for the detection of Mycoplasma pneumoniae in nasopharyngeal aspirates or sputum from respiratory infection. The sensitivity of the two Ag-EIA were similar, but the indirect method using polyclonal rabbit and guinea-pig antisera was more convenient. The Ag-EIA had a detection limit of 10 4–4·5 colony-forming units/ml of s le. It was specific for M. pneumoniae and gave a low level response with M. genitalium. There were no cross-reactions with 10 other species of mycoplasmas. Tests with a wide range of bacteria and chlamydia group antigen, representing agents sometimes found in the respiratory tract, were also negative. At the current level of development, the Ag-EIA detected about 90% of specimens that were also positive for culture 43% of specimens from culture-negative-seropositive patients gave a positive result. The overall pattern of results indicated that while antigen detection is a quick and effective substitute for the slow culture method, serological examination for specific IgM antibody is also necessary to give a complete diagnostic coverage.
Publisher: Wiley
Date: 02-02-2023
DOI: 10.1111/JJNS.12523
Abstract: This study explored the views of an international s le of registered nurses and midwives working in health and social care concerning socially assistive robots (SARs), and the relationship between dimensions of culture and rejection of the idea that SARs had benefits in these settings. An online survey was used to obtain rankings of (among other topics) the extent to which SARs have benefits for health and social care. It also asked for free text responses regarding any concerns about SARs. Most respondents were overwhelmingly positive about SARs' benefits. A small minority strongly rejected this idea, and qualitative analysis of the objections raised by them revealed three major themes: things might go wrong, depersonalization, and patient‐related concerns. However, many participants who were highly accepting of the benefits of SARs expressed similar objections. Cultural dimensions of long‐term orientation and uncertainty avoidance feature prominently in technology acceptance research. Therefore, the relationship between the proportion of respondents from each country who felt that SARs had no benefits and each country's ratings on long‐term orientation and uncertainty avoidance were also examined. A significant positive correlation was found for long‐term orientation, but not for uncertainty avoidance. Most respondents were positive about the benefits of SARs, and similar concerns about their use were expressed both by those who strongly accepted the idea that they had benefits and those who did not. Some evidence was found to suggest that cultural factors were related to rejecting the idea that SARs had benefits.
Publisher: Informa UK Limited
Date: 08-1986
DOI: 10.1080/00039896.1986.9938340
Abstract: This survey included 1,239 children, representing 50% of the elementary school population of the lead smelting town of Port Pirie. Of these children, 7% had a capillary blood lead level equal to or greater than 30 micrograms/dl, which is the Australian National Health and Medical Research Council's "level of concern." There was a statistically significant difference in capillary lead levels by area of residence that was independent of age, sex, soil lead, rainwater tank lead, and school attended. A case-control study indicated that the following subset of factors was most predictive of an elevated blood lead level: household members who worked with lead in their occupations living in a house with flaking paint on the outside walls biting finger nails eating lunch at home on school days when at school, appearing to have relatively dirty clothing when at school, appearing to have relatively dirty hands and living on a household block with a large area of exposed dirt. A program to reduce the risk of elevated blood lead levels in Port Pirie children has been introduced.
Publisher: MDPI AG
Date: 15-10-2017
Publisher: Informa UK Limited
Date: 03-2020
DOI: 10.2147/JPR.S254120
Publisher: Springer Science and Business Media LLC
Date: 03-10-2013
DOI: 10.1007/S00464-013-3204-0
Abstract: Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20-30% of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB. In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity. Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8% after 12 months of follow-up evaluation and 45.1% after 24 months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3% after 12 months and 57.2% after 24 months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8%/54.3% versus 64.1 % (p < 0.001 and <0.01) after 12 months and 45.1%/57.2% versus 70.4% (p < 0.001 and <0.002) after 24 months. Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.
Publisher: Wiley
Date: 07-2008
DOI: 10.1111/J.1445-5994.2007.01546.X
Abstract: The aim of this study was to estimate the effect of rheumatoid arthritis (RA) on the personal income of a cohort of in iduals with RA in Australia. A cross-sectional study of a s le of 497 working age people with RA in Adelaide, South Australia was carried out. The average personal income of an in idual with RA in our cohort in 2003-2004 was $A22 400 compared with the Australian mean annual income of $A38 000. When standardized, the income of our cohort was 66% that of the average income of the Australian population. Overall one-third of the RA cohort relied principally on the social security system for their income and more than 75% of the cohort estimated they had lost greater than $A10 000 per annum in personal income as a result of their disease. In iduals with RA who were not working had annual incomes on average of more than $A20 000 less than those who continued to work. The personal income loss associated with RA in Australia is of enormous significance. It reduces a large population of in iduals to relative financial poverty and potentially limits their access to a range of services including private health services.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2009
Abstract: A number of surveys have examined use of complementary and alternative medicines (CAM) in Australia. However, there are limited Australian data on use of CAM and over-the-counter (OTC) medicines in the elderly population. The main aims of this study were to examine self-medication practices with CAM and OTC medicines among older Australians and variables associated with their use. The Australian Longitudinal Study of Ageing (ALSA) is an ongoing multidisciplinary prospective study of the older population which commenced in 1992 in South Australia. Data collected in 4 waves of ALSA between 1992 and 2004 were used in this study with a baseline s le of 2087 adults aged 65 years and over, living in the community or residential aged care. OTC medicines were classified according to the World Health Organization Anatomical Therapeutic Chemical (ATC) classification. CAM were classified according a modified version of the classification adopted by the Therapeutics Goods Administration (TGA) in Australia. The prevalence of CAM or OTC use ranged from 17.7% in 2000-2001 to 35.5% in 2003-2004. The top classes of CAM and OTC medicines used remained relatively constant over the study period. The most frequent classes of CAM used were vitamins and minerals, herbal medicines and nutritional supplements while the most commonly used OTC were analgesics, laxatives and low dose aspirin. Females and those of younger age were more likely to be CAM users but no variable was associated with OTC use. Participants seemed to self-medicate in accordance with approved indications, suggesting they were informed consumers, actively looking after their own health. However, use of analgesics and aspirin are associated with an increased risk of adverse drug events in the elderly. Future work should examine how self-medication contributes to polypharmacy and increases the risk of adverse drug reactions.
Publisher: Springer Science and Business Media LLC
Date: 03-12-2008
DOI: 10.1007/S11605-008-0761-Y
Abstract: Different prediction models for operative mortality after esophagectomy have been developed. The aim of this study is to independently validate prediction models from Philadelphia, Rotterdam, Munich, and the ASA. The scores were validated using logistic regression models in two cohorts of patients undergoing esophagectomy for cancer from Switzerland (n = 170) and Australia (n = 176). All scores except ASA were significantly higher in the Australian cohort. There was no significant difference in 30-day mortality or in-hospital death between groups. The Philadelphia and Rotterdam scores had a significant predictive value for 30-day mortality (p = 0.001) and in-hospital death (p = 0.003) in the pooled cohort, but only the Philadelphia score had a significant prediction value for 30-day mortality in both cohorts. Neither score showed any predictive value for in-hospital death in Australians but were highly significant in the Swiss cohort. ASA showed only a significant predictive value for 30-day mortality in the Swiss. For in-hospital death, ASA was a significant predictor in the pooled and Swiss cohorts. The Munich score did not have any significant predictive value whatsoever. None of the scores can be applied generally. A better overall predictive score or specific prediction scores for each country should be developed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
DOI: 10.1161/CIRCOUTCOMES.111.000006
Abstract: We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance. The Young at Heart multicenter, randomized, controlled trial compared usual postdischarge care (UC) with nurse-led, home-based intervention (HBI). The primary end point was rate of all-cause hospital stay (31.5±7.5 months follow-up). In total, 602 patients (aged 70±10 years, 72% men) were randomized to UC (n=296) or HBI (n=306, 96% received ≥1 home visit). Overall, 42 patients (7.0%) died, and 492 patients (82%) accumulated 2397 all-cause hospitalizations associated with 10 258 hospital days costing $17 million. There were minimal group differences (HBI versus UC) in the primary end point of all-cause hospital stay (5405 versus 4853 days median [interquartile range], 0.08 [0.03–0.17] versus 0.07 [0.03–0.13] atient per month). There were similar trends with respect to all hospitalizations (1197 versus 1200 P =0.802) and associated costs ($8.66 versus $8.58 million P =0.375). At 2 years, however, more HBI versus UC (39% versus 27% odds ratio, 1.67 95% confidence interval, 1.15–2.41 P =0.007) patients were assessed as stable and optimally managed. For women, HBI outcomes were predominantly worse than UC outcomes. In men, HBI was associated with reduced risk of cardiovascular hospitalization (adjusted hazard ratio, 0.68 95% confidence interval, 0.46–0.99 P =0.044) with less cardiovascular hospitalizations (192 versus 269 P =0.054) and costs ($2.49 versus $3.53 million P =0.046). HBI did not reduce recurrent all-cause hospitalization compared with UC in privately insured cardiac patients overall. However, it did convey some benefits in cardiac outcomes for men. Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358. URL: www.anzctr.org.au/trial_view.aspx?id=82509 .
Publisher: AMPCo
Date: 07-2013
DOI: 10.5694/MJA13.10445
Abstract: To evaluate the impact of a fruit and vegetable subsidy program on short-term health outcomes of disadvantaged Aboriginal children. A before-and-after study involving clinical assessments, health record audits and blood testing of all children aged 0-17 2013s (n = 167) from 55 participating families at baseline and after 12 months at three Aboriginal community-controlled health services in New South Wales. All assessments were completed between December 2008 and September 2010. A weekly box of subsidised fruit and vegetables linked to preventive health services and nutrition promotion at an Aboriginal Medical Service. Change in episodes of illness, health service and emergency department attendances, antibiotic prescriptions and anthropometry. There was a significant decrease in oral antibiotics prescribed (- 0.5 prescriptions/2013 95% CI, - 0.8 to - 0.2) during 12 months of participation in the program compared with the 12 months before the program. The proportion of children classified as overweight or obese at baseline was 28.3% (38/134) and the proportion in each weight category did not change (P = 0.721) after 12 months. A small but significant increase in mean haemoglobin level (3.1 g/L 95% CI, 1.4-4.8 g/L) was shown, although the proportion with iron deficiency (baseline, 41% follow-up, 37% P = 0.440) and anaemia (baseline, 8% follow-up, 5% P = 0.453) did not change significantly. it and vegetable subsidy program was associated with improvements in some indicators of short-term health status among disadvantaged Aboriginal children. A controlled trial is warranted to investigate the sustainability and feasibility of healthy food subsidy programs in Australia.
Publisher: Cambridge University Press (CUP)
Date: 07-06-2013
DOI: 10.1017/S0007114513001700
Abstract: Healthy food subsidy programmes have not been widely implemented in high-income countries apart from the USA and the UK. There is, however, interest being expressed in the potential of healthy food subsidies to complement nutrition promotion initiatives and reduce the social disparities in healthy eating. Herein, we describe the impact of a fruit and vegetable (F& V) subsidy programme on the nutritional status of a cohort of disadvantaged Aboriginal children living in rural Australia. A before-and-after study was used to assess the nutritional impact in 174 children whose families received weekly boxes of subsidised F& V organised through three Aboriginal medical services. The nutritional impact was assessed by comparing 24 h dietary recalls and plasma carotenoid and vitamin C levels at baseline and after 12 months. A general linear model was used to assess the changes in biomarker levels and dietary intake, controlled for age, sex, community and baseline levels. Baseline assessment in 149 children showed low F& V consumption. Significant increases ( P 0·05) in β-cryptoxanthin (28·9 nmol/l, 18 %), vitamin C (10·1 μmol/l, 21 %) and lutein–zeaxanthin (39·3 nmol/l, 11 %) levels were observed at the 12-month follow-up in 115 children, although the self-reported F& V intake was unchanged. The improvements in the levels of biomarkers of F& V intake demonstrated in the present study are consistent with increased F& V intake. Such dietary improvements, if sustained, could reduce non-communicable disease rates. A controlled study of healthy food subsidies, together with an economic analysis, would facilitate a thorough assessment of the costs and benefits of subsidising healthy foods for disadvantaged Aboriginal Australians.
Publisher: Public Library of Science (PLoS)
Date: 21-08-2015
Publisher: Public Library of Science (PLoS)
Date: 17-11-2010
Publisher: PeerJ
Date: 10-07-2014
DOI: 10.7717/PEERJ.489
Publisher: Wiley
Date: 16-02-2011
DOI: 10.1002/PRI.465
Abstract: Non-specific low back pain (LBP) is a leading cause of disability in developed countries. Behavioural interventions have been found efficacious in reducing disability in LBP. Operant conditioning is one type of behavioural intervention being employed by physiotherapists however, the effectiveness of physiotherapist-provided operant conditioning (POC) in the management of LBP disability is unknown. This review aims to answer the question: is POC more effective than comparison interventions in reducing LBP disability? A systematic review of randomized controlled trials was conducted using a qualitative analysis of effect. Participants were adults ≥18 years with non-specific LBP. The intervention was defined as a time contingent, graduated increase in activity including goal setting and the education and reinforcement of positive pain behaviours with the aim of decreasing disability. The primary outcome measure was back pain specific disability. Secondary outcomes included generic functional status, pain intensity, sick leave, fear avoidance beliefs or behaviour and adverse effects. Fifteen trials involving 3737 people were included. Eight studies reported a clinically significant difference. The POC intervention was not found to be inferior to any of the comparison interventions in reducing disability. Moderate evidence was found that POC is more effective than other behavioural interventions in reducing long term disability in chronic LBP. Moderate evidence showed POC may be more effective than other treatments in reducing post-treatment fear avoidance beliefs in a sub-acute population but less effective in reducing short term fear avoidance beliefs in a population with mixed LBP. Moderate evidence showed POC is more effective than a placebo intervention in reducing short term pain in sub-acute LBP. POC may be considered efficacious in the treatment of LBP. Physiotherapists may also consider POC for its additional effect of reducing long term disability in chronic LBP.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2012
Publisher: JMIR Publications Inc.
Date: 11-2021
Abstract: nteractive, mixed-reality technologies such as augmented reality (AR), virtual reality (VR) and holographic technology may provide a novel, low-cost solution to fast-track the translation of evidence into practice and may help overcome barriers to both mental health and asthma management service uptake. he aim of this study was to investigate if mixed reality technology is an acceptable mechanism for the delivery of a component of CBT for the management of symptoms of elevated psychological distress among young people with asthma. o explore the perceived acceptability of these technologies, mixed reality tools were evaluated via qualitative, one-on-one interviews with young people with asthma and symptoms of psychological distress, parents/caregivers of young people with asthma and symptoms of psychological distress, and relevant health professionals. The Theoretical Framework of Acceptability (TFA) was used for deductive coding of recorded interview transcripts. hree young people with asthma and symptoms of psychological distress (2 female, mean age (years) = 14, SD= 1.73), four parents/caregivers of in iduals with asthma (1 female, mean age (years) = 55, SD= 14.58) and six health professionals (4 females, mean age = 40.8, SD= 4.32) consented to participate. Four constructs – experienced affective attitude, experienced effectiveness, self-efficacy and intervention coherence – were coded in all participant transcripts. The most frequently coded constructs were experienced affective attitude and intervention coherence both reported a total of 96 times, while the least frequently coded construct was anticipated opportunity cost reported a total of 5 times. Participants were mostly positive about the mixed reality resources. However, some concerns were raised regarding ethicality, particularly in relation to privacy, accessibility, and messaging. Participants noted the need for technology to be used in conjunction with face-to-face engagement with health professionals, and that some patients would respond to this type of delivery mechanism better than others. hese results suggest that mixed reality technology for the purposes of delivery of psychological intervention may be an acceptable addition to current healthcare practices for young people with asthma and symptoms of psychological distress. he study was prospectively registered with the Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620001109998.
Publisher: BMJ
Date: 02-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2006
Publisher: Wiley
Date: 20-05-2015
DOI: 10.1111/DAR.12152
Abstract: It is well established that alcohol can cross the placenta to the fetus and can affect both physical and psychological development of the infant however, many women continue to drink during pregnancy. It is therefore important to determine whether interventions can be successful in reducing alcohol consumption among pregnant women. Past reviews have investigated the effectiveness of clinical interventions in reducing alcohol consumption in pregnancy however, the aim of the current review was to focus on the effectiveness of public health interventions. A critical literature review was conducted by searching several electronic databases using key words such as 'pregnancy', 'alcohol', 'interventions' and 'public health'. Studies were included if they utilised a public health intervention and included alcohol consumption or levels of knowledge as an outcome measure. Seven studies were included in the review. Interventions included multimedia and educational interventions. Improvements in knowledge were reported in six studies, whereas one study found contradictory results. Four studies used alcohol consumption rates as an outcome measure, and although a reduction in consumption was reported, the results were non-significant. The effectiveness of public health interventions that aim to increase awareness and reduce alcohol consumption among pregnant women cannot be assessed because of the paucity of studies. The results of this critical review emphasise a lack of evidence and highlight the need for further evaluation research on this topic.
Publisher: Oxford University Press (OUP)
Date: 1986
Abstract: Pulmonary hypertension is a common but often overlooked complication associated with thalassemia syndromes. There are limited data on the safety and efficacy of selective pulmonary vasodilators in this at-risk population. We, therefore, designed a 12-week, open-label, phase 1/2, pilot-scale, proof-of-principle trial of sildenafil therapy in 10 patients with β-thalassemia and at increased risk of pulmonary hypertension based on an elevated tricuspid regurgitant jet velocity >2.5 m/s on Doppler-echocardiography. Variables compared at baseline and after 12 weeks of sildenafil treatment included Doppler-echocardiographic parameters, 6-minute walked distance, Borg Dyspnea Score, New York Heart Association functional class, pulmonary function, and laboratory parameters. Treatment with sildenafil resulted in a significant decrease in tricuspid regurgitant jet velocity by 13.3% (3.0±0.7 versus 2.6±0.5 m/s, P=0.04), improved left ventricular end systolic/diastolic volume, and a trend towards a improved New York Heart Association functional class. No significant change in 6-minute walked distance was noted. Sildenafil was well tolerated, although minor expected adverse events were commonly reported. The total dose of sildenafil (mg) was strongly correlated with percent change in nitric oxide metabolite concentration in the plasma (ρ=0.80, P=0.01). There were also significant increases in plasma and erythrocyte arginine concentrations. Our study suggests that sildenafil is safe and may improve pulmonary hemodynamics in patients at risk of pulmonary hypertension however, it was not demonstrated to improve the distance walked in 6 minutes. Clinical trials are needed to identify the best treatment strategy for pulmonary hypertension in patients with β-thalassemia. (clinicaltrials.gov identifier: NCT00872170).
Publisher: Briefland
Date: 10-09-2014
DOI: 10.5812/ASJSM.23072
Publisher: SAGE Publications
Date: 18-08-2019
Abstract: A functioning long-term vascular access is required for haemodialysis therapy however, establishing this can be challenging in the setting of advanced age and vessels damaged by diabetes. Complications include the inability to insert two needles for the treatment resulting in miscannulation trauma and in some cases insertion of a temporary central venous access device. The broad objective of this review is to define the evidence base regarding cannulation practices in the initiation of haemodialysis via an arteriovenous fistula or an arteriovenous graft. This review uses the framework recommended by the Joanna Briggs Institute and the process by which papers were included or excluded followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses group approach. A total of 20 primary research studies met the inclusion criteria. Cannulation in the 10- to 15-week period rather than delaying past this time frame is associated with the best outcomes. New vascular access given time to mature through single-needle haemodialysis treatments may improve long-term patency. Duplex ultrasound mapping prior to initiation of cannulation supports the clinical decision-making process on timing of and selection of cannulation sites. Cannulation trauma at the initiation of haemodialysis could potentially be reduced with a strategy of incremental haemodialysis using single-needle treatment supported with duplex ultrasonography assessment to ‘map’ the vascular access as a guide for clinicians prior to cannulation initiation.
Publisher: Springer Science and Business Media LLC
Date: 15-02-2013
Publisher: World Scientific Pub Co Pte Ltd
Date: 03-2012
DOI: 10.1142/S0218957712500091
Abstract: Relatively little has been published on the range of risk factors contributing to musculoskeletal injuries in ambulance officers. This study aims to identify perceived risk factors for back, neck and shoulder musculoskeletal injuries and claims in relation to working conditions, and the physical and psychological demands of the job. This was a cross-sectional study using an internet-based survey in an Australian ambulance service. The survey included demographic questions and questions on psychosocial factors related to the job and the way in which work is organized, musculoskeletal injuries sustained and claims submitted in the previous 12 months and two open ended questions on perceived risk factors for injury and injury risk mitigation strategies. Ambulance officers who felt they were able to take sufficient breaks were less likely to sustain a back, neck or shoulder musculoskeletal injury, and those who perceived their work required high levels of physical effort were more likely to submit a claim for these injuries. Two important perceived causal factors contributing to musculoskeletal injuries were the uncontrolled environment and non-adherence to manual handling techniques. However, suggested risk mitigation strategies of improving fitness and manual handling training, were not supported by the quantitative analysis.
Publisher: Wiley
Date: 07-07-2006
DOI: 10.1111/J.1445-5994.2006.01125.X
Abstract: The aim of this study was to determine the incidence, prevalence, survival and selective demographic characteristics of scleroderma occurring in South Australia over the 10-year period 1993-2002. Analysis of the database of the South Australian Scleroderma Register: a population-based register established in 1993. Patients with scleroderma resident in South Australia (n = 353 at 2002) were ascertained from multiple sources and clinical and demographic data were obtained from mailed questionnaire and from review of computerized hospital databases, case notes or referring letters. Time-space cluster analysis was carried out according to the Knox method. Control data were obtained from the Australian Bureau of Statistics census. The mean prevalence was 21.4 per 10(5) (95% confidence interval 20.2-22.6) and the mean cumulative incidence of 1.5 per 10(5) (95% confidence interval 1.32-1.73) with no significant change in incidence over the study period (P = 0.13). Cumulative survival improved over the study period, with patients with diffuse disease having significantly reduced survival (as compared with limited disease, P < 0.001). The proportion with diffuse disease ( approximately 22%) remained steady. There was a small but significant predisposition in patients with a continental European birthplace (P < 0.001). A family history of scleroderma was noted in 1.6% with lambda1 (familial risk) of 14.3 (95% confidence interval 5.9-34.5). However, a family history of systemic autoimmunity (especially rheumatoid arthritis) was more common (6%). No socioeconomic stratification, temporal clustering nor spatio-temporal clustering was observed either at time of initial symptom or at 10 years before disease onset. Scleroderma occurs relatively infrequently in South Australia with no significant change in incidence observed over the 10-year study period. However, cumulative survival has improved. Identified risk factors include family history of scleroderma (risk approximately 14-fold), female sex (risk approximately 5-fold) and European birthplace (risk approximately 2.5-fold) however, the majority of the disease variance appears unexplained. A stochastic explanation based on genetic instability is favoured to explain this paradox.
Publisher: Oxford University Press (OUP)
Date: 27-06-2003
Publisher: Springer Science and Business Media LLC
Date: 28-02-2017
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.COLEGN.2014.09.012
Abstract: This article presents findings from a scoping review that sought to highlight what is known about pre-registration paid employment practices of undergraduate nursing students. Researchers have identified large numbers of undergraduate nursing students engaging in paid employment. This review was prompted by our interest in the different employment choices that students make and whether these choices have any impact on transition to practice. A scoping review was designed to map the existing evidence base on undergraduate student nurse employment practices. Scoping reviews support the identification of a broad range of literature, which encompasses all types of study design. Utilising key search terms, databases searched included MEDLINE, CINAHL, Psych INFO, EMBASE, SCOPUS, SCIRUS, Joanna Briggs Institute, Web of Science, Informit Health and the Cochrane database. We utilised Arksey and O'Malley's five-stage approach: identifying the research question identifying relevant studies study selection charting the data and collating, summarising and reporting the results. Based on the research question, relevant literature was selected which was reported in accordance with Arksey and O'Malley's framework. The scoping review identified 40 articles that explored the nature of undergraduate student nurse paid employment activity. Highlighted themes included: reasons for engaging in paid employment specific paid employment models paid employment and academic performance, and paid employment choice and transition to graduate practice. The review highlighted a lack of studies detailing the relationship between paid employment and transition to graduate nurse practice, particularly those studies situated within the hospitality sector.
Publisher: Wiley
Date: 27-07-2021
DOI: 10.1002/SONO.12279
Abstract: Ultrasound is a safe and inexpensive way to image the adult liver. Recently a valid and reliable equation was developed to determine the size of the adult liver using three simple ultrasound measurements. An upper limit of normal using this equation of 2223 cm 3 has been reported. This study aimed to determine the sensitivity, specificity, and predictive values of this cut off to determine hepatomegaly. A low‐risk and a high‐risk group participant group were recruited, each with 30 participants. Each participant had a liver ultrasound and liver volume calculated from the equation and an MRI where liver volume was calculated. The ultrasound volume equation using a hepatomegaly cut off 2223 cm 3 , was compared to the reference standard of MRI volume using a hepatomegaly cut off of 2185 cm 3 as reported by Kromrey et al. The ultrasound demonstrated a sensitivity of 90.9% (CI 58.7–99.7), a specificity of 97.9% (CI 89.1–99.9), a positive predictive value of 90.9 (CI 58.7–98.6) and a negative predictive value of 97.9% (CI 88.1–99.7). Liver volume calculated by using three linear ultrasound measurements in an equation, and an upper limit of 2223 cm 3 , has high diagnostic accuracy to determine hepatomegaly.
Publisher: Informa UK Limited
Date: 14-06-2019
Publisher: Oxford University Press (OUP)
Date: 23-09-2017
Publisher: Public Library of Science (PLoS)
Date: 31-07-2017
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.CTCP.2014.08.002
Abstract: To investigate complementary and alternative medicine (CAM) use amongst a cohort of osteoarthritis (OA) sufferers and to explore reasons for use. A self-administered questionnaire was used to assess CAM use and its relationship with self-rated health status, patient knowledge of OA and attitudes towards OA management. Sixty-nine percent of respondents (95% CI, 64%-73%) reported that they had tried CAM, with little difference between age groups and genders. Patients who had a better knowledge of their condition and excellent self-rated health were more likely to use CAM. An aversion to the side effects of conventional medicine, failure to engage in exercise, and a belief in the efficacy of CAM were the principal factors underlying use. As CAM use is a key component of the self-management strategies for a substantial proportion of Australians with OA, users need to be more fully informed about evidence of efficacy.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2022
DOI: 10.1186/S40352-022-00185-7
Abstract: The lives of women experiencing incarceration are complex, impacting many aspects of parenting. Incarceration can present an opportunity for women to access parenting education. However, their specific needs have to be considered. Few parenting programs for women experiencing incarceration have involved the women as part of their development. Six focus groups were conducted in a prison setting involving thirty-one women to explore and understand their parenting education needs. Four main themes were identified to reflect the complex lives of the women and their parenting education needs. These themes were: working towards a positive self, communication as a lifeline, supporting and nurturing their children and hopefulness and reconnecting. The trauma women experienced in their lives was apparent during discussions. Women requested a non-judgmental parenting program to be developed to meet their specific needs and circumstances. The program needed to be designed to enable them to share stories with women in similar situations. Women gave insights into some of the specific content and topics they would like included in a parenting program. The women revealed experiences of trauma in their lives, demonstrating the importance of the need for a trauma informed approach to parenting education.
Publisher: Emerald
Date: 16-11-2015
Abstract: – The purpose of this paper is to test the effectiveness of a self-directed cognitive behavioural therapy (CBT) booklet allowing immediate access to treatment for anxiety during alcohol use disorder (AUD) interventions. – Parallel pilot randomised controlled trial: 69 in iduals in AUD treatment, continued to receive treatment alone (control: n =29) or in addition, a self-directed, four week CBT booklet to manage anxiety (intervention: n =40). Primary outcome measures were changes in state (SAnx) and trait anxiety (TAnx) at four weeks. Secondary outcome measures were changes in adaptive (ACop), maladaptive (MCop) coping and quality of life (QoL, physical (PHQoL), psychological (PSQoL), social (SQoL), environment (EQoL)) at four weeks. – Participants had significantly higher SAnx ( p 0.01) and TAnx ( p 0.01) baseline scores compared to the general population. There were no statistically significant group changes in SAnx or TAnx ( p 0.05). Control group allocation predicted improvement in ACop ( p 0.01), MCop ( p 0.05), PHQoL ( p 0.01), PSQoL ( p 0.05) and SQoL ( p 0.01) CBT group allocation predicted improvement in EQoL ( p =0.05). All effect sizes were small to moderate (Cohen’s d 0.50). Percentage of book completion did not determine changes in anxiety, coping or quality of life. – A four week self-directed CBT booklet did not significantly reduce anxiety during AUD treatment. Larger s le sizes will determine the most suitable treatment delivery mode for this type of CBT.
Publisher: Springer Science and Business Media LLC
Date: 27-07-2019
DOI: 10.1038/S41390-019-0506-5
Abstract: Non-contact heart rate (HR) and respiratory rate (RR) monitoring is necessary for preterm infants due to the potential for the adhesive electrodes of conventional electrocardiogram (ECG) to cause damage to the epidermis. This study was performed to evaluate the agreement between HR and RR measurements of preterm infants using a non-contact computer vision system with comparison to measurements obtained by the ECG. A single-centre, cross-sectional observational study was conducted in a Neonatal Unit. Ten infants and their ECG monitors were videoed using two Nikon cameras for 10 min. HR and RR measurements obtained from the non-contact system were extracted using advanced signal processing techniques and later compared to the ECG readings using Bland-Altman analysis. The non-contact system was able to detect an apnoea when the ECG determined movement as respirations. Although the mean bias between both methods was relatively low, the limits of agreement for HR were -8.3 to 17.4 beats per minute (b.p.m.) and for RR, -22 to 23.6 respirations per minute (r.p.m.). This study provides necessary data for improving algorithms to address confounding variables common to the neonatal population. Further studies investigating the robustness of the proposed system for premature infants are therefore required.
Publisher: Informa UK Limited
Date: 08-2016
DOI: 10.2147/JMDH.S110751
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.JPAINSYMMAN.2012.02.024
Abstract: Evidence-based approaches are needed to improve the delivery of specialized palliative care. The aim of this trial was to improve on current models of service provision. This 2×2×2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) in idualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of in iduals randomized to the case conferencing intervention received it based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P=0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P=0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P=0.0143 patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P=0.0206). Pain was unchanged. GP education did not change outcomes. A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective GP education was not effective.
Publisher: SAGE Publications
Date: 24-11-2011
DOI: 10.1111/J.1747-4949.2011.00686.X
Abstract: There is strong evidence for a dose–response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40–80 points or motor 38–62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction.
Publisher: SAGE Publications
Date: 06-2007
Abstract: Background: Orthoses for children with flexible excess pronation are estimated to cost Australian parents millions of dollars per year however, there is no high-level evidence that orthoses improve function or reduce pain. Methods: A randomized parallel, single-blinded, controlled trial of custom-made and ready-made orthoses was conducted in children between the ages of 7 and 11 years with bilateral flexible excess pronation. The diagnosis was based on calcaneal eversion and navicular drop. Outcomes included gross motor proficiency, self-perception, exercise efficiency, and pain. Measurements were taken at baseline, and at 3 and 12 months. Of the 178 children who participated at baseline, 160 continued to the end of the trial. Results: After randomization, baseline characteristics were similar between the three treatment groups (custom-made, ready-made, and control). Statistical modeling demonstrated that although for most outcome measures there were statistically significant trends over time, none of the group comparisons were statistically significant. A sub-group analysis of those presenting with pain found no significant differences at 3 or 12 months. Conclusions: This study found no evidence to justify the use of in-shoe orthoses in the management of flexible excess foot pronation in children.
Publisher: Wiley
Date: 19-09-2018
DOI: 10.1111/ADJ.12649
Abstract: The management of medical emergencies is widely considered a requisite skill for all dentists. Timely intervention of an emergency can significantly alter the outcome for a patient's morbidity and possible mortality. This scoping review examines the prevalence of medical emergencies in dental practice, as well as dentists' attitude, confidence, and competence, of medical emergency management within a dental setting. Key findings include a lack of preparedness towards medical emergencies, despite a universal recognition of the importance and desire to improve key medical skills.
Publisher: Wiley
Date: 05-07-2018
DOI: 10.1111/INM.12518
Abstract: Central to the role of mental health clinicians is the assessment of needs. A number of assessment tools have been used to evaluate the needs of in iduals diagnosed with a mental illness. These tools have largely been developed for people with a severe and persistent mental illness and may not be suitable for in iduals who are recovering from a first episode of mental illness. The aims of this review were therefore to identify the needs experienced by in iduals recovering from a first episode of mental illness determine what tools have been used to evaluate these needs and explore whether existing tools adequately reflect the needs described in the literature. Twenty-one articles were included, comprising articles which identified needs (n = 10), needs assessment tools (n = 1), or articles which identified both needs and a needs assessment tool (n = 10). Results indicate that in iduals who have been admitted to a specialized mental health unit and are recovering from a first episode of mental illness may experience an extensive range of needs, spanning emotional, psychological, social, informational, functional, practical, and relationship needs. Four established needs assessment tools were found to have been used to evaluate these needs however, these do not appear to represent all needs discovered in this review, were mostly developed for populations with a long-term mental illness, and may not be suitable for assessing the needs of in iduals recovering from a first episode of mental illness following a presentation to a specialized mental health unit.
Publisher: Springer Science and Business Media LLC
Date: 06-04-2004
Publisher: Informa UK Limited
Date: 28-03-2022
DOI: 10.1080/00207144.2022.2052297
Abstract: This study aimed to examine the potential feasibility of an online hypnotic intervention for women with persistent pelvic pain. The secondary aim was to explore the effect of the hypnosis intervention on anxiety, depression, pain severity, coping, pain catastrophizing, and pain disability in comparison to a no-intervention control. Twenty women with persistent pelvic pain completed assessment questionnaires and were recruited from a variety of social media sites related to persistent pelvic pain and randomized to either control or hypnotic intervention groups. The intervention group completed a 7-week online hypnotic intervention. Results found a 30% dropout rate and modest compliance (90%-40%) with practice of audio recordings. Comments from the 7 participants who completed the hypnosis intervention indicated it was acceptable. Significant reductions in screening measures of anxiety and depression were found however, there were no significant effects shown for pain severity, avoidant coping, pain catastrophizing, or pain disability. The intervention is potentially feasible, but further refinement and optimization is needed to increase retention, compliance, and potential effects.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
DOI: 10.1007/S10350-006-0815-8
Abstract: Health-related quality of life has become an important outcome in cancer treatment. Detailed health-related quality of life measures were taken as part of a trial of follow-up of patients with colon cancer by general practitioners and surgeons. This study was designed as a longitudinal assessment of health-related quality of life after treatment for carcinoma of the colon and patient satisfaction with two different settings of follow-up (general practitioners vs. surgeons). A total of 338 patients were recruited into randomized (n = 203) and patient preference (n = 135) follow-up groups. Prospectively assessed physical and mental health-related quality of life measures and patient satisfaction are reported during two years. Elderly and less educated patients prefer follow-up by general practitioners over surgeons. Overall, physical health-related quality of life is reduced early after treatment however, this returns to normal levels at one year. Mental quality of life, anxiety, and depression are at or above population levels throughout the two-year follow-up period. There were no differences in physical or psychologic health-related quality of life measures between general practitioner and surgeon groups at any time during follow-up. Overall, more advanced Dukes stage is associated with a trend to improved mental health-related quality of life. Patients' ability to choose the setting of follow-up has no influence on health-related quality of life compared with random allocation to general practitioner or surgeon. Patients are equally highly satisfied with follow-up by general practitioner or surgeon. After recovery from treatment for colon cancer, health-related quality of life is similar to the general population. Good health-related quality of life outcomes and high patient satisfaction are as well provided by general practitioners in the community setting as by surgeon review.
Publisher: Informa UK Limited
Date: 05-09-2018
Publisher: Springer Science and Business Media LLC
Date: 24-12-2013
DOI: 10.1007/S00268-013-2415-9
Abstract: Antireflux surgery is effective for the treatment of gastroesophageal reflux, but not all patients benefit equally from it. The challenge is to identify the patients who will ultimately benefit from antireflux surgery. The aim of this study was to identify preoperative factors that predict clinical outcome after antireflux surgery, with special interest in the influence of socioeconomic factors. Preoperative clinical and socioeconomic data from 1,650 patients who were to undergo laparoscopic fundoplication were collected prospectively. Clinical outcome measures (persistent heartburn, dysphagia, satisfaction) were assessed at short-term (1 year) and longer-term (≥ 3 years) follow-up. At early follow-up, male gender (relative risk [RR] 1.091, p < 0.001) and the presence of a hiatus hernia (RR 1.065, p = 0.002) were independently associated with less heartburn. Male gender was also associated with higher overall satisfaction (RR 1.046, p = 0.034). An association was found between postoperative dysphagia and age (RR 0.988, p = 0.007) and the absence of a hiatus hernia (RR 0.767, p = 0.001). At longer-term follow-up, only male gender (RR 1.125, p < 0.001) was an independent prognostic factor for heartburn control. Male gender (RR 0.761, p = 0.001), the presence of a hiatus hernia (RR 0.823, p = 0.014), and cerebrovascular comorbidities (RR 1.306, p = 0.019) were independent prognosticators for dysphagia at longer-term follow-up. A hiatus hernia was the only factor associated with better overall satisfaction. Socioeconomic factors did not influence any clinical outcomes at short- and longer-term follow-up. Male gender and hiatus hernia are associated with a better clinical outcome following laparoscopic fundoplication, whereas socioeconomic status does not influence outcome.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.DRUGALCDEP.2019.107595
Abstract: Illicit stimulant use is associated with long-lasting changes in movement and movement-related brain regions. The aim of our study was to investigate the prevalence of movement dysfunction in this population. We hypothesized that prevalence of self-reported movement dysfunction is higher among stimulant users than non-stimulant users. Three groups of adults completed a survey containing questions about demographics, health, drug use, and movement. The groups consisted of ecstasy users with no history of meth hetamine use (ecstasy group, n = 190, 20 ± 3 yrs.), meth hetamine users (meth hetamine group, n = 331, 23 ± 5 yrs.), and non-stimulant users (control group, n = 228, 25 ± 8 yrs.). Movement data was analyzed with logistic regression. In the unadjusted logistic regression model, group had a significant effect on fine hand control, tremor, and voice/speech questions, but not on other movement domain questions. The prevalence of tremor and abnormal fine hand control was significantly higher in the ecstasy and meth hetamine groups than in the control group (p < 0.018), and changes in voice/speech was more prevalent in the ecstasy group than in the control group (p = 0.015). Age and use of cannabis and hallucinogens were confounding variables. However, inspection of chi-square tables suggests that the effect of these parameters on the movement data is likely to be minor. The prevalence of self-reported tremor and changes in fine hand control and voice/speech is significantly higher in stimulant users than in non-stimulant users. Inclusion of these common and noticeable changes in body function may aid public health c aigns that target prevention or harm minimization.
Publisher: SLACK, Inc.
Date: 02-2015
DOI: 10.3928/1081597X-20150122-04
Abstract: To establish if average refractive overcorrection or undercorrection of corneal astigmatism based on the “rule” of the astigmatism occurs if toric intraocular lenses (IOLs) are calculated on the basis of anterior corneal measurements, and to calculate an adjustment for in idual eyes to avoid this systematic error. One hundred forty-three consecutive eyes of 115 patients underwent phacoemulsification with IOL powers calculated using anterior corneal curvature data alone. Eyes were grouped as either “with-the-rule” or “against-the-rule” on the basis of the steep anterior corneal meridian. Targeted versus achieved astigmatic outcomes were compared. Main outcome measure was residual refractive astigmatism following the insertion of a toric IOL due to the likely effect of posterior corneal astigmatism. Significant prediction errors in astigmatic outcome occurred only with IOL cylinders of 2 diopters or less. Overcorrection occurred by a factor of 1.38 in with-the-rule eyes and undercorrection occurred by a factor of 0.65 in against-the-rule eyes. A coefficient of adjustment of 0.75 for with-the-rule eyes and 1.41 for against-the-rule eyes can be applied to the corneal astigmatism power value to calculate a more appropriate IOL cylinder power than that calculated by using unadjusted anterior corneal curvature measurements. These adjustment coefficients apply only to those eyes that would have received IOLs with 2 diopters of cylinder or less and calculated with such unadjusted measurements. Greater IOL cylinder powers are sufficiently accurately calculated using unadjusted values. [ J Refract Surg . 2015 (2):98–102.]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/13814780600780627
Abstract: Cluster randomized trials occur when groups or clusters of in iduals, rather than the in iduals themselves, are randomized to intervention and control groups and outcomes are measured on in iduals within those clusters. Within primary care, between 1997 and 2000, there has been a virtual doubling in the number of published cluster randomized trials. A recent systematic review, specifically within primary care, found study quality to be both generally lower than that reported elsewhere and not to have shown any recent quality improvement. To discuss the design, conduct and analysis of cluster randomized trials within primary care in terms of the appropriate expertise required, potential bias, ethical considerations and expense. Compared with trials that involve the randomization of in idual participants, cluster randomized trials are more complex to design and analyse and, for a given s le size, have decreased power and a broadening of confidence intervals. Cluster randomized trials are specifically prone to potential bias at two levels-the cluster and in idual. Regarding the former, it is recommended that cluster allocation be undertaken by a party independent to the research team and careful consideration be given to ensure minimal cluster attrition. Bias at the in idual level can be overcome by identifying trial participants before randomization and at this time obtaining consent for intervention, data collection or both. A unique ethical aspect to cluster randomized trials is that cluster leaders may consent to the trial on behalf of potential cluster members. Additional costs of cluster randomized trials include the increased number of patients required, the complexity in their design and conduct and, usually, the need to recruit clusters de novo. Cluster randomized trials are a powerful and increasingly popular research tool. They are uniquely placed for the conduct of research within primary-care clusters where intracluster contamination can occur. Associated methodological issues are straightforward and surmountable and just need careful consideration and management.
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.PATHOL.2022.08.001
Abstract: Diagnosis and assessment of patients with prostate cancer is dependent on accurate interpretation and grading of histopathology. However, morphology does not necessarily reflect the complex biological changes occurring in prostate cancer disease progression, and current biomarkers have demonstrated limited clinical utility in patient assessment. This study aimed to develop biomarkers that accurately define prostate cancer biology by distinguishing specific pathological features that enable reliable interpretation of pathology for accurate Gleason grading of patients. Online gene expression databases were interrogated and a pathogenic pathway for prostate cancer was identified. The protein expression of key genes in the pathway, including adaptor protein containing a pleckstrin homology (PH) domain, phosphotyrosine-binding (PTB) domain, and leucine zipper motif 1 (Appl1), Sortilin and Syndecan-1, was examined by immunohistochemistry (IHC) in a pilot study of 29 patients with prostate cancer, using monoclonal antibodies designed against unique epitopes. Appl1, Sortilin, and Syndecan-1 expression was first assessed in a tissue microarray cohort of 112 patient s les, demonstrating that the monoclonal antibodies clearly illustrate gland morphologies. To determine the impact of a novel IHC-assisted interpretation (the utility of Appl1, Sortilin, and Syndecan-1 labelling as a panel) of Gleason grading, versus standard haematoxylin and eosin (H&E) Gleason grade assignment, a radical prostatectomy s le cohort comprising 114 patients was assessed. In comparison to H&E, the utility of the biomarker panel reduced subjectivity in interpretation of prostate cancer tissue morphology and improved the reliability of pathology assessment, resulting in Gleason grade redistribution for 41% of patient s les. Importantly, for equivocal IHC-assisted labelling and H&E staining results, the cancer morphology interpretation could be more accurately applied upon re-review of the H&E tissue sections. This study addresses a key issue in the field of prostate cancer pathology by presenting a novel combination of three biomarkers and has the potential to transform clinical pathology practice by standardising the interpretation of the tissue morphology.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.CTIM.2011.05.005
Abstract: Health consumers are increasingly using the Internet to access information about health care, to self-diagnose, and to purchase medication. The use of the Internet to purchase herbal products is of particular interest because of the high level of consumer expenditure on herbal medicines, and the misperception by some consumers that herbal products are natural, and thus absent of any contraindications, drug interactions and adverse effects. It is possible that consumers may purchase herbal medicines via the Internet without consulting health professionals and therefore, use these medicines in an unsafe manner. To examine the quality of e-commerce websites that sell herbal products specifically, websites where St. John's wort (Hypericum perforatum) can be purchased. Cross-sectional survey of 54 selected websites, including online pharmacies, online health food stores and manufacturers of herbal medicines. A modified version of the DISCERN instrument was used to assess the quality of websites. The majority of websites rated poorly with a concerning lack of information about the interaction between hypericum and warfarin, anti-depressants and oral contraceptives. Most sites also failed to provide sufficient information about the contraindications and adverse effects of hypericum treatment. The results of this study strongly support the need for improved consumer education about herbal medicine, as well as the application of more stringent standards to websites that sell medications.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2018
Publisher: Wiley
Date: 10-2011
DOI: 10.1111/J.1741-6612.2011.00530.X
Abstract: To identify and evaluate the management and care of older people with multiple chronic health problems (MCHP). Administrative health data from the Department of Veterans' Affairs and bio-social data from the Australian Longitudinal Study of Ageing are used to determine prevalence of MCHP, treatment patterns and patient outcomes. Focus groups and semistructured interviews are used to gain patient and health practitioner perspectives. The prevalence of MCHP in older people is high (65%) and is associated with increased use of health services, mortality and poorer self-rated health. Australian disease-specific guidelines fail to address MCHP, and treatment conflicts with the potential to cause harm, were common. Improvements in the care and management of older people with MCHP requires: a multifaceted approach, across the health-care system better coordination of holistic, patient-centred multidisciplinary care and effective communication and education of all stakeholders. The Health reform agenda in Australia provides an opportunity for change.
Publisher: Wiley
Date: 22-08-2013
DOI: 10.1111/J.1365-2648.2012.06123.X
Abstract: To identify predictors of successful transition from undergraduate student to registered nurse and to identify whether any particular pre-registration paid employment choice impacted on transition. Nursing students in Australia and internationally, engage in a variety of paid employment whilst completing their university studies. However, there is little empirical evidence about the different types of employment chosen by students and any relationship to graduate nurse transition. A descriptive questionnaire survey. This cross-sectional study was conducted with newly graduated nurses throughout Australia. The survey data were collected over 4 months in 2011, with 392 registered nurses completing a questionnaire. Respondents were categorized into four groups, according to their chosen work type (hospitality/retail, enrolled nurse, other healthcare worker, and non-worker) and transition scores were identified. Transition scores were significantly higher for undergraduates who were employed compared with non-workers. Postregistration institutional work factors appeared to be stronger predictors of successful transition than pre-registration employment factors. Assistance in dealing with complex patients, orientation to a new environment, and respect from colleagues were the best predictors for successful transition. Engaging in some form of paid employment in the final year of undergraduate university study is beneficial. However, it is not pre-registration employment choice per se that is the best predictor of successful transition, but the influence of work factors which new graduates experience in their first year of practice.
Publisher: Springer Science and Business Media LLC
Date: 30-09-2011
DOI: 10.1007/S10995-011-0889-3
Abstract: To identify pre-pregnancy risk factors for diabetes in pregnancy among a cohort of Australian Indigenous women. Data on 1,009 Indigenous women of childbearing age who participated in a 1998-2000 health screening program in far north Queensland were linked to Queensland hospitalisations data. Women who attended hospital after their health check for a pregnancy-related condition were identified. The data on women who were hospitalised for birth were also linked to Queensland perinatal data. Of 220 women who gave birth, 23 had diabetes in the pregnancy following their health check. A strong predictor of having a subsequent pregnancy affected by diabetes was suboptimal glucose control before conception. The presence of the metabolic syndrome predicted over a threefold increase in risk among non-diabetic women after adjustment for age and ethnicity (PR, 3.50 95% CI, 1.54-8.00). For each 1-cm increase in waist circumference, there was an age-adjusted increase in risk of 4% for diabetes in pregnancy (1.04 1.01-1.06). For each 1-mmHg increase in blood pressure (systolic and diastolic), there was an age-adjusted increase in risk of 3% (1.03 1.01-1.05 and 1.03 1.00-1.07, respectively). Associations between hypercholesterolaemia and dyslipidaemia and diabetes in the subsequent pregnancy were diminished after adjustment for age and ethnicity. The risk for women with "hyper-triglyceridaemic waist" phenotype before pregnancy was diminished by adjustment for age, ethnicity and baseline fasting glucose. Alcohol intake, smoking, level of physical activity and red cell folate showed little effect. Identification of women at particularly high risk for future diabetes in pregnancy, given their pre-pregnancy health, is important so that they can manage their risks and where overweight or obesity is a factor, interventions aimed at weight management should be implemented.
Publisher: No publisher found
Date: 1992
Publisher: American Thoracic Society
Date: 15-03-2009
Publisher: Informa UK Limited
Date: 07-2021
DOI: 10.2147/JMDH.S313109
Publisher: Hindawi Limited
Date: 2005
DOI: 10.1111/J.1365-2834.2004.00452.X
Abstract: This paper focuses on the changing nature of nurses' perceptions of their work. It examines the major sources of satisfaction and dissatisfaction experienced by nurses working at a major teaching hospital in May 2000. Coding categories reflected four components of nurses' work experiences: organizational, interpersonal, structural and professional. Organizational aspects of work were over-represented as sources of satisfaction and dissatisfaction and related to perceived changes in management philosophy (increasing productivity with limited resources). Study findings provide some clear goals for responsive, sensitive management.
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JSAMS.2012.09.005
Abstract: Australian Football (AF) is a collision sport containing high injury rates in junior competition. Successful performance at the elite junior level not only requires superior specific football knowledge and skills, but also well developed fitness qualities. However, no studies have examined the link between physical fitness qualities and injury in AF. Prospective cohort. Injury data were collected through the use of a Player Movement Record (PMR) and a standardized Injury Report Form (IRF). Fitness test data was collected during the pre-season of the 2010 and 2011 seasons. 382 players consented to participate in the study. The cohort experienced an injury incidence rate of 24.29/standardized club (40 players/club). A faster 5-m sprint was associated with 'injury status' (p=0.016) and a 'knee' region (p≤0.001) injury. A faster planned agility score was associated with an increased risk of a 'hip/groin/thigh' region (p=0.010) injury, and specifically a 'quadriceps strain' (p=0.005). A lower 20-m shuttle run was associated with an increased risk of a 'shin/ankle/foot' (p=0.045) injury. Increased injury severity was associated with a higher left foot running vertical jump (VJ) (p=0.040), and faster 5-m sprint (p=0.043). Lower aerobic endurance, faster 5-m acceleration and greater planned agility were associated with an increased risk of various injury types in elite junior AF players. Furthermore, a higher left foot running VJ and faster 5-m acceleration were associated with injury severity. These results may largely relate to a greater work capacity placing a higher load upon the musculoskeletal system in contact and non-contact situations.
Publisher: Elsevier BV
Date: 02-2006
DOI: 10.1016/J.CCT.2005.09.006
Abstract: The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005.
Publisher: Informa UK Limited
Date: 03-02-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2009
DOI: 10.1016/J.JCRS.2009.03.048
Abstract: To assess the astigmatic effect of biaxial microincision cataract surgery (MICS) with insertion of an UltraChoice 1.0 Rollable Thinlens intraocular lens (IOL) in a sufficiently powered controlled study. Queen Elizabeth Hospital, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, Australia. Consecutive patients having biaxial MICS were evaluated prospectively. Keratometry was performed preoperatively and postoperatively. Vector analysis of the alteration in the keratometric cylinder was compared with that in control eyes not having surgery but having keratometry over a similar time frame. There were 76 eyes in the surgical group and 74 in the control group. The right-hand incision used for IOL insertion had a mean external opening width of 2.00 mm and a mean internal width of 1.89 mm. The left-hand incision measured a mean of 1.49 mm and 1.46 mm, respectively. There was no statistically significant difference between the surgical group and the routine variability in keratometry in the untreated control group in surgically induced astigmatism (surgical group, 0.57 diopter [D] +/- 0.05 [SEM] control group, 0.54 +/- 0.06 D P =.660) or the degree of mean calculated flattening effect at the right-hand incision (0.01 +/- 0.06 D and -0.05 +/- 0.05 D, respectively P = .405) or at the left-hand incision (-0.06 +/- 0.05 D and 0.03 +/- 0.06 D, respectively P = .283). Biaxial MICS with insertion of IOL through a temporal incision of 2.0 mm offers prospects of astigmatic neutrality in cataract surgery.
Publisher: SAGE Publications
Date: 07-2006
DOI: 10.1191/1479972306CD112OA
Abstract: Studies in many countries have identified gaps between what is known from research evidence and what is done in clinical practice. Merely making research evidence available to practitioners does not cause much change in their behaviour, and researchers are now looking for more effective ways to improve the implementation of evidence. We report outcomes at three months of a parallel group trial of an evidence based patient manual designed to improve implementation of evidence by the patient’s doctors. The patient manual was produced with extensive patient and professional input. It contained summaries of the evidence for treatments used in COPD (chronic obstructive pulmonary disease) and prompted discussion of evidence with doctors. Participants in the intervention arm of the trial ( n - 125) were supplied with the manual and participants in the control arm ( n - 124) were supplied with a p hlet about COPD produced by the Australian Lung Foundation. The primary outcome measure (rates of current influenza vaccination and bone density testing) was an indicator of evidence based management of COPD. Secondary outcomes were quality of life (mastery component), satisfaction with information, communication with usual doctor, and anxiety. At three months no pattern of benefit in outcome measures was found for either group. Process measures showed high levels of personal use of the manual but progression to conversations with doctors for fewer than half of participants, and little treatment change. The findings highlight the difficulties of promoting changes in health behaviour and show that even when all stakeholders are consulted success is not guaranteed. Further research is required to identify those patients most likely to use manuals such as the one reported here, and how to make patient mediated interventions more effective for a greater proportion of the target population.
Publisher: JMIR Publications Inc.
Date: 13-08-2020
DOI: 10.2196/18992
Abstract: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated. This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal the authors acknowledge the ersity within Aboriginal cultures. This study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed. A scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government. The scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women’s voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study. PRR1-10.2196/18992
Publisher: Elsevier BV
Date: 09-1991
DOI: 10.1016/0167-5273(91)90300-E
Abstract: We prospectively studied 69 consecutive patients hospitalized with a primary diagnosis of acute left ventricular failure so as to assess the impact of vasodilators on incidence and morbidity of acute symptomatic left ventricular failure. The determinants of duration of hospitalization, in-hospital mortality and symptomatic status 2 months after discharge were examined. There were 9 in-hospital deaths (13%), and survival at 60 days was 77%. Median duration of hospitalization was 9 days, and 33% of the surviving patients remained in New York Heart Association functional class III-IV 60 days subsequent to discharge. Of the patients, 49 (76%) had previously received treatment for left ventricular failure: 30 (61%) of these had received vasodilators, most commonly angiotensin converting enzyme inhibitors and nitrates. Ischaemic chest pain was present in 34 (49%) of the patients. Acute utilization of vasodilators (45% of patients) was largely limited to nitrate therapy associated with ischaemic chest pain (P less than 0.01). Multiple logistic regression revealed previous left ventricular failure, advanced age and hypokalaemia as significant correlates of prolonged hospitalization (greater than 9 days). Previous left ventricular failure was also predictive of persistent severe disability two months subsequent to discharge. No factor was a significant predictor of in-hospital death. Although preceding treatment with digoxin and incremental angiotensin converting enzyme inhibitor therapy tended to predict brief hospitalization, the parameter of acute ischaemia, other biochemical anomalies and modes of acute or chronic therapy were not significant correlates of any end point. We conclude that preceding disability, rather than mode of treatment, predicts an adverse outcome in acute left ventricular failure.
Publisher: World Scientific Pub Co Pte Ltd
Date: 03-2011
DOI: 10.1142/S0218957711500023
Abstract: This study aims to determine whether pre-employment medical, physical or psychological assessments can predict future back, neck and shoulder musculoskeletal injuries and claims in an Australian ambulance service. This was a retrospective observational study based on linked datasets. Poisson regression analysis was undertaken to determine which pre-employment personality traits, using the Fifteen Factor Questionnaire and 36 medical and functional capacity evaluation variables, predicted the number of injuries and claims in ambulance officers. Ambulance officers who at pre-employment assessment demonstrated more conceptual, intuitive and anxious personality traits, and those ambulance officers who had hypermobile joints, self-limited weights lifted, played less sport or exercised less, were more likely to sustain future back, neck or shoulder musculoskeletal injuries or submit workers compensation claims. In idual pre-employment risk factors were found to predict musculoskeletal injuries and claims in a cohort of ambulance officers. Anxious as opposed to stable personality types and conceptual rather than practical personality types appear to be at greater risk of an injury or submitting a claim, as were recruits with hypermobile joints. Identification of in idual risk factors at recruitment may assist in the selection of suitable applicants into the ambulance service as well as providing a focus for career counseling where relevant.
Publisher: Wiley
Date: 11-08-2003
DOI: 10.1046/J.1440-1673.2003.01179.X
Abstract: Although radiological evaluation plays an integral role in the management of oncology patients, little is known about which elements of such evaluation are most important or about how satisfied clinicians are with the quality of radiology services in cancer patients. We have developed a 36-item anonymous survey evaluating availability of and satisfaction with radiology services to medical oncologists. The survey was distributed to members of the Medical Oncology Group of Australia resident in Australia. We received 124 responses (51%). Most respondents (76.9%) were satisfied with their radiology services. Satisfaction correlated closely with the availability of standardized reporting and promptness of reporting (P < 0.001). Oncologists in private practise were more likely to receive prompt reports (P < 0.0001). Oncologists in public practice were more concerned about availability of CT scanning (P = 0.02). Services that were reported as less frequently available, despite being ranked as very important, included measurements of key lesions and comparison to previous studies. Standardized reporting was considered helpful by 91% of respondents. Only 32.5% of respondents reported receiving such a summary in more than 50% of cases and 21% never received such a summary. Our findings highlight the need for closer collaboration between oncologists and radiologists in order to address specific needs and develop optimal patterns of practise. Consideration should be given to standardization of reporting of radiology studies in oncology.
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.NEDT.2013.06.024
Abstract: The process of transition for newly qualified registered nurses in their first year of practice remains a difficult and onerous proposition. Aside from well-documented issues pertaining to orientation, preceptorship, appropriate patient allocation, indifferent communication and feedback from senior nursing staff, other influences can determine how new graduates adjust to the role of beginning registered nurse. The dataset from a large Australian study, that examined the impact of pre-registration paid employment on graduate nurse transition, contained a significant amount of data that indicated that undergraduate work choice might influence how senior colleagues view graduate nurses during their transition to registered nurse practice. Although this issue was beyond the scope of the original study, the volume of data and recurrence of this issue provided a strong rationale for further exploration. A secondary study was designed to explore the research question does previous undergraduate work choice influence how graduate nurses are viewed by senior colleagues during their transition to registered nurse? Using secondary analysis, and an interpretive descriptive approach, two qualitative data sets arising from focus groups and open ended questionnaire responses were analysed and three organising themes identified drawing on prior learning, the burden of employment choice and outside the setting. The global theme "confidence and perceptions" describes graduate nurses' views about their prior paid employment choice being beneficial to them and perceived to assist them in the process of transition. Findings suggest that depending on the choice of prior paid employment, new graduates (particularly those who were formerly enrolled or second level nurses) are treated differently by their senior colleagues in terms of the level of support offered in transition, whether prior skills and experiences from previous paid employment are acknowledged, made light of or dismissed. For successful transition to registered nurse practice it is recommended that senior nursing staff treat each new graduate equally, not based on prior paid employment experiences, and that all new graduates regardless of their prior work experiences require a period of adjustment to their new role.
Publisher: Association for Vascular Access
Date: 09-2016
DOI: 10.1016/J.JAVA.2016.02.002
Abstract: Background: The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used for peripherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certain vein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veins available to determine the most optimal vessel to introduce a catheter. It is important that clinicians have an understanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominance on vein size to determine whether their clinical practice is appropriate. Methods: A scoping review of published literature was performed to determine existing knowledge regarding the diameters of veins used for PICC insertion and the influence of patient factors such as hand dominance and laterality (left or right arm) on vein size. Results: There was limited published research about the diameters of the basilic, brachial, and cephalic veins at the midupper arm, with only 6 studies identified. Three of the 6 selected articles focused on vein diameter measurement to inform arteriovenous fistula development. Only 1 study included participants undergoing PICC insertion. Scant research examined the effect of laterality on vein diameter and 1 study was identified that reported the influence of hand dominance or vein type on the diameter of veins used for PICC insertion. Conclusions: This review found that there is a paucity of studies that have examined the veins used for PICC insertion. Nevertheless, it appears that the basilic vein has the largest diameter (with smaller brachial and cephalic veins), although this is not always the case. Laterality and hand dominance does not seem to influence vein diameter. Further research about the vasculature used for PICC insertion is needed to inform clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 12-2013
DOI: 10.1186/1471-2458-13-1212
Abstract: Diabetes mellitus is an increasingly prevalent metabolic disorder that is associated with substantial disease burden. Australia has an opportunity to improve ways of caring for the growing number of people with diabetes, but this may require changes to the way care is funded, organised and delivered. To inform how best to care for people with diabetes, and to identify the extent of change that is required to achieve this, the Diabetes Care Project (DCP) will evaluate the impact of two different, evidence-based models of care (compared to usual care) on clinical quality, patient and provider experience, and cost. The DCP uses a pragmatic, cluster randomised controlled trial design. Accredited general practices that are situated within any of the seven Australian Medicare Locals/Divisions of General Practice that have agreed to take part in the study were invited to participate. Consenting practices will be randomly assigned to one of three treatment groups for approximately 18 to 22 months: (a) control group (usual care) (b) Intervention 1 (which tests improvements that could be made within the current funding model, facilitated through the use of an online chronic disease management network) or (c) Intervention 2 (which includes the same components as Intervention 1, as well as altered funding to support voluntary patient registration with their practice, incentive payments and a care facilitator). Adult patients who attend the enrolled practices and have established (≥12 month’s duration) type 1 diabetes mellitus or newly diagnosed or established type 2 diabetes mellitus are invited to participate. Multiple outcomes will be studied, including changes in glycosylated haemoglobin (primary outcome), changes in other biochemical and clinical metrics, incidence of diabetes-related complications, quality of life, clinical depression, success of tailored care, patient and practitioner satisfaction, and budget sustainability. This project responds to a need for robust evidence of the clinical and economic effectiveness of coordinated care for the management of diabetes in the Australian primary care setting. The outcomes of the study will have implications not only for diabetes management, but also for the management of other chronic diseases, both in Australia and overseas. Australian New Zealand Clinical Trials Registry ( ACTRN12612000363886 ) World Health Organisation (U1111-1128-0481).
Publisher: Springer Science and Business Media LLC
Date: 05-08-2011
DOI: 10.1038/EYE.2011.182
Publisher: Springer Science and Business Media LLC
Date: 10-05-2014
DOI: 10.1007/S40279-014-0178-6
Abstract: Studies have demonstrated that longer-term heat acclimation training (≥8 heat exposures) improves physical performance. The physiological adaptations gained through short-term heat acclimation (STHA) training suggest that physical performance can be enhanced within a brief timeframe. The aim of this systematic review was to determine if STHA training (≤7 heat exposures) can improve physical performance in healthy adults. MEDLINE, PubMed, and SPORTDiscus™ databases were searched for available literature. Studies were included if they met the following criteria: STHA intervention, performance measure outcome, apparently healthy participants, adult participants (≥18 years of age), primary data, and human participants. A modified McMaster critical appraisal tool determined the level of bias in each included study. Eight papers met the inclusion criteria. Studies varied from having a low to a high risk of bias. The review identified aerobic-based tests of performance benefit from STHA training. Peak anaerobic power efforts have not been demonstrated to improve. At the review level, this systematic review did not include tolerance time exercise tests however, certain professions may be interested in this type of exercise (e.g. fire-fighters). At the outcome level, the review was limited by the moderate level of bias that exists in the field. Only two randomized controlled trials were included. Furthermore, a limited number of studies could be identified (eight), and only one of these articles focused on women participants. The review identified that aerobic-based tests of performance benefit from STHA training. This is possibly through a number of cardiovascular, thermoregulatory, and metabolic adaptations improving the perception of effort and fatigue through a reduction in anaerobic energy release and elevation of the anaerobic threshold. These results should be viewed with caution due to the level of available evidence, and the limited number of papers that met the inclusion criteria of the review. STHA training can be applied in the team-sport environment during a range of instances within the competitive season. A mixed high-intensity protocol may only require five sessions with a duration of 60 min to potentially improve aerobic-based performance in trained athletes.
Publisher: Wiley
Date: 02-2016
DOI: 10.1111/IMJ.12949
Abstract: Using Australian guidelines for management of acute coronary syndromes, we assessed the probability of an Indigenous patient receiving interventional and therapeutic care after presenting in two metropolitan hospitals. A retrospective case note review of patients admitted through two Adelaide public tertiary hospital emergency departments from December 2007 to December 2009. The study cohort was 488 patients with high-risk clinical features without ST-segment elevation. Indigenous patients were significantly younger, present later in the disease process and have a higher burden of cardiovascular risk factors when compared with non-Indigenous patients. Indigenous patients were 54% more likely to receive angiography (Risk ratios (RR) = 1.54 95% CI 1.31 1.81) than non-Indigenous patients, however, this difference disappeared after adjustment for age, sex and propensity score. Indigenous patients were 20% more likely to receive the recommended medications (RR = 1.19, 95% CI 1.01 1.40) compared with non-Indigenous patients. Patients over 65 years were 53% less likely to receive an angiogram (RR = 0.47, 95% CI 0.38 0.56) and were 35% less likely to receive the recommended medications (RR = 0.65, 95% CI 0.54 0.78) than a patient at the ages of 18-49. Women were almost 20% less likely to receive an angiogram (RR = 0.81, 95% CI 0.66 0.99) and 20% less likely to receive the recommended medications (RR = 0.80, 95% CI 0.71 0.91) when compared with men. The likelihood of receiving medications on discharge was significantly influenced by age, gender, ethnicity, comorbid burden and revascularisation. The younger age and significantly higher-risk profile of Indigenous adults presenting to SA hospitals with acute coronary syndromes appears to lead to different management decisions, which may well be led by patient factors. Many of these risk conditions can be better managed in the primary care setting.
Publisher: Springer Science and Business Media LLC
Date: 05-02-2016
DOI: 10.1007/S10552-015-0710-5
Abstract: Cancer of the esophagus is a highly lethal disease with many patients presenting with metastatic spread of their tumor at diagnosis a consequence of this late presentation is the 5-year survival rate of <20 %. Barrett's esophagus (BE), a premalignant condition of the distal esophagus, is the main risk factor for adenocarcinoma of the esophagus. The development of a risk prediction tool that could assist healthcare professionals in identifying people at increased risk of developing BE would be advantageous. Understanding the factors that influence the risk of developing BE is the first stage of developing a risk prediction tool. A scoping review was undertaken to address the following question 'what factors influence the risk of developing Barrett's esophagus?' Forty-six articles were included in this review. The majority of articles reviewed were case-control or cohort studies. S les sizes ranged from 68 to 84,606. Risk factors reported to be statistically significant were ided into three categories: demographic, lifestyle and clinical factors. Strongest risk factors identified include: male gender, increasing age, white race, smoking, obesity and gastro-esophageal reflux disease symptoms, while some aspects of a person's diet appear to act as a protective measure. Risk factors for BE are complex and need to be considered by healthcare professionals when identifying patients that could benefit from endoscopic eradication. These results provide a stepping stone for the future development of a risk prediction model.
Publisher: Springer Science and Business Media LLC
Date: 08-10-2012
Publisher: Association for Vascular Access
Date: 12-2013
DOI: 10.1016/J.JAVA.2013.08.001
Abstract: Background: Peripherally inserted central catheters (PICCs) are increasingly inserted by trained registered nurses, necessitating the development of specialized skills such as the use of ultrasound. The selection of an adequately sized vein is an important factor in reducing adverse events such as deep vein thrombosis. However, PICC nurses may receive minimal training in the use of ultrasound for vein measurement. Objective: We aimed to demonstrate the reliability of a vein measurement protocol using ultrasound by a PICC nurse trained in sonography. Methods: The diameter of the basilic, brachial, and cephalic veins in the left arms of healthy participants (n =12) were measured using ultrasound by a PICC nurse and a sonographer. A PICC nurse performed the measurement twice and the sonographer once the PICC nurse's results were compared for intra-rater reliability and compared with the sonographer for inter-rater reliability. The results were analyzed using intraclass correlation coefficients (ICCs). Results: Inter-rater reliability between the PICC nurse and the sonographer was adequate, the ICC for the brachial vein was 0.60 (95% confidence interval [CI], 0.06–0.87), basilic vein ICC was 0.87 (95% CI, 0.58–0.96) and cephalic vein ICC was 0.77 (95% CI, 0.39–0.93). Intra-rater reliability of the PICC nurse was higher the ICC for the brachial vein was 0.80 (95% CI, 0.44–0.94), basilic vein ICC was 0.92 (95% CI, 0.67–0.98), and cephalic vein ICC was 0.78 (95% CI, 0.40–0.93). Conclusions: Using a suitable protocol, a PICC nurse was able to measure vein diameter reliably when compared with a sonographer and consistently replicate these results.
Publisher: Informa UK Limited
Date: 12-2018
DOI: 10.2147/JPR.S179409
Publisher: AMPCo
Date: 2016
DOI: 10.5694/MJA15.00739
Abstract: To determine whether certain characteristics of general practices are associated with good glycaemic control in patients with diabetes and with completing an annual cycle of care (ACC). Our cross-sectional analysis used baseline data from the Australian Diabetes Care Project conducted between 2011 and 2014. Practice characteristics were self-reported. Characteristics of the patients that were assessed included glycaemic control (HbA1c level ≤ 53 mmol/mol), age, sex, duration of diabetes, socio-economic disadvantage (SEIFA) score, the complexity of the patient's condition, and whether the patient had completed an ACC for diabetes in the past 18 months. Clustered logistic regression was used to establish predictors of glycaemic control and a completed ACC. Data were available from 147 general practices and 5455 patients with established type 1 or type 2 diabetes in three Australian states. After adjustment for other patient characteristics, only the patient completing an ACC was statistically significant as a predictor of glycaemic control (P = 0.011). In a multivariate model, the practice having a chronic disease-focused practice nurse (P = 0.036) and running educational events for patients with diabetes (P = 0.004) were statistically significant predictors of the patient having complete an ACC. Patient characteristics are moderately good predictors of whether the patient is in glycaemic control, whereas practice characteristics appear to predict only the likelihood of patients completing an ACC. The ACC is an established indicator of good diabetes management. This is the first study to report a positive association between having completed an ACC and the patient being in glycaemic control.
Publisher: AMPCo
Date: 03-2012
DOI: 10.5694/MJA11.10853
Abstract: To determine if the improvement in inpatient glycaemic control observed with basal-bolus insulin (BBI) over sliding-scale insulin (SSI) in the formal study setting translates to routine clinical conditions. Cross-sectional study in which capillary blood glucose levels (BGLs) were prospectively measured four times daily for up to 8 days in 124 patients with type 2 diabetes admitted to a tertiary teaching hospital and treated with BBI between November 2008 and May 2010. Data from the BBI treatment group were compared with retrospective data from 96 patients treated with SSI between June 2001 and May 2006. Mean daily BGL independent effect of insulin regimen on mean daily BGL. Mean baseline BGL was not significantly different in patients receiving BBI and SSI (mean ± SD, 11.3 ± 4.1 v 10.6 ± 4.3 mmol/L P = 0.23). After the first full day of therapy, mean daily BGL for patients receiving BBI was 1.6 ± 3.7 mmol/L lower than baseline BGL, and it remained 1.6-2.4 mmol/L lower than baseline throughout the study (P < 0.001). In contrast, there was no significant change in BGL for patients receiving SSI. Random effects regression analysis indicated that BBI was associated with a significantly lower mean daily BGL than SSI, independent of other variables (P < 0.001). The incidence of hypoglycaemia (BGL < 4 mmol/L) was significantly greater in patients receiving BBI than SSI (3.3% v 1.4% P < 0.001), but there was no significant difference for severe hypoglycaemia (BGL < 2.8 mmol/L) (0.3 v 0.5% P = 0.3). Under routine clinical conditions, BBI is effective and safe across a range of patients and appears to be superior to SSI. Clinical improvements reflected those seen in a strict formal study setting.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15079
Abstract: Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. This study sought to explore general practitioner (GP) attitudes towards CPGs, in general and specifically for osteoarthritis (OA), with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 with a s le of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision-making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that in idual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly ided among respondents for short, 2–3-page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor, with most respondents either not aware of it (30% 95% confidence interval (CI) 27 – 41%), had never used it (19% 95% CI 12 – 29%) or rarely used it (34% 95% CI 25–45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use.
Publisher: Cambridge University Press (CUP)
Date: 28-01-2010
DOI: 10.1017/S1041610209991554
Abstract: Background: Depression is one of the leading contributors to the burden of non-fatal diseases in Australia. Although there is an overall increasing trend in antidepressant use, the relationship between use of antidepressants and depressive symptomatology is not clear, particularly in the older population. Methods: Data for this study were obtained from the Australian Longitudinal Study of Ageing (ALSA), a cohort of 2087 people aged over 65 years at baseline. Four waves of home interviews were conducted between 1992 and 2004 to collect information on sociodemographic and health status. Depressive symptoms were measured by the Center for Epidemiologic Studies – Depression Scale. Use of antidepressants was based on self-report, with the interviewer able to check packaging details if available. Longitudinal analysis was performed using logistic generalized estimating equations to detect if there was any trend in the use of antidepressants, adjusting for potential confounding factors. Results: The prevalence of depressive symptoms was 15.2% in 1992 and 15.8% in 2004 ( p 0.05). The prevalence of antidepressant users increased from 6.5% to 10.9% ( p 0.01) over this period. Among people with depressive symptoms, less than 20% were taking antidepressants at any wave. Among people without depressive symptoms, the prevalence of antidepressant use was 5.2% in 1992 and 12.0% in 2004 ( p 0.01). Being female (OR = 1.67, 95%CI: 1.25–2.24), having poor self-perceived health status (OR = 1.17, 95%CI: 1.04–1.32), having physical impairment (OR = 1.48, 95%CI: 1.14–1.91) and having depressive symptoms (OR = 1.62, 95%CI: 1.24–2.13) significantly increased the use of antidepressants, while living in community (OR = 0.51, 95%CI: 0.37–0.71) reduced the risk of antidepressant use. Conclusions: Use of antidepressants increased, while depressive symptoms remained stable, in the ALSA over a 12-year period. Use of antidepressants was low for people with depressive symptoms.
Publisher: Elsevier BV
Date: 08-1985
DOI: 10.1016/0022-3913(85)90294-X
Abstract: Of 521 patients referred to a specialist prosthodontic practice for complete dentures, 274 were considered as candidates for simple surgery to smooth prominent mylohyoid ridges before denture construction. Of these, 183 were thus treated. The remaining 91 did not receive surgery because of personal preference, underlying medical conditions, or other reasons. The percent who required three or more postinsertion visits to achieve comfort with their dentures was 7% for those who received surgery, 27% for those who required but did not receive surgery, and 17% for those not deemed to require surgery. This suggests that the surgical smoothing of prominent mylohyoid ridges may markedly improve patients' tolerance of dentures in the short term. However, the potential for confounding from extraneous factors in these nonexperimental circumstances must be considered.
Publisher: Informa UK Limited
Date: 02-2004
Publisher: Wiley
Date: 02-2008
DOI: 10.1016/J.OTOHNS.2007.10.031
Abstract: To establish if there is a learning curve for coblation tonsillectomy. Regression analysis of data obtained from surgeons identified from the Australian Tonsillectomy Survey. Thirty otolaryngologists were invited to contribute audit data. Data were stratified into groups of 10 procedures and analysed with regression analysis. Nineteen (70%) surgeons responded. Complete data were obtained for 1700 cases and return to theatre data on 2062 cases. There was a significant learning curve with respect to both primary ( P = 0.050) and secondary ( P = 0.028) hemorrhage rates. Mean rates were 0.3% (95% CI 0.1% to 0.7%) and 2.1% (95% CI 1.5% to 2.9%) for primary and secondary bleeds, respectively, with return to theatre in 0.2% (95% CI 0.1% to 0.5%) and 1.3% (95% CI 0.9% to 1.9%), respectively. The introduction of coblation tonsillectomy into Australia was associated with a statistically significant learning curve with respect to both primary and secondary hemorrhage rates.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DHJO.2015.03.009
Abstract: Parents caring for a child with a rare disease report unmet needs, the origins of which are varied and complex. Few studies have systematically attempted to identify the supportive care needs of parents with a child with a rare disease comprehensively. We have used the widely accepted Supportive Care Needs Framework (SCNF) as the structure for this review. The purpose of the current review was to identify the supportive care needs of parents with a child with a rare disease, irrespective of condition. We conducted a scoping study review comprising 29 studies (1990-2014) to identify and examine the research literature related to the supportive care needs of parents, and to compare these needs with the seven domains outlined in the SCNF. Most common needs cited were social needs (72% of papers), followed by informational needs (65% of papers) and emotional needs (62% of papers), with the most common parental needs overall being information about their child's disease, emotional stress, guilt and uncertainty about their child's future health care needs, parents own caring responsibilities and the need for more general support. A paucity of studies exists that explore the supportive care needs of parents of a child with a rare disease. The SCNF only partially reflects the breadth and type of needs of these parents, and a preliminary revised framework has been suggested. Further research is required in this area, particularly empirical research to amend or confirm the suggested new framework.
Publisher: Informa UK Limited
Date: 24-03-2021
Publisher: Informa UK Limited
Date: 27-02-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Cambridge University Press (CUP)
Date: 26-10-2009
DOI: 10.1017/S002221510999123X
Abstract: To evaluate the peri-operative usefulness of dexmedetomidine in obstructive sleep apnoea surgery. In a clinical audit, patients were ided into a study group (dexmedetomidine used n = 125 82.9 per cent males, 17.1 per cent females mean age 48.1 years) and a control group (dexmedetomidine not used n = 143 85.5 per cent males, 14.5 per cent females mean age 47.4 years). The selected outcome measures were mean arterial pressure, use of anti-hypertensives and use of opioids. Mean arterial pressure was stable (i.e. below 100 mmHg) in 93.3 per cent of the study group and 72.0 per cent of the control group (relative risk 1.30, 95 per cent confidence interval 1.14–1.47). The use of glyceryl trinitrate and hydralazine was significantly less in the study group, compared with controls ( p = 0.005 and .001, respectively). Study group patients underwent more procedures than control patients ( p 0.001) and were more likely to require morphine. No difference was noted in the median dose of opioids. Dexmedetomidine improves haemodynamic stability in patients undergoing surgery for obstructive sleep apnoea. It is reliable and reduces the need for polypharmacy. Its opioid-sparing action has been established in the literature however, this was not demonstrated in our study.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.IJNURSTU.2013.09.002
Abstract: Intravenous antibiotics are the cornerstone of treatment for patients with cystic fibrosis (CF). Midlines are a type of vascular access device (VAD) used exclusively in one treatment facility within Australia, most other centres use peripherally inserted central catheters (PICCs). To ascertain the safety and efficacy of midlines for CF patients receiving intravenous antibiotics. Retrospective observational. A large, major metropolitan teaching hospital in Adelaide, South Australia. Adult patients with a diagnosis of CF, who had a PICC or midline inserted for the commencement of antibiotic therapy during the period 2004-2010 to treat a respiratory exacerbation. Medical records and hospital reports were used to record rates of adverse events and unexpected removal of VADs. The primary outcome was a composite measure of adverse events (catheter-related blood stream infection, deep vein thrombosis, occlusion, pain, infiltration, bleeding, phlebitis, catheter leakage and dislodgement) and whether the VAD was removed unexpectedly. There were 231 midlines and 97 PICCs inserted into 64 patients (39 male and 25 female age range 18-47 years old). Presented as per 1000 VAD days, patients with PICCs and midlines had similar rates of adverse events (14 and 11 adverse events per 1000 VAD days, respectively). Unexpected removal was higher for patients with midlines (6.90 per 1000 VAD days) than for PICCs (2.89 per 1000 VAD days). Incident rate ratios (IRRs) showed that patients with midlines and PICCs had similar rates of adverse events (IRR 1.18, P=0.617, CI 0.62-2.22) although the removal rate of patients with midlines was twice that of patients with PICCs (IRR 2.24, P=0.079, CI 0.91-5.56). As an absolute risk there were only 4.09 more cases of removal for patients with midlines per 1000 VAD days than those with PICCs. Midlines may be an alternative to PICCs for adult CF patients although further research is required with a larger s le size to enable definitive conclusions.
Publisher: Elsevier BV
Date: 06-2014
Abstract: To evaluate the impact of a fruit and vegetable (F&V) subsidy program for disadvantaged Aboriginal children in Australia, implemented alongside the introduction of mandatory folic acid fortification of bread-making flour. A before-and-after evaluation was undertaken of a F&V subsidy program at three Aboriginal community-controlled health services in New South Wales. The program provided a weekly box of subsidised F&V linked to preventive health services and nutrition promotion for families. In this analysis, red blood cell (RBC) folate was assessed together with self-reported dietary intake at baseline and 12 months later in a cohort of 125 children (aged 0-17 years). No children had low RBC folate at baseline or at follow-up however, 33 children (26%) exceeded the reference range of RBC folate at baseline and 38 children (30%) exceeded the reference range at follow-up. Mean RBC folate levels increased substantially in children at follow-up (mean RBC folate z-score increased +0.55 (95%CI 0.36-0.74). Change in F&V intake (p=0.196) and mean bread intake (p=0.676) were not statistically significant predictors for change in RBC folate levels. RBC folate levels increased among these disadvantaged Aboriginal children following mandatory folic acid fortification and participation in a subsidised F&V program. Even before mandatory folic acid fortification, none of these children had low RBC folate. The effect on health of mandatory fortification of foods with folate is not clear, hence, ongoing population-based monitoring of folate levels to assess the impact of mandatory folic acid fortification is important.
Publisher: Oxford University Press (OUP)
Date: 1983
Publisher: Wiley
Date: 07-01-2011
DOI: 10.1111/J.1445-2197.2010.05604.X
Abstract: Adenotonsillectomy (AT) is indicated for children with obstructive sleep disordered breathing however it has associated well-documented morbidity. A subtotal reduction AT has made a resurgence overseas, given a significantly reduced morbidity. This study hypothesized that full AT would provide a greater improvement in quality of life (QOL) when compared with a subtotal reduction AT (SRAT) in children with obstructive sleep disordered breathing. This cohort study used a single surgeon consecutive series of 181 children from the database of the senior author (ASC) following full AT (n= 118) or SRAT (n= 63). QOL was measured by the Glasgow Children's Benefit Inventory (GCBI), which was mailed to parents 3 months to 2 years post-operatively. Ninety-one of the 155 (59%) questionnaires were returned. There was an increase in QOL for children following AT (GCBI Total =+41.5) and SRAT (GCBI Total =+49.5). A significant increase in QOL was noted for all four domains of the GCBI. The GCBI total and four domains had no statistically significant difference in the improvement of scores by the two surgical groups. In this study, an SRAT provides identical post-operative QOL outcomes to full AT when performed for sleep disordered breathing in children. This adds to the evidence that in the absence of infective episodes, SRAT can be considered as a lower risk alternative to full AT.
Publisher: SLACK, Inc.
Date: 02-2013
DOI: 10.3928/1081597X-20130117-09
Abstract: Objective evaluation of accommodation with a bilateral accommodating intraocular lens (IOL) versus monofocal IOLs. Patients received accommodating IOL (Crystalens HD Bausch & Lomb, Rochester, NY) bilaterally after cataract surgery. These were compared to a matched group receiving monofocal IOLs. Preoperative and postoperative distance corrected distance, intermediate, and near vision were evaluated. Objective accommodation was measured with the WAM-5500 Binocular Autorefractor/Keratometer (Grand Seiko, Pty Ltd., Hiroshima, Japan). Nineteen patients were included. Ten received the Crystalens HD in both eyes and nine received one of three monofocal lenses in each eye. Mean postoperative distance corrected distance visual acuity was not statistically different between the two groups. Mean distance corrected intermediate vision was better in the Crystalens HD group (logMAR 0.24 ± 0.11 [control], logMAR 0.11 ± 0.10 [Crystalens HD], P = .033). The groups did not differ significantly for mean distance corrected near vision (logMAR 0.54 ± 0.12 [control], logMAR 0.42 ± 0.15 [Crystalens HD], P = .087). However, a significantly greater proportion of Crystalens HD eyes achieved 0.4 or 0.3 logMAR for near wearing their distance correction ( P = .013). With distance correction, the mean spherical equivalent failed to show any myopia with accommodative effort in either group. Low contrast and low luminance contrast acuity were not significantly different. The Crystalens HD showed some benefit for intermediate visual function compared to the monofocal IOLs with both groups wearing full correction for distance. There were no significant signs of accommodation in either group.
Publisher: Informa UK Limited
Date: 03-03-2020
Publisher: Informa UK Limited
Date: 09-2016
DOI: 10.2147/JMDH.S113898
Publisher: Wiley
Date: 11-2014
DOI: 10.1111/IMJ.12512
Abstract: Several studies have shown that the Australian Medicare-funded chronic disease management programme can lead to improvements in care processes. No study has examined the impact on long-term health outcomes. This retrospective cohort study assessed the association between provision of a general practitioner management plan and time to next potentially preventable hospitalisation for older patients with heart failure. We used the Australian Government Department of Veterans' Affairs (DVA) claims database and compared patients exposed to a general practitioner management plan with those who did not receive the service. Kaplan-Meier analysis and Cox proportional hazards models were used to compare time until next potentially preventable hospitalisation for heart failure between the exposed and unexposed groups. There were 1993 patients exposed to a general practitioner management plan and 3986 unexposed patients. Adjusted results showed a 23% reduction in the rate of potentially preventable hospitalisation for heart failure at any time (adjusted hazard ratio, 0.77 95% confidence interval, 0.64 to 0.92 P = 0.0051) among those with a general practitioner management plan compared with the unexposed patients. Within one year, 8.6% of the exposed group compared with 10.7% of the unexposed group had a potentially preventable hospitalisation for heart failure. A general practitioner management plan is associated with delayed time to next potentially preventable hospitalisation for heart failure.
Publisher: Wiley
Date: 11-06-2007
DOI: 10.1111/J.1445-5994.2007.01432.X
Abstract: The aim of the study was to determine the prevalence of work disability in a cohort of Australians with rheumatoid arthritis. A cross-sectional study of a s le of 497 in iduals aged 18-65 years with rheumatoid arthritis in Adelaide, South Australia, was carried out. Of those employed, 130 (51%) were in full-time employment (> or= 35 h per week) work and 124 (49%) were in part-time employment (average 20 h per week). Overall, the observed/expected numbers working were 254/316 (relative risk 0.8 (0.69-0.91)). Using a comparator adjusted by removing those on the disability support pension, the relative risk of the working was 0.74. The observed/expected numbers working part time in the study group were 124/89 (relative risk 1.4 (1.25-1.65)). Those who continued to work had lower Health Assessment Questionnaire scores, less morning stiffness, superior scores for patient assessed level of function, lower pain scores, lower joint counts, a lower C-reactive protein, better measures of 'patient global assessment' and higher levels of education compared with the group who had ceased work. Overall, of those working at the time of diagnosis, 20% had ceased work within 5 years and approximately 40% had ceased work by 20 years. Of those who ceased work, the mean duration from time of diagnosis to work cessation was 7 years with half the subjects who ceased work doing so within 4 years of diagnosis. Work disability associated with rheumatoid arthritis in Australia is very significant and costly. Work disability occurs relatively early in the disease and is associated with several identifiable variables, many of which may be amenable to intervention strategies.
Publisher: John Libbey Eurotext
Date: 03-2010
Abstract: Open, right-sided, transthoracic esophagectomy with one-lung ventilation (OLV) triggers a massive inflammatory reaction. The influence of the OLV on the inflammatory cascade is unclear. Data on the inflammatory response in the ventilated left and collapsed right lung, respectively, are scarce. The aim of this study was to analyze this reaction in bronchoalveolar lavage (BAL) fluid from both lungs, the right pleural space and the peripheral blood, and to study its time course. Concentrations of interleukin (IL)-6, IL-8, IL-10 and IL-1RA in the BAL fluids from the right and left lungs, respectively, in the peripheral blood and in the right pleural space in patients undergoing transthoracic esophagectomy for cancer, were determined using enzyme-linked immunosorbent assays in 29 patients. Assay of the pro-inflammatory cytokines in the bilateral BAL fluids showed significantly higher concentrations in the ventilated left lung at the time of extubation. The anti-inflammatory response was only seen with respect to IL-1RA, but not IL-10, and was mostly restricted to the ventilated left lung. In the blood, only IL-6, IL-10 and IL-1RA increased, whereas IL-8 showed little change. The response was already observed at the end of surgery, indicating a rapid reaction to the surgical and anesthetic trauma. In the pleural fluid, all cytokine concentrations increased, and the highest values were detected on day one post-surgery, and decreased thereafter. Pulmonary complications or anastomotic leakage were not related to the cytokine concentrations. Both the ventilated left and the collapsed right lung showed an inflammatory response. The response was more pronounced on the ventilated left side and the time courses were significantly different. In the blood, the pro-inflammatory IL-6 and both anti-inflammatory cytokines increased early on. All cytokines increased in the pleural cavity. The findings underline the complexity of the inflammatory reaction associated with OLV in transthoracic esophagectomy.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.DIABRES.2015.01.012
Abstract: To explore the relationship between infection with Strongyloides stercoralis and the likelihood of having type 2 diabetes mellitus (T2DM). Cross-sectional survey of 259 Aboriginal adults living in a remote community in northern Australia during 2013. Prior infection with S. stercoralis was determined by ELISA testing on serum. Main outcomes were eosinophil count, T2DM diagnosis, HbA1c, BMI, fasting lipids, Hb, blood pressure. Ninety two participants (36%) had prior infection with S. stercoralis and 131 (51%) had T2DM. Those with previous S. stercoralis infection (ELISA titre ≥0.3) were 61% less likely to have a diagnosis of T2DM than those uninfected, adjusted for age, triglycerides, blood pressure and BMI using propensity score (adjusted OR=0.39, 0.23-0.67, P=0.001). In this remote community where prevalence of both S. stercoralis and T2DM is very high, infection with S. stercoralis appears to be associated with a significantly reduced risk of T2DM in adults. A plausible immunological mechanism has been identified in animal models. If confirmed, this result may have practical implications for the prevention of T2DM and associated metabolic disorders in humans. This finding should be explored further with larger longitudinal studies in transitional populations where the risk of both conditions is high. No external funding was required for this study.
Publisher: Wiley
Date: 21-03-2017
Publisher: Wiley
Date: 12-2016
DOI: 10.1111/IMJ.13286
Abstract: Little is known about the impact of a general practitioner management plan (GPMP) on health outcomes of patients with diabetes. To examine the impact of a GPMP on the risk of hospitalisation for diabetes. A retrospective study using administrative data from the Australian Government Department of Veterans' Affairs was conducted (1 July 2006 to 30 June 2014) of diabetes patients either exposed or unexposed to a GPMP. The primary end-point was the risk of first hospitalisation for a diabetes-related complication and was assessed using Cox proportional hazard regression models with death as a competing risk. Secondary end-points included rates of receiving guideline care for diabetes, with differences assessed using Poisson regression analyses. A total of 16 214 patients with diabetes were included 8091 had a GPMP, and 8123 did not. After 1 year, 545 (6.7%) patients with a GPMP and 634 (7.8%) of patients without a GPMP were hospitalised for a diabetes complication. There was a 22% reduction in the risk of being hospitalised for a diabetes complication (adjusted hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.69-0.87, P < 0.0001) for those who received a GPMP by comparison to those who did not. Increased rates of diabetes guideline care, HbA1c claims (adjusted HR 1.29, 95% CI 1.25-1.33) and microalbuminura claims (adjusted HR 1.65, 95% CI 1.58-1.72) were observed after a GPMP. Provision of a GPMP in older patients with diabetes resulted in improved health outcomes, delaying the risk of hospitalisation at 12 months for diabetes complications. GPMP should be included as part of routine primary care for older patients with diabetes.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1111/J.1753-6405.2011.00729.X
Abstract: Identify preventable pre-pregnancy risk factors that may affect the prevalence of miscarriage among a cohort of Australian Indigenous women. Data from 1,009 Indigenous women of childbearing age who participated in a 1999-2000 health screening program in far-north Queensland were linked to Queensland hospitalisation data. Women who attended hospital after their health check (censor date: March 2008) for a pregnancy-related condition were identified. Characteristics associated with becoming pregnant and subsequent miscarriage were analysed using generalised linear models. After adjusting for age and ethnicity, women who became pregnant were more likely to be smokers and to have low red cell folate at baseline. The risk of miscarriage increased with age. Women who reported risky drinking or had elevated gamma-glutamyl transferase were also at higher risk. After further adjustment for risky drinking, the presence of chlamydia or gonorrhoea before pregnancy was associated with miscarriage. The presence of both infections at baseline compared with women who had no infection, again after further adjustment for risky drinking, was strongly associated with miscarriage these women had more than a four-fold increase in risk (PR: 4.57 [2.21-9.46]). Elevated body mass index, high blood pressure and smoking were not statistically significantly associated with risk of miscarriage. A high prevalence of pre-pregnancy sexually transmitted infections and high rates of risky drinking are associated with miscarriage among young Indigenous women in rural and remote communities in north Queensland.
Publisher: BMJ
Date: 12-02-2009
Abstract: Sleep hypoventilation has been proposed as a cause of progressive hypercapnic respiratory failure and death in patients with severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine the effects of nocturnal non-invasive bi-level pressure support ventilation (NIV) on survival, lung function and quality of life in patients with severe hypercapnic COPD. A multicentre, open-label, randomised controlled trial of NIV plus long-term oxygen therapy (LTOT) versus LTOT alone was performed in four Australian University Hospital sleep/respiratory medicine departments in patients with severe stable smoking-related COPD (forced expiratory volume in 1 s (FEV1.0) <1.5 litres or <50% predicted and ratio of FEV1.0 to forced vital capacity (FVC) 46 mm Hg and on LTOT for at least 3 months) and age 20/h) or morbid obesity (body mass index >40) were excluded. Outcome measures were survival, spirometry, arterial blood gases, polysomnography, general and disease-specific quality of life and mood. 144 patients were randomised (72 to NIV + LTOT and 72 to LTOT alone). NIV improved sleep quality and sleep-related hypercapnia acutely, and patients complied well with therapy (mean (SD) nightly use 4.5 (3.2) h). Compared with LTOT alone, NIV (mean follow-up 2.21 years, range 0.01-5.59) showed an improvement in survival with the adjusted but not the unadjusted Cox model (adjusted hazard ratio (HR) 0.63, 95% CI 0.40 to 0.99, p = 0.045 unadjusted HR 0.82, 95% CI 0.53 to 1.25, p = NS). FEV1.0 and PaCO2 measured at 6 and 12 months were not different between groups. Patients assigned to NIV + LTOT had reduced general and mental health and vigour. Nocturnal NIV in stable oxygen-dependent patients with hypercapnic COPD may improve survival, but this appears to be at the cost of worsening quality of life. ACTRN12605000205639.
Publisher: Cambridge University Press (CUP)
Date: 22-08-2019
Abstract: A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced. Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis. Five major themes were identified within the data. These were labelled ‘hospital experiences’, ‘engaging with medical and community-based supports’, ‘health and wellbeing impacts from the injury’, ‘everyday living’ and ‘family adjustments post-injury’. While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an in idualised, coordinated transition support, may reduce the risks for re-admission with further head injuries.
Publisher: Springer Science and Business Media LLC
Date: 10-2007
Publisher: Cambridge University Press (CUP)
Date: 31-07-2019
Abstract: Increasingly, narrative and creative arts approaches are being used to enhance recovery after traumatic brain injury (TBI). Narrative and arts-based approaches congruent with Indigenous storytelling may therefore provide benefit during the transition from hospital to home for some Indigenous TBI patients. This qualitative study explored the use and impact of this approach as part of a larger, longitudinal study of TBI transition with Indigenous Australians. A combined narrative and arts-based approach was used with one Indigenous Australian artist to describe his transition experiences following TBI. Together with the researchers and filmmaking team, the artist was involved in aspects of the process. The artist contributed two paintings, detailing the story of his life and TBI. Based on the artworks, a film was co-created. Following the viewing of the film, impacts of the narrative and arts-based process were examined through semi-structured interviews with the artist, a service provider and a family member. Multiple sources of data were used in the final thematic analysis including transcripts of the interviews and filming, paintings (including storylines) and researcher notes. Positive impacts from the process for the artist included positive challenge healing and identity understanding TBI and raising awareness. This approach may enable the in idual to take ownership over their transition story and to make sense of their life following TBI at a critical point in their recovery. A combined narrative and arts-based approach has potential as a culturally responsive rehabilitation tool for use with Indigenous Australians during the transition period following TBI.
Publisher: Informa UK Limited
Date: 04-04-2016
Publisher: American Medical Association (AMA)
Date: 08-2011
DOI: 10.1001/ARCHOPHTHALMOL.2011.188
Abstract: To describe the refractive outcome of toric intraocular lens (IOL) implantation by taking into account the effect on astigmatic outcome of the anterior chamber depth and the sphere power of the IOL, and to examine whether the predictability of the toric effect can be improved. In a university department in a publicly funded hospital, 38 eyes of 29 patients underwent routine cataract surgery with insertion of a toric implant (SN60TT AcrySof Toric). The corneal plane effective cylinder power of the IOL was calculated, including the effect on this value of the anterior chamber depth and pachymetry and of the sphere power of the IOL. The mean (SD) corneal plane equivalent cylinder power of the IOL predicted preoperatively by the manufacturer as 1.58 (0.47) diopters (D) vs 2.02 (0.64) D by us (calculated using predicted postoperative anterior chamber depth and IOL sphere values). The mean (SD) measured postoperative value was 1.78 (0.89) D, which was better predicted by us. The manufacturer currently appears to underestimate the corneal plane effective cylinder power of its toric IOLs. Improved outcome could be achieved by estimating the effective corneal plane cylinder power of the IOL, as altered by the anterior chamber depth and pachymetry and by the IOL sphere power, but this is currently not addressed by the manufacturer.
Publisher: Springer Science and Business Media LLC
Date: 04-2015
Publisher: Wiley
Date: 17-06-2015
DOI: 10.1111/JEP.12402
Abstract: Quality indicators (QIs) derived from the review of medical records, administrative databases, and patient questionnaires and interviews have been frequently used to assess the quality of osteoarthritis (OA) care. The purpose of this review is to summarize studies that have assessed the quality of OA care using QIs. We systematically searched MEDLINE, EMBASE, CINAHL and PsycINFO for English-language studies indexed by October 2014. Articles were included if they used any QIs for assessing the quality of OA care. We summarized the results of these studies, and with meta-analysis, generated an overall conclusion about the quality of care as measured by QIs for each treatment domain for OA care. Fourteen studies assessed as being of high-quality were included in the review, with the number of QIs ranging from 1 to 21. Four of the 14 studies solely assessed the quality of OA care, while the other studies assessed health care quality for a range of conditions that included OA. The quality of OA care as assessed by a meta-analysis of QI pass rates across studies was suboptimal for all treatment domains (pass rates: pain and functional status assessment – 48.5%, 95% CI 32.6-64.6% non-drug treatment – 36.1%, 95% CI 27.8-44.7% drug treatment – 37.5%, 95% CI 30.8-44.5% surgical referral – 78.9%, 95% CI 57.4-94.2%). Despite efforts made at improving care for patients with OA, the wide ergence between evidence and consensus-based recommended care and practice has been reaffirmed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2022
DOI: 10.2215/CJN.08780621
Abstract: Clinical trials in nephrology are enriched for patients with micro- or macroalbuminuria to enroll patients at risk of kidney failure. However, patients with normoalbuminuria can also progress to kidney failure. TNF receptor-1, TNF receptor-2, and kidney injury marker-1 (KIM-1) are known to be associated with kidney disease progression in patients with micro- or macroalbuminuria. We assessed the value of TNF receptor-1, TNF receptor-2, and KIM-1 as prognostic biomarkers for CKD progression in patients with type 2 diabetes and normoalbuminuria. TNF receptor-1, TNF receptor-2, and KIM-1 were measured using immunoassays in plasma s les from patients with type 2 diabetes at high cardiovascular risk participating in the Canagliflozin Cardiovascular Assessment Study trial. We used multivariable adjusted Cox proportional hazards analyses to estimate hazard ratios per doubling of each biomarker for the kidney outcome, stratified the population by the fourth quartile of each biomarker distribution, and assessed the number of events and event rates. In patients with normoalbuminuria ( n =2553), 51 kidney outcomes were recorded during a median follow-up of 6.1 (interquartile range, 5.8–6.4) years (event rate, 3.5 95% confidence interval, 2.6 to 4.6 per 1000 patient-years). Each doubling of baseline TNF receptor-1 (hazard ratio, 4.2 95% confidence interval, 1.8 to 9.6) and TNF receptor-2 (hazard ratio, 2.3 95% confidence interval, 1.5 to 3.6) was associated with a higher risk for the kidney outcome. Baseline KIM-1, urinary albumin-creatinine ratio, and eGFR were not associated with kidney outcomes. The event rates in the highest quartile of TNF receptor-1 (≥2992 ng/ml) and TNF receptor-2 (≥11,394 ng/ml) were 5.6 and 7.0 events per 1000 patient-years, respectively, compared with 2.8 and 2.3, respectively, in the lower three quartiles. TNF receptor-1 and TNF receptor-2 are associated with kidney outcomes in patients with type 2 diabetes and normoalbuminuria. CANagliflozin cardioVascular Assessment Study (CANVAS), NCT01032629
Publisher: Oxford University Press (OUP)
Date: 08-07-2006
Abstract: Protein as well as starch is fermented in the colon, but the interaction between protein and starch fermentation and the impact on colonic oncogenesis is unknown. High-protein diets increase delivery of protein to the colon and might promote oncogenesis through generation of toxic products. We investigated the interaction of resistant starch (RS) with digestion-resistant potato protein (PP) on colonic fermentation events and their relationship to intestinal tumourigenesis. Male Sprague-Dawley rats were fed an AIN-76A-based diet for 4 weeks and intestinal neoplasms were induced by azoxymethane. Experimental diets included the following: no added RS or PP, 10% high amylose maize starch (source of RS) replacing digestible starch, 15% PP replacing casein and 10% high amylose maize starch+15% PP. Rats were maintained on diets until killed at 30 weeks. Feeding RS significantly increased short-chain fatty acid (SCFA) levels (P<0.001) in the caecum and colon. Importantly, butyrate concentration was significantly increased in the distal colon with RS (P<0.001). Feeding PP increased protein fermentation products, but this effect was reduced by adding RS to the diet. Intestinal neoplasms and colorectal adenocarcinomas were reduced by feeding RS (P<0.01) regardless of whether PP was fed, whereas PP alone increased the incidence and number of small intestinal neoplasms including the adenocarcinomas (P<0.01). In conclusion, RS altered the colonic luminal environment by increasing the concentration of SCFAs including butyrate and lowering production of potentially toxic protein fermentation products. These effects of RS not only protected against intestinal tumourigenesis but also ameliorated the tumour-enhancing effects of feeding indigestible protein.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.NEPR.2013.07.007
Abstract: This paper describes the views of new graduate nurses on what factors they believe are important contributors for successful transition to registered nurse practice. Transition from student to new graduate nurse is challenging and stressful, with health care providers expecting graduates to "hit the ground running". The reality is that most graduates experience role adjustment difficulties and require support from senior colleagues within health care organisations. Drawing on a larger Australian study that examined pre-registration paid employment and its impact on graduate nurse transition, findings in this paper suggest that successful transition is linked to post-registration or employer factors and less so to pre-registration paid employment factors. Utilising interpretive description of two qualitative data sets three organising themes were identified: a matching skill set, the beginning foundation and a job well done. The global theme, valuing beginning practice describes newly qualified nurse's views on being valued by the nursing profession and how they were accepted into the work environment. Despite the stressors faced by the majority of new graduate nurses adjusting to the rigours of practice, graduate transition can be improved by supportive institutional practices and fostering collegial respect. Successful graduate nurse transition improves job satisfaction and is an effective strategy to address the ongoing pressures of recruitment and retention of new graduates.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: Wiley
Date: 2012
DOI: 10.1002/EBCH.1808
Publisher: Wiley
Date: 08-11-2013
DOI: 10.1111/JOCN.12190
Abstract: To explore issues related to sexual function and relationships, for men and their wives or partners, following diagnosis and treatment for prostate cancer. A diagnosis of prostate cancer and subsequent treatment result in a significant number of men experiencing some impairment to their sexual function. There is scant research into the impact of changed sexual function on these men's masculinity, sexuality, intimate relationships and their needs regarding counselling and supportive care. Internet-based survey. Focus groups and couple interviews were used to improve validity for questionnaire items designed to provide insight into men's experiences of prostate cancer in areas such as sexual function and relationships. The questionnaire included both closed and open-ended questions and had the option for the wife or partner to complete a section. Qualitative research revealed 17 specific categories within three key themes: sexual dysfunction, loss of libido and masculinity. The questionnaire found, unexpectedly, the majority of men said that they had sufficient emotional and psychological support. Wives artners confirmed cancer had impacted on their partner's feelings of masculinity (71%), compared to 42% of men who felt that this was the case. Predictors of loss of libido, erectile dysfunction and 'feeling less of a man' were developed. Univariate predictors included hormone therapy, regrets about treatment choice, cancer having impacted on masculinity and distress during the last week. Men are not able to clearly identify the challenges prostate cancer brings especially changes to their masculinity. The findings strongly suggest that for men with prostate cancer, nursing assessments of men's sexual health be augmented by information gained from their partners further, these assessments should be augmented with a careful exploration of these men's psyche guided by the knowledge that masculinity influences perceptions of self (being a man) and help seeking.
Publisher: Springer Science and Business Media LLC
Date: 09-1989
DOI: 10.1007/BF00144832
Publisher: Elsevier BV
Date: 10-1987
Publisher: Wiley
Date: 17-08-2011
DOI: 10.1002/PDS.2219
Abstract: Warfarin management in the elderly population is complex as medicines prescribed for concomitant diseases may further increase the risk of major bleeding associated with warfarin use. We aimed to quantify the excess risk of bleeding-related hospitalisation when warfarin was co-dispensed with potentially interacting medicines. A retrospective cohort study was undertaken over a 4-year period from July 2002 to June 2006 to examine bleeding risk associated with medications co-administered in patients taking warfarin using an administrative claims database from the Australian Department of Veterans' Affairs. All veterans aged 65 years and over who were new users of warfarin were followed until death or study end. Risk of bleeding was assessed using a Poisson GEE model adjusting for age, gender, socioeconomic status, co-morbidity index, previous bleeding related hospitalisations and indicators of health service use. Overall, 17661 veterans who used warfarin at any time during the study period were included. The overall incidence rate of bleeding-related hospitalisations was 4.1 (95% CI 3.7-4.6) per 100 person-years in veterans who were not receiving potentially interacting medicines. Bleeding-related hospitalisation rates were significantly increased when warfarin was co-prescribed with low-dose aspirin (Adjusted rate ratio (AdjRR) 1.44, 95% CI 1.00-2.07), clopidogrel (AdjRR 2.23, 95% CI 1.48–3.36), clopidogrel with aspirin (AdjRR 3.44, 95% CI 1.28-9.23), amiodarone (AdjRR 3.33, 95% CI 1.38–8.00) and antibiotics (AdjRR 2.34, 95% CI 1.55-3.54). Models assessing bleeding risk with warfarin should take account of the range of potentially harmful medicine combinations used in elderly people with comorbid conditions.
Publisher: Elsevier BV
Date: 12-1992
Publisher: Informa UK Limited
Date: 09-01-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-03-2006
Publisher: JMIR Publications Inc.
Date: 07-04-2020
Abstract: he mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated. his study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal the authors acknowledge the ersity within Aboriginal cultures. his study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed. scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government. he scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women’s voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study. > RR1-10.2196/18992
Publisher: Elsevier BV
Date: 1993
DOI: 10.1016/S0959-8049(05)80418-6
Abstract: To assess the long-term effects of cancer treatment and consequences of cure, 102 index cancer cases were compared with 95 neighbourhood controls of similar age and sex and with 78 cardiac controls. The quality of life experienced by these three groups was examined using multiple instruments with proven psychometric properties. All the major quality of life domains (physical, psychological and social) were covered. The findings revealed that the index cases were similar to their neighbours in areas of subjective well-being. However, the index cases exhibited more sexual dysfunction, were more conscientious, determined and emotionally disciplined, and applied the defence mechanisms of displacement and reaction formation more often than the neighbourhood controls. The cardiac controls were older, more anxious, more conventional/less imaginative and used suppression as a defence mechanism to a greater degree than the index cases. In conclusion, young adult cancer survivors enjoy a quality of life similar to their neighbours, whereas coronary bypass survivors adjust less well psychosocially.
Publisher: Wiley
Date: 28-02-2013
DOI: 10.1002/PDS.3424
Abstract: This study aimed to examine the effect of antidepressant use on persistence with newly initiated oral antidiabetic medicines in older people. A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2000 to 30 June 2008 of new users of oral antidiabetic medicines (metformin or sulfonylurea). Antidepressant medicine use was determined in the 6 months preceding the index date of the first dispensing of an oral antidiabetic medicine. The outcome was time to discontinuation of diabetes therapy in those with antidepressant use compared with those without. Competing risks regression analyses were conducted with adjustment for covariates. A total of 29,710 new users of metformin or sulfonylurea were identified, with 7171 (24.2%) dispensed an antidepressant. Median duration of oral antidiabetic medicines was 1.81 years (95% CI 1.72–1.94) for those who received an antidepressant at the time of diabetes medicine initiation, by comparison to 3.23 years (95% CI 3.10–3.40) for those who did not receive an antidepressant. Competing risk analyses showed a 42% increased likelihood of discontinuation of diabetes medications in persons who received an antidepressant (subdistribution hazard ratio 1.42, 95% CI 1.37–1.47, p < 0.001). The results of this large population-based study demonstrate that depression may be contributing to non-compliance with medicines for diabetes and highlight the need to provide additional services to support appropriate medicine use in those initiating diabetes medicines with co-morbid depression.
Publisher: Wiley
Date: 29-05-2019
DOI: 10.1111/COA.13364
Abstract: To assess whether access to saltwater chlorinated swimming pools in remote Aboriginal communities is beneficial in reducing levels of middle ear disease and hearing loss in school children. A prospective 3-year cohort study of children in 10 remote Aboriginal communities in South Australia with (n = 4) or without (n = 6) swimming pools. Outback Australia. Eight hundred and thirteen school-age children residing in remote South Australia. Prevalence of open and closed middle ear disease and prevalence of hearing loss. About 2107 ear assessments were conducted during the study period. 70.7% of children in communities with pools failed a screening test of hearing compared with 68.6% of children in non-pool communities (P = 0.637). 32.3% of children had chronic otitis media (COM). There was no difference between pool and non-pool communities in the frequency of either inactive (19.4% pool vs 22.6% non-pool P = 0.232) or active (19.8% pool vs 17.8% non-pool P = 0.383) COM. In children with bilateral intact tympanic membranes, 21.2% had unilateral and 20.6 had bilateral type B tympanograms. There was no difference between pool and non-pool communities in the frequency of type B tympanometry (P = 0.465). Hearing loss associated with both open and closed middle ear disease remains highly prevalent in children living in remote Aboriginal communities in South Australia. Access to swimming pools in this population does not appear to significantly reduce these high levels of middle ear disease or associated hearing loss.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.EJON.2013.03.010
Abstract: To compare patient reported outcomes between robotic assisted surgery and non-robotic assisted surgery. This was an international web-based survey based on a qualitative research and literature review, an internet-based questionnaire was developed with approximately 70 items. The questionnaire included both closed and open-ended questions. Responses were received from 193 men of whom 86 had received either open (OP) or robotic (RALP) surgery. A statistically significant (p=0.027), ranked analysis of covariance was found demonstrating higher recent distress in the robotic (RALP) surgery group. Although not statistically significant, there was a pattern of men having robotic (RALP) surgery reporting fewer urinary and bowel problems, but having a greater rate of sexual dysfunction. Men who opt for robotic surgery may have higher expectations for robotic (RALP) surgery, when these expectations are not fully met they may be less likely to accept the consequences of this major cancer surgery. Information regarding surgical choice needs to be tailored to ensure that men diagnosed with prostate cancer are fully informed of not only short term surgical and physical outcomes such as erectile dysfunction and incontinence, but also of potential issues with regards to masculinity, lifestyle and sexual health.
Publisher: SAGE Publications
Date: 15-08-2018
Abstract: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions. A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national s le of the Bhutan pediatric patient population (0–12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success. The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%–80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients. Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients’ clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.JSAMS.2006.11.006
Abstract: Although a restricted hip range of motion has been previously associated with chronic groin injury the temporal course of this association remains unclear. Accordingly the purpose of this prospective cohort study was to report preliminary findings examining whether hip joint range of motion restriction is associated with subsequent onset of athletic chronic groin injury. End-range internal and external hip joint range of motion was determined in 29 elite Australian football players, without previous history of groin injury. The players were followed for two subsequent playing seasons for the development of chronic groin injury. Four athletes developed chronic groin injury defined as at least 6 weeks of groin pain and missing match playing time. In athletes that developed chronic groin injury a lower body weight (p=0.02) and reduced total hip joint range of motion (p=0.03) were found to be associated. This study suggests that hip stiffness is associated with later development of chronic groin injury and as such may be a risk factor for this condition. This work should be viewed as preliminary and caution is advised in applying the conclusion to clinical practice as the numbers in this study were small.
Publisher: Springer Science and Business Media LLC
Date: 21-07-2016
Publisher: Wiley
Date: 03-08-2006
DOI: 10.1111/J.1445-5994.2006.01155.X
Abstract: To better understand the personal barriers that limit participation in faecal occult blood test (FOBT) screening for colorectal cancer, non-participants from a recent screening initiative were sent detailed questionnaires, defining their reasons for not participating, as well as how to make screening more attractive. The important barrier was procrastination. The type of FOBT kit offered influenced the reasons for not participating. Convenient FOBT and greater general practitioner involvement may be important for optimizing community acceptance of FOBT-based screening.
Publisher: American Medical Association (AMA)
Date: 08-2011
DOI: 10.1001/ARCHOPHTHALMOL.2011.178
Abstract: To describe the refractive outcome of toric intraocular lens (IOL) implantation by comparing the postoperative refractive astigmatism with the preoperative keratometric astigmatism target. In a university department of a publicly funded hospital, 38 eyes of 29 patients underwent routine cataract surgery with insertion of a toric implant (SN60TT AcrySof Toric). Surgically induced astigmatism was derived using vector analysis of refractive outcome vs predicted postoperative keratometric astigmatism and compared with the targeted induced astigmatism. Postoperative remaining refractive astigmatism of 0.97 diopters (D) was achieved vs a target of 0.61 D. A mean (SD) surgically induced astigmatism value of 1.78 (0.89) D was derived compared with a mean (SD) targeted induced astigmatism value of 1.58 (0.47) D (calculated by the manufacturer's online calculator, which predicts IOL corneal plane equivalent cylinder power and postoperative keratometric cylinder). Toric IOLs are a safe, predictable method of astigmatic correction. However, some remaining astigmatism is commonly present owing to the necessary nonzero astigmatic targets imposed by the steps between IOL cylinder powers, variability of axis, and power effects of surgical incisions as well as by underestimation of the corneal plane cylinder power of the IOLs by the manufacturer.
Publisher: Informa UK Limited
Date: 26-02-2023
Publisher: Informa UK Limited
Date: 03-2018
DOI: 10.2147/CEG.S158627
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1442-9071.2009.02028.X
Abstract: To investigate the astigmatic changes induced by biaxial microincisional cataract surgery with enlargement of one incision to accommodate a foldable standard lens. In a prospective controlled trial one eye each of 50 patients was evaluated. Two temporal microincisions were applied and the right-hand incision was enlarged to 2.8 mm to allow for the insertion of the lens. Based on preoperative and postoperative keratometry readings, vector analysis was performed to calculate the surgically induced astigmatism (SIA) and the flattening effect of each of the two incisions at their meridia. To assess the degree of measurement error, a non-surgical control group underwent keratometry over the same time frame and vector analysis was used to calculate the same indices based on the variation in the keratometry readings. Six weeks postoperatively, mean SIA was 0.66 +/- 0.08 D in the study group and 0.51 +/- 0.05 D in the non-surgical control group (P = 0.041). At the right-hand incision, a flattening of 0.34 +/- 0.09 D was measured in the study group as opposed to a steepening of 0.03 +/- 0.06 D in the control group (P < 0.001). At the smaller left-hand incision, steepening effects of 0.28 +/- 0.08 and 0.05 +/- 0.06 D occurred, respectively (P = 0.011). Biaxial microincisional cataract surgery with enlargement of one incision to 2.8 mm is not astigmatically neutral, demonstrating a statistically significantly larger SIA than that attributable to measurement error.
Publisher: Mary Ann Liebert Inc
Date: 11-2009
Abstract: This research investigated whether bioimpedance spectroscopy (BIS) has the potential to improve prognostication in an outpatient clinic for patients with cancer receiving palliative care. Survival time, and BIS measures of basal metabolic rate and 11 body composition parameters (extracellular fluid [ECF], intracellular fluid [ICF], ratio of ECF to ICF, fluid in trunk and each arm and leg, protein mass, mineral mass, and percent body fat) were recorded for 84 oncology patients. None of the BIS measures showed a linear association with survival time. However, threshold values associated with short survival were identified for basal metabolic rate and 6 of the body composition measures related to fluid (ECF, ratio of ECF to ICF, fluid in right and left arms, and right and left legs). In addition, almost all patients who died within 6 weeks of assessment reached the threshold values for ECF and/or ECF:ICF ratio. Results confirm that elevated metabolic rate and accumulation of body fluid are indicators of a poor prognosis in patients with cancer receiving palliative care. Because BIS is simple for clinicians to use, is noninvasive, and allows early detection of these parameters, it has the potential to improve prognostication.
Publisher: Informa UK Limited
Date: 02-01-2023
Publisher: Springer Science and Business Media LLC
Date: 31-01-2011
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.EJSO.2010.05.012
Abstract: Tumor-infiltrating lymphocytes (TILs) and forkhead box transcription factor positive (FoxP3(+)) regulatory T-lymphocytes (TREGs) have been analyzed in a variety of tumors but not in oesophageal adenocarcinoma. Tissue from 130 adenocarcinomas of the oesophagus was re-evaluated in the centre and periphery of tumour, respectively, using immunohistochemical staining with anti-CD3, anti-CD4, anti-CD8, anti-CD25 and anti-FoxP3 antibodies. Patients were stratified according neoadjuvant treatment. 106 patients proceeded directly to surgery and 24 underwent pre-operative radio-chemotherapy (RCT). In patients without RCT, TILs were found significantly more frequently in the periphery with the exception of CD25(+) cells. Patients with centrally low counts of FoxP3(+) TREGs had higher tumour stages than patients with high counts (p < 0.011). The number of FoxP3(+) TREGs was significantly associated with the number of CD8(+) cells (centre: p < 0.001, periphery: p = 0.002). The multivariate regression analysis identified UICC stage (IIB/III vs. I/IIA, hazard ratio 2.6, p = 0.011) and completeness of resection (no vs. yes, hazard ratio 2.3, p = 0.015) as independent predictors of survival. RCT significantly reduced the number of TREGs in the centre (p = 0.016) but not the number of the other TILs. UICC stage and completeness of resection but none of the TILs were prognostic markers for long-term survival. We found no morphologic evidence that TREGs suppress immunological response, represented by the infiltration of CD8(+) cells. Preoperative RCT affected the centre of tumours more than the periphery, which may indicate that it does not inhibit the host-to-tumour reaction. RCT affects TREGs more than the other TILs.
Publisher: Wiley
Date: 21-04-2015
DOI: 10.1002/EJHF.272
Abstract: The aim of this study was to determine the effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in in iduals at risk of developing de novo chronic heart failure (CHF). A pragmatic, single-centre (tertiary-referral hospital with specialist cardiological services), open-label, randomized controlled trial with blinded endpoint adjudication was carried out. In total, 624 cardiac inpatients (66 ± 11 years, 71% male, and 70% with CAD) were randomly allocated (1:1) to standard care or the study intervention. The intention-to-treat cohort comprised 310 standard care and 301 intervention participants. During 51.0 ± 8.2 months follow-up, 38/310 (12%) standard care [mean event-free survival 1865 days, 95% confidence interval (CI) 1817-1913 days] vs. 41/301 (14%) intervention participants (1855 days, 95% CI 1804-1906 days) experienced the primary composite endpoint of de novo CHF hospitalization or all-cause mortality (P = 0.574). Although there were no statistically significant differences in the rate of cardiovascular-related and emergency hospitalizations, the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) group accumulated 478 (0.214 ± 0.70 vs. 0.095 ± 0.284 days articipant/month P = 0.052) and 1097 fewer days of hospital stay (0.391 ± 1.80 vs. 0.199 ± 0.47 days articipant/month P = 0.023), respectively, compared with standard care. The intervention group also showed better cardiac recovery on echocardiography at 3 years [81/226 (35.8%) vs. 56/225 (24.9%), odds ratio 1.44, 95% CI 1.08-1.92, P = 0.011]. Relative to a high level of standard care, the NIL-CHF intervention was ineffective in preventing CHF and rehospitalization. On the other hand, it was associated with reduced hospital stay and improved cardiac function over the long term. Australian New Zealand Clinical Trials Registry (No. 12608000022369).
Publisher: Informa UK Limited
Date: 02-08-2022
Publisher: Springer Science and Business Media LLC
Date: 23-05-2010
DOI: 10.1007/S12529-010-9101-1
Abstract: Population screening reduces mortality from colorectal cancer, yet factors associated with uptake of screening are incompletely understood. The purpose of the study was to determine demographic and psychosocial factors associated with participation in faecal occult blood test (FOBT)-based colorectal cancer (CRC) screening in an average risk community programme in Adelaide, South Australia. A questionnaire consistent with the Preventive Health Model was used to determine demographic and psychosocial differences between previous FOBT-based screening participants (n = 413, response rate 93.2%) and non-participants (n = 481, response rate 47.9%). Results were analysed by univariate and multivariate generalised linear modelling, and factors associated with participation were identified. Factor analysis of psychosocial items revealed an optimal three-factor solution (knowledge, faecal aversion, belief in the value of screening). Following multivariate analyses, two psychosocial and two demographic factors remained as predictors of FOBT screening behaviour: (1) items related to faecal aversion (Aversion), relative risk (RR) = 0.61, CI = 0.55-0.69, (2) perceptions about the value of screening (Value), RR = 1.45, CI = 1.13-1.85, (3) age band 65-69 (Age, five age bands, relative to age 50-54), RR = 1.43, CI = 1.16-1.76 and FOBT type (Test three tests, Hemoccult, FlexSure, InSure randomly assigned, relative to Hemoccult: FlexSure: RR = 1.41, CI = 1.17-1.71, InSure: RR = 1.76, CI = 1.47-2.11. The psychosocial factors associated with non-participation in FOBT-based CRC screening are amenable to interventions designed to improve participation. The small relative risks values associated with each predictor, however, raise the possibility that additional factors are likely to influence screening participation.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.JPHYS.2016.05.015
Abstract: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for in idual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which in idual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? This study pooled in idual data from two randomised, controlled trials (n=350) using an in idual patient data meta-analysis and multivariate regression. People with stroke admitted to inpatient rehabilitation facilities. Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of in idual patient data.Journal of Physiotherapy62: 124-129].
Publisher: SAGE Publications
Date: 19-03-2015
DOI: 10.1111/IJS.12470
Abstract: Increased therapy has been linked to improvements in functional ability of people with stroke. To determine the effectiveness of two alternative models of increased physiotherapy service delivery (seven-day week therapy or group circuit class therapy five days a week) to usual care. Three-armed randomized controlled trial with blinded assessment of outcome. People admitted with a diagnosis of stroke, previously independently ambulant and with a moderate level of disability were recruited. ‘Usual care’ was in idual physiotherapy provided five-days a week. Seven-day week therapy was usual care physiotherapy provided seven-days a week. Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions, five-days a week. Primary outcome was distance walked on the six-minute walk test at four-weeks post-randomization. Two hundred eighty-three participants were randomized primary outcome data were available for 259 (92%). In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72). Length of stay was shorter for seven-day (mean difference −2·9 days, 95% confidence interval −17·9 to 12·0) and circuit class participants (mean difference −9·2 days, 95% confidence interval −24·2 to 5·8) compared to usual care, but this was not significant. Both seven-day therapy and group circuit class therapy increased physiotherapy time, but walking outcomes were equivalent to usual care.
Publisher: JMIR Publications Inc.
Date: 31-07-2019
DOI: 10.2196/12632
Abstract: Young people with refugee experiences are widely acknowledged as encountering multiple disadvantages that affect their school completion and retention, university entry, and subsequent employment. This paper discusses the rationale for and protocol of a mixed methods investigation focusing on improving education and employment outcomes among refugee background youth aged 15 to 24 years from three focus regions: the Middle East (Afghanistan, Iran, Iraq, Syria), South Asia (Nepal, Bhutan, Myanmar/Burma, Pakistan) and Africa (Sudan, South Sudan, Liberia, Ethiopia, Somalia, DR Congo). The rationale of the project is to identify the facilitators and barriers to successful transition from school to further education and employment investigate participant awareness of support systems available when faced with education and employment difficulties redress the disadvantages encountered by refugee background youth and bridge the gap between research, policy, and practice in relation to social inclusion and participation. The study involves collecting survey data from 600 youth followed by in idual interviews with a subset of 60 youth, their parents rimary caregivers, and their teachers. A cross-sectional survey will assess facilitators and barriers to successful transition from school to further education and employment. In idual interviews will provide context-rich data on key issues relevant to education and employment outcomes. The study began in 2016 and is due for completion by the end of 2019. The quantitative survey has been conducted with 635 participants and was closed in March 2019. The qualitative interview stage is ongoing, and the current total in April 2019 is 93 participants including educators, youth, and family members of the youth. Analysis and presentation of results will be available in 2020. Some preliminary findings will be available during the late half of 2019. This project will contribute new and unique insights to knowledge in relation to key factors influencing education and employment outcomes among refugee youth. This research will enable effective planning for the needs of some of Australia’s most disadvantaged and marginalized young people, leading to a sustainable improvement in the education and employability of young refugees. DERR1-10.2196/12632
Publisher: Elsevier BV
Date: 1984
Predictors of Psychological Outcomes and the Effectiveness and Experience of Psychological Interventions for Adult Women with Chronic Pelvic Pain: A Scoping Review
Publisher: Informa UK Limited
Date: 05-2020
DOI: 10.2147/JPR.S245723
Publisher: Springer Science and Business Media LLC
Date: 10-2008
DOI: 10.1245/S10434-008-0155-0
Abstract: Controversy exists over the Sixth Edition of the International Union Against Cancer (UICC) TNM staging system for esophageal cancer. Inclusion of additional information such as the number of metastatic lymph nodes and extracapsular lymph node invasion may improve the current staging system and lead to optimization of patient treatment. All patients in Adelaide who underwent resection for esophageal cancer between 1997 and 2007 were identified from a prospective database. Two independent observers then reexamined all pathology slides from the original resection. Univariate and multivariate analysis was performed to identify significant prognostic factors. The goodness of fit and accuracy of additional prognostic factors were assessed, and the staging system was modified according to this information. There were 240 patients (mean age, 62 years) who met the inclusion criteria. The 5-year overall survival rate was 36% (median, 24 months). Only histological grade and a refined pN stage were found to be independent prognostic factors that could then be used to improve current TNM staging. Sub ision of pN stage into three groups (0, 1-2, and >2 positive nodes) showed significant differences in 5-year survival between all three groups: 53% vs 27% vs 6%, respectively (P < .01). The optimal staging model was the same for patients who received neoadjuvant therapy and surgery (n = 116), and those who underwent surgery alone (n = 124). A staging model that incorporates a refined pN stage and histological grade appears to be more accurate than the current UICC-TNM staging system. This staging model is still applicable in patients who receive neoadjuvant therapy.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2017
Publisher: Informa UK Limited
Date: 04-03-2021
Publisher: Informa UK Limited
Date: 06-06-2020
Publisher: JMIR Publications Inc.
Date: 16-11-2021
DOI: 10.2196/33572
Abstract: Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Australian New Zealand Clinical Trials Registry ACTRN12621001452886 fum5tjz PRR1-10.2196/33572
Publisher: Informa UK Limited
Date: 17-10-2012
DOI: 10.3109/17549507.2012.721397
Abstract: This study aimed to explore psychosocial factors contributing to the development of functional voice disorders (FVD) and those differentiating between organic voice disorders (OVD) and a non-voice-disordered control group. A case-control study was undertaken of 194 women aged 18-80 years diagnosed with FVD (n = 73), OVD (n = 55), and controls (n = 66). FVD women were allocated into psychogenic voice disorder (PVD) (n = 37) and muscle tension voice disorder (MTVD) (n = 36) for sub-group analysis. Dependent variables included biographical and voice assessment data, the number and severity of life events and difficulties and conflict over speaking out (COSO) situations derived from the Life Events and Difficulties Schedule (LEDS), and psychological traits including emotional expressiveness scales. Four psychosocial components differentiated between the FVD and control group accounting for 84.9% of the variance: severe events, moderate events, severe COSO, and mild COSO difficulties. Severe events, severe and mild COSO difficulties differentiated between FVD and OVD groups, accounting for 80.5% of the variance. Moderate events differentiated between PVD and MTVD sub-groups, accounting for 58.9% of the variance. Psychological traits did not differentiate between groups. Stressful life events and COSO situations best differentiated FVD from OVD and control groups. More refined aetiological studies are needed to differentiate between PVD and MTVD.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2007
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1080/00313020500058268
Abstract: To develop a technique for homogeneity testing of serum aliquot s les suitable for use in the Quality Assurance Program in Clinical Immunology (QAP Pty Ltd). Albumin was selected as the surrogate protein marker for the product to be tested and the coefficient of dispersion (COD) calculated as the measure of homogeneity. To detect changes in the average level of homogeneity, cumulative sum control (cusum) charts were used. The COD(%) for each triplicate reading of albumin obtained from 34 specimens was normally distributed with a mean of 0.49% and a standard deviation of 0.25%. In industrial quality control schemes the action line is generally set at the upper 99% confidence limits, hence any triplicate s le would be considered to have acceptable homogeneity if the COD was < or = 1.08%. Cusum charts were created to monitor albumin homogeneity over time. The use of albumin measurement as the surrogate appears statistically suitable for homogeneity testing in QAP programs for immunodiagnostic testing. CUSUM charts are particularly useful to monitor such homogeneity testing.
Publisher: SAGE Publications
Date: 2013
DOI: 10.4137/SART.S8108
Abstract: Tobacco smoking remains the single most preventable cause of morbidity and mortality in developed countries and poses a significant threat across developing countries where tobacco use prevalence is increasing. Nicotine dependence is a chronic disease often requiring multiple attempts to quit repeated interventions with pharmacotherapeutic aids have become more popular as part of cessation therapies. First-line medications of known efficacy in the general population include varenicline tartrate, bupropion hydrochloride, nicotine replacement therapy products, or a combination thereof. However, less is known about the use of these products in marginalized groups such as the indigenous, those with mental illnesses, youth, and pregnant or breastfeeding women. Despite the efficacy and safety of these first line pharmacotherapies, many smokers continue to relapse and alternative pharmacotherapies and cessation options are required. Thus, the aim of this review is to summarize the existing and developing pharmacotherapeutic and other options for smoking cessation, to identify gaps in current clinical practice, and to provide recommendations for future evaluations and research.
Publisher: SAGE Publications
Date: 30-07-2009
Abstract: The aim of this study was to evaluate a novel patient-held manual designed to reduce the evidence–practice gap in chronic obstructive pulmonary disease (COPD). The intervention manual contained summaries of research evidence. It was developed using current best practice for patient information materials and designed to cause discussion of evidence between patient and doctor. A controlled before-and-after study was employed in two similar but geographically separate regions of metropolitan Adelaide, South Australia. Participants had moderate to severe COPD, with 249 included at baseline and 201 completing the study. Evidence-based COPD management was measured using an indicator with three components: rates of influenza vaccination, bone density testing, and pulmonary rehabilitation. A survey of behavioral steps leading to practice change was conducted with the trial. Analysis, by median split of socioeconomic disadvantage, showed significant difference between study arms for only one component of the indicator of evidence-based practice, enrolment in pulmonary rehabilitation and only for the most socioeconomically disadvantaged stratum. For both socioeconomic strata, more intervention participants than control participants reported remembering being given the information material, reading part or all, and finding it very or quite helpful. Other significant differences were restricted to the stratum of greatest socioeconomic disadvantage: reading all of the material, learning from it, referring back, and talking to a doctor about a topic from the material. Above 90% of all participants who received the manual reported reading from it, 42% reported discussing topics with a doctor, but only 10% reported treatment change attributable to the manual. We have found that people with COPD will read an evidence manual developed using current best practice. However, the study demonstrated improvement for only one of the three components of an indicator of evidence-based disease management for only the most socioeconomically disadvantaged stratum of participants. Future interventions should be designed to better translate reading uptake into evidence-based disease management.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2006
Abstract: Studies investigating adverse events have traditionally been principally undertaken from a medical perspective. The impact that experience of an adverse event has on consumer confidence in health care is largely unknown. The objectives of the study were to seek public opinion on 1) the rate and severity of adverse events experienced in hospitals and 2) the perception of safety in hospitals, so that predictors of lack of safety could be identified. A multistage, clustered survey of persons residing in South Australia (2001), using household interviews (weighted n = 2,884). A total of 67% of respondents aged over forty years reported having at least one member of their household hospitalised in the past five years with the average being two hospital admissions in five years. Respondents stated that 7.0% (95%CI: 6.2% to 7.9%) of those hospital admissions were associated with an adverse event 59.7% of respondents (95% CI: 51.4% to 67.5%) rated the adverse event as really serious and 48.5% (95% CI: 40.4% to 56.8%) stated prolonged hospitalisation was required as a consequence of the adverse event. Perception of safety in hospitals was largely affected by the experience of an adverse event really serious events were the most significant predictor of lack of safety in those aged 40 years and over (RR 2.38 p .001). The experience of adverse events negatively impacted on public confidence in hospitals. The consumer-reported adverse event rate in hospitals (7.0%) is similar to that identified using medical record review. Based on estimates from other studies, self-reported claims of adverse events in hospital by consumers appear credible, and should be considered when developing appropriate treatment regimes.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2006
Publisher: Informa UK Limited
Date: 04-2023
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 12-1984
DOI: 10.1016/S0140-6736(84)91617-9
Abstract: Q fever is an important cause of morbidity in Australian meatworkers recently there have been sharp outbreaks of Q fever in abattoirs in several states. In an attempt to control Q fever by vaccination, 924 nonimmune volunteers at two South Australian abattoirs were inoculated with one dose of a purified, formalin-inactivated, Coxiella burneti, Henzerling strain, phase 1 vaccine. Some 56% of workers in one abattoir, and 64% in the other, seroconverted after vaccination. In the 18 months after vaccination, no Q fever occurred in fully vaccinated subjects, whereas there were 34 cases in 1349 unvaccinated workers. Transient local reactions were noted in most vaccinated subjects only a few had mild general reactions. No cases of vaccine-enhanced disease were observed. Vaccination of susceptible in iduals with a purified C burneti phase 1 vaccine appears to be safe and effective in preventing Q fever in the abattoir.
Publisher: Elsevier BV
Date: 04-2001
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11100
Abstract: Objective. To compare the demographic, socioeconomic, and medical characteristics of patients who had a General Practitioner Management Plan (GPMP) with those for patients without GPMP. Methods. Cohort study of patients with chronic diseases during the time period 1 July 2006 to 30 June 2008 using the Australian Department of Veterans’ Affairs (DVA) claims database. Results. Of the 88 128 veterans with chronic diseases included in the study, 23 015 (26%) veterans had a GPMP and 11 089 (13%) had a Team Care Arrangement (TCA). Those with a GPMP had a higher number of comorbidities (P 0.001), and a higher use of services such as health assessment and medicine review (P 0.001) than did those without GPMP. Diabetes was associated with a significantly increased use of GPMP compared with all other chronic diseases except heart failure. Conclusions. GPMPs are used in a minority of patients with chronic diseases. Use is highest in people with diabetes. What is known about the topic? Despite the fact that the Chronic Disease Management (CDM) program is appreciated by patients and allied health professionals, limited research has assessed how it is used in practice. What does this paper add? In the Veteran population, use of a General Practitioner Management Plan (GPMP) was associated with a higher number of comorbidities and of prior hospitalisations. Across chronic diseases use of GPMPs was low but was higher in people with diabetes. What are the implications for practitioners? Further research into the effect of CDM program on improvement of health outcomes is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
DOI: 10.1016/J.JCRS.2016.10.004
Abstract: To evaluate the accuracy of the cylinder power choice and the astigmatic refractive outcome for toric intraocular lenses (IOLs), the cylinder power of which was calculated using the Goggin nomogram that allows for the likely effect of posterior corneal astigmatism. The Queen Elizabeth Hospital, Adelaide, Australia. Observational case series. The absolute value of the prediction error of the toric IOL cylinder power effect in consecutive eyes with preoperative anterior keratometric cylinder values of 1.0 diopter (D) or more was compared with the absolute value of the prediction error in a historical control group. The anteriorly measured keratometric cylinder values were altered by 2 coefficients of adjustment, one for with-the-rule eyes and one for against-the-rule eyes, before calculation of the IOL cylinder power to be implanted. In the controls, unadjusted keratometric cylinder values were used. The case-series group comprised 31 eyes (29 patients) and the control group, 65 eyes. The absolute error in prediction of the toric IOL cylinder power effect was reduced from a median of 0.45 D (95% confidence interval [CI], 0.33-0.58) in the controls to a median of 0.23 D (95% CI, 0.13-0.35) in the adjusted eyes (P = .004). Adjustment of toric IOL cylinder power by application of a coefficient of adjustment to anteriorly measured keratometric cylinder values based on the keratometric rule of the eye led to a clinically and statistically significant improvement in refractive astigmatic outcome. No author has a financial or proprietary interest in any material or method mentioned.
Publisher: Human Kinetics
Date: 11-2016
Abstract: Athletes often seek the minimum required time that might elicit a physiological or performance change. It is reasonable to suggest that heat training may improve aerobic-based performance in mild conditions. Therefore, rather than providing a traditional heat-exposure stimulus (ie, 7–10 × 60–100 min sessions), the current article details 2 studies that aimed to determine the effect of brief (≤240 min exposure) heat training on the second lactate threshold (LT 2 ) in mild conditions. Forty-one participants completed 5 (study 1, n = 18) or 4 (study 2, n = 23) perceptually regulated treadmill exercise training sessions in 35°C and 30% relative humidity (RH) (experimental group) or 19°C and 30% RH (control group). Preincremental and postincremental exercise testing occurred in mild conditions (19°C and 30% RH). Linear mixed-effects models analyzed the change in LT 2 . Heat training did not substantially change LT 2 in either study 1 (+1.2%, d = 0.38, P = .248) or study 2 (+1.9%, d = 0.42, P = .163). LT 2 was not substantially changed in the control group in study 1 (+1.3%, d = 0.43, P = .193), but a within-group change was evident in study 2 (+2.3%, d = 1.04, P = .001). Brief heat training was inadequate to improve the speed at LT 2 in mild conditions more than comparable training in mild conditions. The brief nature of the heattraining protocol did not allow adaptations to develop to the extent required to potentially confer a performance advantage in an environment that is less thermally stressful than the training conditions.
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.ATHORACSUR.2008.11.060
Abstract: Minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) has been shown to have clinical advantages, but selection bias is present. All patients undergoing MIE or OE for cancer between 1999 and 2007 were eligible for analysis. To minimize selection bias, only patients who also met the selection criteria for the thoracoscopic approach were included in the open esophagectomy group. Fifty-six patients underwent MIE and 98 OE. No significant differences in demographics or pathologic data between groups occurred, with the exception of thoracic epidural analgesia (OE 98%, MIE 71.1%, p < 0.001), and neoadjuvant treatment (OE 50.5%, MIE 71.4%, p = 0.016). Morbidity and in-hospital death were not significantly different. Duration of surgery was longer in MIE (250 vs 209 minutes, p < 0.001) and blood loss less (320 mL vs 857 mL, p < 0.001). Intensive care unit stay was shorter in MIE (3.0 vs 6.8 days, p = 0.022). The relative risk (RR) for in-hospital death was 0.57 (p = 0.475) if the patients underwent MIE. After adjusting for thoracic epidural analgesia, the RR was 0.29 (p = 0.213) for the MIE group. The RR for surgical morbidity was 1.47 (p = 0.154) for patients undergoing MIE. Neoadjuvant treatment increased the RR for surgical morbidity to 1.78 (p = 0.028). No difference between the two groups concerning survival occurred. The MIE is comparable with the OE. In MIE, neoadjuvant treatment increased the risk of surgical morbidity. Thoracic epidural analgesia in MIE reduced the risk of in-hospital death and should be considered for all patients undergoing esophagectomy.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2007
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Funder: National Health and Medical Research Council
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